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Little is known about methylphenidate (MPH) use and mortality outcomes.
To investigate the association between MPH use and mortality among children with an attention-deficit hyperactivity disorder (ADHD) diagnosis.
This population-based cohort study analysed data from Taiwan's National Health Insurance Research Database (NHIRD). A total of 68 096 children and adolescents aged 4–17 years with an ADHD diagnosis and prescribed MPH between 2000 and 2010 were compared with 68 096 without an MPH prescription, matched on age, gender and year of first ADHD diagnosis. All participants were followed to death, migration, withdrawal from the National Health Insurance programme or 31 December 2013. MPH prescriptions were measured on a yearly basis during the study period, and the association between MPH use and mortality was analysed using a repeated-measures time-dependent Cox regression model. The outcome measures included all-cause, unnatural-cause (including suicide, accident and homicide) and natural-cause mortality, obtained from linkage to the National Mortality Register in Taiwan.
The MPH group had lower unadjusted all-cause, natural-, unnatural- and accident-cause mortality than the comparison group. After controlling for potential confounders, MPH use was associated with a significantly lower all-cause mortality (adjusted hazard ratio AHR = 0.81, 95% CI 0.67–0.98, P = 0.027), delayed use of MPH was associated with higher mortality (AHR = 1.05, 95% CI 1.01–1.09) and longer MPH use was associated with lower mortality (AHR = 0.83, 95% CI 0.70–0.98).
MPH use is associated with a reduced overall mortality in children with ADHD in this cohort study, but unmeasured confounding cannot be excluded absolutely.
The reflectance spectroscopic characteristics of cyanobacteria-dominated microbial mats in the McMurdo Dry Valleys (MDVs) were measured using a hyperspectral point spectrometer aboard an unmanned aerial system (remotely piloted aircraft system, unmanned aerial vehicle or drone) to determine whether mat presence, type and activity could be mapped at a spatial scale sufficient to characterize inter-annual change. Mats near Howard Glacier and Canada Glacier (ASPA 131) were mapped and mat samples were collected for DNA-based microbiome analysis. Although a broadband spectral parameter (a partial normalized difference vegetation index) identified mats, it missed mats in comparatively deep (> 10 cm) water or on bouldery surfaces where mats occupied fringing moats. A hyperspectral parameter (B6) did not have these shortcomings and recorded a larger dynamic range at both sites. When linked with colour orthomosaic data, B6 band strength is shown to be capable of characterizing the presence, type and activity of cyanobacteria-dominated mats in and around MDV streams. 16S rRNA gene polymerase chain reaction amplicon sequencing analysis of the mat samples revealed that dominant cyanobacterial taxa differed between spectrally distinguishable mats, indicating that spectral differences reflect underlying biological distinctiveness. Combined rapid-repeat hyperspectral measurements can be applied in order to monitor the distribution and activity of sentinel microbial ecosystems across the terrestrial Antarctic.
Attention-deficit/hyperactivity disorder (ADHD) is associated with a higher risk of burn injury than in the normal population. Nevertheless, the influence of methylphenidate (MPH) on the risk of burn injury remains unclear. This retrospective cohort study analysed the effect of MPH on the risk of burn injury in children with ADHD.
Data were from Taiwan's National Health Insurance Research Database (NHIRD). The sample comprised individuals younger than 18 years with a diagnosis of ADHD (n = 90 634) in Taiwan's NHIRD between January 1996 and December 2013. We examined the cumulative effect of MPH on burn injury risk using Cox proportional hazards models. We conducted a sensitivity analysis for immortal time bias using a time-dependent Cox model and within-patient comparisons using the self-controlled case series model.
Children with ADHD taking MPH had a reduced risk of burn injury, with a cumulative duration of treatment dose-related effect, compared with those not taking MPH. Compared with children with ADHD not taking MPH, the adjusted hazard ratio for burn injury was 0.70 in children taking MPH for <90 days (95% confidence interval (CI) 0.64–0.77) and 0.43 in children taking MPH for ≥90 days (95% CI 0.40–0.47), with a 50.8% preventable fraction. The negative association of MPH was replicated in age-stratified analysis using time-dependent Cox regression and self-controlled case series models.
