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Bloodstream infections (BSIs) are a frequent cause of morbidity in patients with acute myeloid leukemia (AML), due in part to the presence of central venous access devices (CVADs) required to deliver therapy.
To determine the differential risk of bacterial BSI during neutropenia by CVAD type in pediatric patients with AML.
We performed a secondary analysis in a cohort of 560 pediatric patients (1,828 chemotherapy courses) receiving frontline AML chemotherapy at 17 US centers. The exposure was CVAD type at course start: tunneled externalized catheter (TEC), peripherally inserted central catheter (PICC), or totally implanted catheter (TIC). The primary outcome was course-specific incident bacterial BSI; secondary outcomes included mucosal barrier injury (MBI)-BSI and non-MBI BSI. Poisson regression was used to compute adjusted rate ratios comparing BSI occurrence during neutropenia by line type, controlling for demographic, clinical, and hospital-level characteristics.
The rate of BSI did not differ by CVAD type: 11 BSIs per 1,000 neutropenic days for TECs, 13.7 for PICCs, and 10.7 for TICs. After adjustment, there was no statistically significant association between CVAD type and BSI: PICC incident rate ratio [IRR] = 1.00 (95% confidence interval [CI], 0.75–1.32) and TIC IRR = 0.83 (95% CI, 0.49–1.41) compared to TEC. When MBI and non-MBI were examined separately, results were similar.
In this large, multicenter cohort of pediatric AML patients, we found no difference in the rate of BSI during neutropenia by CVAD type. This may be due to a risk-profile for BSI that is unique to AML patients.
We describe the baseline characteristics and complications of individuals with influenza in the US FDA’s Sentinel System by antiviral treatment timing.
Retrospective cohort design.
Individuals aged ≥6 months with outpatient diagnoses of influenza in June 2014–July 2017, 3 influenza seasons.
We identified the comorbidities, vaccination history, influenza testing, and outpatient antiviral dispensings of individuals with influenza using administrative claims data from 13 data partners including the Centers for Medicare and Medicaid Services, integrated delivery systems, and commercial health plans. We assessed complications within 30 days: hospitalization, oxygen use, mechanical ventilation, critical care, ECMO, and death.
There were 1,090,333 influenza diagnoses in 2014–2015; 1,005,240 in 2016–2017; and 578,548 in 2017–2018. Between 49% and 55% of patients were dispensed outpatient treatment within 5 days. In all periods >80% of treated individuals received treatment on the day of diagnosis. Those treated on days 1–5 after diagnosis had higher prevalences of diabetes, chronic obstructive pulmonary disease, asthma, and obesity compared to those treated on the day of diagnosis or not treated at all. They also had higher rates of hospitalization, oxygen use, and critical care. In 2014–2015, among those aged ≥65 years, the rates of hospitalization were 45 per 1,000 diagnoses among those treated on day 0; 74 per 1,000 among those treated on days 1–5; and 50 per 1,000 among those who were untreated.
In a large, national analysis, approximately half of people diagnosed with influenza in the outpatient setting were treated with antiviral medications. Delays in outpatient dispensed treatment were associated with higher prevalence of comorbidities and higher rates of complication.
Firearm injuries are a significant public health problem. Prior studies have analyzed firearm death data or adult firearm injury data, but few studies have analyzed firearm injury data specifically among youth. To inform the current debate surrounding gun policy in the United States, this study aims to provide an estimate of the immense burden of youth firearm injury and its associated risk factors. Therefore, we performed a descriptive analysis of the Nationwide Emergency Department Sample (NEDS), the largest all-payer emergency department database in the United States, from January 2006 to September 2015. All patients age < 21 who presented with any diagnosis of firearm-related injuries were included.
There were an estimated 198,839 incidents of firearm-related emergency department visits for patients age < 21 from 2006 through 2015. After presenting to the ED, an estimated 11,909 cases resulted in death. The population adjusted rate of firearm-related emergency department visits was highest in the South and Midwest. This study demonstrates the significant burden of firearm injury among youth. Having a reliable estimate of the number of children harmed by firearms each year is a critical tool for policymakers — and may make common-sense gun safety measures more politically possible.