This study showed that MPH treatment was associated with a lower risk of burn injury in a cumulative duration of treatment dose-related effect manner.
We correlated antibiotic consumption measured by point prevalence survey with defined daily doses (DDD) across multiple hospitals. Point prevalence survey had a higher correlation (1) with monthly DDDs than annual DDDs, (2) in nonsurgical versus surgical wards, and (3) on high- versus low-utilization wards. Findings may be hospital specific due to hospital differences.
We illustrate the extraordinary potential of the (far-IR) Origins Survey Spectrometer (OSS) on board the Origins Space Telescope (OST) to address a variety of open issues on the co-evolution of galaxies and AGNs. We present predictions for blind surveys, each of 1000 h, with different mapped areas (a shallow survey covering an area of 10 deg2 and a deep survey of 1 deg2) and two different concepts of the OST/OSS: with a 5.9 m telescope (Concept 2, our reference configuration) and with a 9.1 m telescope (Concept 1, previous configuration). In 1 000 h, surveys with the reference concept will detect from ∼1.9×106 to ∼8.7×106 lines from ∼4.8×105 to 2.7×106 star-forming galaxies and from ∼1.4×104 to ∼3.8×104 lines from ∼1.3×104 to 3.5×104 AGNs. The shallow survey will detect substantially more sources than the deep one; the advantage of the latter in pushing detections to lower luminosities/higher redshifts turns out to be quite limited. The OST/OSS will reach, in the same observing time, line fluxes more than one order of magnitude fainter than the SPICA/SMI and will cover a much broader redshift range. In particular it will detect tens of thousands of galaxies at z ≥ 5, beyond the reach of that instrument. The polycyclic aromatic hydrocarbons lines are potentially bright enough to allow the detection of hundreds of thousands of star-forming galaxies up to z ∼ 8.5, i.e. all the way through the reionisation epoch. The proposed surveys will allow us to explore the galaxy–AGN co-evolution up to z ∼ 5.5−6 with very good statistics. OST Concept 1 does not offer significant advantages for the scientific goals presented here.
The present study evaluates the use of multiple correspondence analysis (MCA), a type of exploratory factor analysis designed to reduce the dimensionality of large categorical data sets, in identifying behaviours associated with measures of overweight/obesity in Vanuatu, a rapidly modernizing Pacific Island country.
Starting with seventy-three true/false questions regarding a variety of behaviours, MCA identified twelve most significantly associated with modernization status and transformed the aggregate binary responses of participants to these twelve questions into a linear scale. Using this scale, individuals were separated into three modernization groups (tertiles) among which measures of body fat were compared and OR for overweight/obesity were computed.
Ni-Vanuatu adults (n 810) aged 20–85 years.
Among individuals in the tertile characterized by positive responses to most of or all the twelve modernization questions, weight and measures of body fat and the likelihood that measures of body fat were above the US 75th percentile were significantly greater compared with individuals in the tertiles characterized by mostly or partly negative responses.
The study indicates that MCA can be used to identify individuals or groups at risk for overweight/obesity, based on answers to simply-put questions. MCA therefore may be useful in areas where obtaining detailed information about modernization status is constrained by time, money or manpower.
Sepsis is defined as the dysregulated host response to an infection resulting in life-threatening organ dysfunction. The metabolic demand from inefficiencies in anaerobic metabolism, mitochondrial and cellular dysfunction, increased cellular turnover, and free-radical damage result in the increased focus of micronutrients in sepsis as they play a pivotal role in these processes. In the present review, we will evaluate the potential role of micronutrients in sepsis, specifically, thiamine, l-carnitine, vitamin C, Se and vitamin D. Each micronutrient will be reviewed in a similar fashion, discussing its major role in normal physiology, suspected role in sepsis, use as a biomarker, discussion of the major basic science and human studies, and conclusion statement. Based on the current available data, we conclude that thiamine may be considered in all septic patients at risk for thiamine deficiency and l-carnitine and vitamin C to those in septic shock. Clinical trials are currently underway which may provide greater insight into the role of micronutrients in sepsis and validate standard utilisation.
Charles R. Plott, Division of the Humanities and Social Sciences, California Institute of Technology,
Hsing Yang Lee, Division of the Humanities and Social Sciences, California Institute of Technology,
Travis Maron, Division of the Humanities and Social Sciences, California Institute of Technology
The history of the continuous combinatorial auction marks the evolution of the mechanism. The concept of a combinatorial auction is due to Rassenti, Smith, and Bulfin (1982) who were motivated by the use of simultaneous ascending price auctions to allocate landing rights (Grether, Isaac, and Plott (1979 and subsequently published in 1989)). The ideas were generalized by Banks, Ledyard, and Porter (1989) to include the concept of a “standby queue” which serves a function similar to non-winning bids in the current system.
The first example of a continuous combinatorial auction is found at Brewer and Plott (1996). They demonstrate that representations in terms of binary confects of packages afford both the flexibility for widespread application and the computational speed required to support the auction. This early mechanism depended heavily on the existence of a fixed set of packages on which bids could be placed. The computer could quickly compute non-intersecting packages that maximized the value of the sale and permitted the auction to proceed as a type of continuous, simultaneous, ascending price auction. The packages played the role of items on which bids were placed. The nonintersecting packages that produced the most revenue from the auction were declared the leading bids at each instant of time. That first mechanism was followed by slight generalization to a procurement problem in which the buyer organized sellers to minimize procurement cost and sellers could offer endogenous packages. The organization was a simultaneous, decreasing price auction.
In the 1990s, the FCC was considering the adoption of a combinatorial auction as a replacement for the simultaneous, rounds-based, ascending price auction that the FCC had used to auction parts of the electromagnetic spectrum. The initial research focused on a hybrid process that consisted of rounds followed by a continuous phase. (See the report of Charles R. Plott, FCC Why River Conference, May 5–7, 2000). Experiments with the hybrid revealed that, that most of the adjustment and efficiently came from the continuous phase. That discovery led to the study of combinatorial auctions that operated only in continuous time.
Cerebrovascular reactivity monitoring has been used to identify the lower limit of pressure autoregulation in adult patients with brain injury. We hypothesise that impaired cerebrovascular reactivity and time spent below the lower limit of autoregulation during cardiopulmonary bypass will result in hypoperfusion injuries to the brain detectable by elevation in serum glial fibrillary acidic protein level.
We designed a multicentre observational pilot study combining concurrent cerebrovascular reactivity and biomarker monitoring during cardiopulmonary bypass. All children undergoing bypass for CHD were eligible. Autoregulation was monitored with the haemoglobin volume index, a moving correlation coefficient between the mean arterial blood pressure and the near-infrared spectroscopy-based trend of cerebral blood volume. Both haemoglobin volume index and glial fibrillary acidic protein data were analysed by phases of bypass. Each patient’s autoregulation curve was analysed to identify the lower limit of autoregulation and optimal arterial blood pressure.
A total of 57 children had autoregulation and biomarker data for all phases of bypass. The mean baseline haemoglobin volume index was 0.084. Haemoglobin volume index increased with lowering of pressure with 82% demonstrating a lower limit of autoregulation (41±9 mmHg), whereas 100% demonstrated optimal blood pressure (48±11 mmHg). There was a significant association between an individual’s peak autoregulation and biomarker values (p=0.01).
Individual, dynamic non-invasive cerebrovascular reactivity monitoring demonstrated transient periods of impairment related to possible silent brain injury. The association between an impaired autoregulation burden and elevation in the serum brain biomarker may identify brain perfusion risk that could result in injury.
Recent studies point to overlap between neuropsychiatric disorders in symptomatology and genetic aetiology.
To systematically investigate genomics overlap between childhood and adult attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and major depressive disorder (MDD).