We investigated whether neurobehavioral markers of risk for emotion dysregulation were evident among newborns, as well as whether the identified markers were associated with prenatal exposure to maternal emotion dysregulation. Pregnant women (N = 162) reported on their emotion dysregulation prior to a laboratory assessment. The women were then invited to the laboratory to assess baseline respiratory sinus arrhythmia (RSA) and RSA in response to an infant cry. Newborns were assessed after birth via the NICU Network Neurobehavioral Scale. We identified two newborn neurobehavioral factors—arousal and attention—via exploratory factor analysis. Low arousal was characterized by less irritability, excitability, and motor agitation, while low attention was related to a lower threshold for auditory and visual stimulation, less sustained attention, and poorer visual tracking abilities. Pregnant women who reported higher levels of emotion dysregulation had newborns with low arousal levels and less attention. Larger decreases in maternal RSA in response to cry were also related to lower newborn arousal. We provide the first evidence that a woman's emotion dysregulation while pregnant is associated with risks for dysregulation in her newborn. Implications for intergenerational transmission of emotion dysregulation are discussed.
Three wild oats phenotypes were grown in wheat stands sown at different dates in greenhouse and field trials. Wild oats growth and seed output, and their effects on wheat biomass were not different among phenotypes when wild oats emerged 2 wk after the wheat. In experiments in which wild oats were planted in germinated wheat, one phenotype was shorter, weighed less, and produced fewer seed than the other phenotypes. Another phenotype reduced wheat biomass more than the other phenotypes. Vernalization increased vegetative growth and reduced spikelet production of one phenotype, but had no effect on its competitiveness with wheat.
Catherine Esnouf, Institut National de la Recherche Agronomique (INRA), Paris,Marie Russel, Institut National de la Recherche Agronomique (INRA), Paris,Nicolas Bricas, Centre de Co-opération Internationale en Recherche Agronomique pour le Développement (CIRAD), Paris
The duALIne project chose to examine the methods used to assess food sustainability in a chapter of its own, separate from the sectorial approaches presented previously, so that this examination could be as open as possible. This chapter focuses in particular on the specific issues posed by food vis-à-vis the methods currently used to measure sustainability. Under this approach, this chapter looks firstly at the complexity of food systems, then how the associated challenges of sustainability could be structured and finally presents some methods and indicators and the research questions they raise.
Measuring performance has become a widespread activity in modern societies. It is the benchmark by which political and economic choices are regularly backed and/or justified. Performance indicators, whatever their objective, have seen exponential development, as have the operators who construct them. Assessing the performance of food systems through the prism of sustainable development is still a recent concern that requires in-depth reflection, both in terms of its scope and of the issue(s) to be assessed on the one hand, and regarding the choices of the sustainable challenges targeted or the assessment methods to be used on the other.
The growth hormone (GH)–insulin-like growth factor-1 (IGF-1) axis is dramatically altered in patients with anorexia nervosa (AN). The aim of the present study was to investigate whether GH and IGF-1 could be predictors of outcome in patients with a restrictive form of AN. Blood levels of GH, IGF-1, adipocytokines, ghrelin, insulin, glucose, and sex and thyroid hormones were measured in eleven women inpatients with AN and in ten healthy women controls. Three stages were compared during refeeding: admission (T0), when BMI reached 16 kg/m2 (T1) and at discharge when BMI reached 17·5 kg/m2 (T2). Clinical status was assessed 6 months after discharge from hospital (T3), and remission was defined by the maintenance of a BMI ≥ 17·5 kg/m2. AN patients in remission (AN-R; n 6) had significantly higher GH levels at admission than those who relapsed (AN-NR; n 5) (P< 0·05). During refeeding (Δ = T2 − T0), the AN-R group differed from the AN-NR group only by both GH level decrease (P< 0·05) and BMI increase (P< 0·05). In multiple regression analysis, ΔGH was associated negatively and significantly and Δleptin and Δbody fat mass levels were associated positively and significantly with BMI at T3 and explained 88 % of its variability (r2 0·88, P< 0·05). The present study suggests that a low GH level at admission and the absence of its decrease after weight recovery could predict short-term relapse in women suffering from a restrictive form of AN.