Analysis of whole-genome blood gene expression and genetic risk scores of 318 individuals. Participants included individuals affected with adult ADHD (n = 93), childhood ADHD (n = 17), MDD (n = 63), ASD (n = 51), childhood dual diagnosis of ADHD–ASD (n = 16) and healthy controls (n = 78).
Weighted gene co-expression analysis results reveal disorder-specific signatures for childhood ADHD and MDD, and also highlight two immune-related gene co-expression modules correlating inversely with MDD and adult ADHD disease status. We find no significant relationship between polygenic risk scores and gene expression signatures.
Our results reveal disorder overlap and specificity at the genetic and gene expression level. They suggest new pathways contributing to distinct pathophysiology in psychiatric disorders and shed light on potential shared genomic risk factors.
Accurate estimation of food portion size is critical in dietary studies. Hands are potentially useful as portion size estimation aids; however, their accuracy has not been tested. The aim of the present study was to test the accuracy of a novel portion size estimation method using the width of the fingers as a ‘ruler’ to measure the dimensions of foods (‘finger width method’), as well as fists and thumb or finger tips. These hand measures were also compared with household measures (cups and spoons). A total of sixty-seven participants (70 % female; age 32·7 (sd 13·7) years; BMI 23·2 (sd 3·5) kg/m2) attended a 1·5 h session in which they estimated the portion sizes of forty-two pre-weighed foods and liquids. Hand measurements were used in conjunction with geometric formulas to convert estimations to volumes. Volumes determined with hand and household methods were converted to estimated weights using density factors. Estimated weights were compared with true weights, and the percentage difference from the true weight was used to compare accuracy between the hand and household methods. Of geometrically shaped foods and liquids estimated with the finger width method, 80 % were within ±25 % of the true weight of the food, and 13 % were within ±10 %, in contrast to 29 % of those estimated with the household method being within ±25 % of the true weight of the food, and 8 % being within ±10 %. For foods that closely resemble a geometric shape, the finger width method provides a novel and acceptably accurate method of estimating portion size.
Introduction: Currently the top 5% of complex patients consume 84% of Ontario’s Hospital and Home Care costs. There is a critical need for a dynamic, person-centred care planning process for medically complex patients with real time dialogue between ED/acute care and community care providers at care transitions. A care pathway was developed in the Sunnybrook Health Science Centre’s Emergency Department using quality improvement methodology and team. The purpose of this study is to evaluate the impact of the emergency room huddle for complex care patients on emergency doctors’ perceptions of patient safety and ED efficiency measures such as department flow and delays. Methods: Intervention - Medically complex patients with frequent ED use are now automatically flagged upon registration in the Emergency Department (ED) and an ED Care Coordination team is notified by secure email: GEM nurse, ED CCAC Care Coordinator, SW, OT/PT. The GEM nurse initiates a comprehensive patient assessment in the Emergency Department right after triage and the CCAC Care Coordinator initiates a teleconference with the patient’s family physician and community Care Coordinator with the patient’s consent. Usual physician assessment is preceded and followed by an inter-professional huddle (including the EM doctor, GEM nurse, CCAC nurse and SW, OT, PT) to ensure patient's needs, goals and team recommendations are clear. Emergency doctors who have participated in an inter-professional huddle for complex care patients are contacted via a semi-structured interview and Qualtrics surveys evaluating perceptions of patient safety and ED efficiency measures such as department flow and delays. Results: Qualitative analysis of the results will be conducted and results updated at a later date. Conclusion: Safety is enhanced through better communication between ED providers, patients, their family physicians and community care providers. It is essential that the inter-professional huddle is recognized by emergency physicians as an important element of patient safety and care. An evaluation of ED doctor’s perception of the huddle will help us understand enablers and barriers to the process and inspire further quality improvements to enhance patient care.
The subsurface exploration of other planetary bodies can be used to unravel their geological history and assess their habitability. On Mars in particular, present-day habitable conditions may be restricted to the subsurface. Using a deep subsurface mine, we carried out a program of extraterrestrial analog research – MINe Analog Research (MINAR). MINAR aims to carry out the scientific study of the deep subsurface and test instrumentation designed for planetary surface exploration by investigating deep subsurface geology, whilst establishing the potential this technology has to be transferred into the mining industry. An integrated multi-instrument suite was used to investigate samples of representative evaporite minerals from a subsurface Permian evaporite sequence, in particular to assess mineral and elemental variations which provide small-scale regions of enhanced habitability. The instruments used were the Panoramic Camera emulator, Close-Up Imager, Raman spectrometer, Small Planetary Linear Impulse Tool, Ultrasonic drill and handheld X-ray diffraction (XRD). We present science results from the analog research and show that these instruments can be used to investigate in situ the geological context and mineralogical variations of a deep subsurface environment, and thus habitability, from millimetre to metre scales. We also show that these instruments are complementary. For example, the identification of primary evaporite minerals such as NaCl and KCl, which are difficult to detect by portable Raman spectrometers, can be accomplished with XRD. By contrast, Raman is highly effective at locating and detecting mineral inclusions in primary evaporite minerals. MINAR demonstrates the effective use of a deep subsurface environment for planetary instrument development, understanding the habitability of extreme deep subsurface environments on Earth and other planetary bodies, and advancing the use of space technology in economic mining.
Surgical site infections (SSIs) are responsible for significant morbidity and mortality. Preadmission skin antisepsis, while controversial, has gained acceptance as a strategy for reducing the risk of SSI. In this study, we analyze the benefit of an electronic alert system for enhancing compliance to preadmission application of 2% chlorhexidine gluconate (CHG).
DESIGN, SETTING, AND PARTICIPANTS
Following informed consent, 100 healthy volunteers in an academic, tertiary care medical center were randomized to 5 chlorhexidine gluconate (CHG) skin application groups: 1, 2, 3, 4, or 5 consecutive applications. Participants were further randomized into 2 subgroups: with or without electronic alert. Skin surface concentrations of CHG (μg/mL) were analyzed using a colorimetric assay at 5 separate anatomic sites.
Preadmission application of chlorhexidine gluconate, 2%
Mean composite skin surface CHG concentrations in volunteer participants receiving EA following 1, 2, 3, 4, and 5 applications were 1,040.5, 1,334.4, 1,278.2, 1,643.9, and 1,803.1 µg/mL, respectively, while composite skin surface concentrations in the no-EA group were 913.8, 1,240.0, 1,249.8, 1,194.4, and 1,364.2 µg/mL, respectively (ANOVA, P<.001). Composite ratios (CHG concentration/minimum inhibitory concentration required to inhibit the growth of 90% of organisms [MIC90]) for 1, 2, 3, 4, or 5 applications using the 2% CHG cloth were 208.1, 266.8, 255.6, 328.8, and 360.6, respectively, representing CHG skin concentrations effective against staphylococcal surgical pathogens. The use of an electronic alert system resulted in significant increase in skin concentrations of CHG in the 4- and 5-application groups (P<.04 and P<.007, respectively).
The findings of this study suggest an evidence-based standardized process that includes use of an Internet-based electronic alert system to improve patient compliance while maximizing skin surface concentrations effective against MRSA and other staphylococcal surgical pathogens.
Infect. Control Hosp. Epidemiol. 2016;37(3):254–259
The use of underground geological repositories, such as in radioactive waste disposal (RWD) and in carbon capture (widely known as Carbon Capture and Storage; CCS), constitutes a key environmental priority for the 21st century. Based on the identification of key scientific questions relating to the geophysics, geochemistry and geobiology of geodisposal of wastes, this paper describes the possibility of technology transfer from high-technology areas of the space exploration sector, including astrobiology, planetary sciences, astronomy, and also particle and nuclear physics, into geodisposal. Synergies exist between high technology used in the space sector and in the characterization of underground environments such as repositories, because of common objectives with respect to instrument miniaturization, low power requirements, durability under extreme conditions (in temperature and mechanical loads) and operation in remote or otherwise difficult to access environments.