Plasma concentrations of vitamin E and carotenoids are governed by several factors, including genetic factors. Single nucleotide polymorphisms (SNP) in some genes involved in lipid metabolism have recently been associated with fasting plasma concentrations of these fat-soluble micronutrients. To further investigate the role of genetic factors that modulate the plasma concentrations of these micronutrients, we assessed whether SNP in five candidate genes (apo C-III, CETP, hepatic lipase, I-FABP and MTP) were associated with the plasma concentrations of these micronutrients. Fasting plasma vitamin E and carotenoid concentrations were measured in 129 French Caucasian subjects (forty-eight males and eighty-one females). Candidate SNP were genotyped by PCR amplification followed by restriction fragment length polymorphisms. Plasma γ-tocopherol, α-carotene and β-carotene concentrations were significantly different (P < 0·05) in subjects who carried different SNP variants in hepatic lipase. Plasma α-tocopherol concentrations were significantly different in subjects who had different SNP variants in apo C-III and cholesteryl ester transfer protein (CETP). Plasma lycopene concentrations were significantly different (P < 0·05) in women who had different SNP variants in intestinal fatty acid binding protein (I-FABP). Finally, there was no effect of SNP variants in microsomal TAG transfer protein upon the plasma concentrations of these micronutrients. Most of the observed differences remained significant after the plasma micronutrients were adjusted for plasma TAG and cholesterol. These results suggest that apo C-III, CETP and hepatic lipase play a role in determining the plasma concentrations of tocopherols while hepatic lipase and I-FABP may modulate plasma concentrations of carotenoids.
Diet is a major aspect of glycaemic control in type 2 diabetes, particularly among the elderly. The objective of this study was to describe the food habits of elderly diabetic subjects compared with non-diabetic ones and to examine the difference between their nutritional behaviour and nutritional recommendations. This study was based on the Three City (3C) community-based cohort. The food habits of 1336 participants aged 65 or over, including 149 diabetic subjects, were evaluated using a FFQ and a 24 h recall of food consumption. For both sexes, intake of carbohydrates was lower for diabetic compared to non-diabetic subjects, essentially due to a lower intake of mono-/disaccharides. For diabetic men, this was compensated for by a higher intake of protein whereas women had a lower energy intake overall. Fibre intake was also higher in diabetic men. There was no absolute increase in fats intake, neither for men nor for women, and distribution of subtypes of fats (saturated, monounsaturated and polyunsaturated) did not differ between diabetic and non-diabetic subjects. Carbohydrates provided 40·5 % of energy intake in diabetic men and 43·9 % in diabetic women. Contrary to nutritional recommendations for diabetic subjects, for approximately two-thirds of the diabetic subjects carbohydrates represented less than 45 % of daily energy intake. Although food habits of elderly diabetic subjects differed from those of non-diabetic ones, these habits are not totally in line with nutritional recommendations. These results should be taken into account to adapt nutritional advice given to the diabetic population.
Resveratrol has been widely investigated for its potential health properties, although little is known about its metabolism in vivo Here we investigated the distribution of metabolic products of [3H]trans-resveratrol, following gastric administration. At 2h, plasma concentrations reached 1·7% of the administered dose, whilst liver and kidney concentrations achieved 1·0 and 0·6%, respectively. Concentrations detected at 18h were lower, being only 0·5% in plasma and a total of 0·35% in tissues. Furthermore, whilst kidney and liver concentrations fell to 10 and 25%, respectively, of concentrations at 2h, the brain retained 43% of that measured at 2h. Resveratrol-glucuronide was identified as the major metabolite, reaching 7μm in plasma at 2h. However, at 18h the main form identified in liver, heart, lung and brain was native resveratrol aglycone, indicating that it is the main form retained in the tissues. No phenolic degradation products were detected in urine or tissues, indicating that, unlike flavonoids, resveratrol does not appear to serve as a substrate for colonic microflora. The present study provides additional information about the nature of resveratrol metabolites and which forms might be responsible for its in vivo biological effects.