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Previous genetic association studies have failed to identify loci robustly associated with sepsis, and there have been no published genetic association studies or polygenic risk score analyses of patients with septic shock, despite evidence suggesting genetic factors may be involved. We systematically collected genotype and clinical outcome data in the context of a randomized controlled trial from patients with septic shock to enrich the presence of disease-associated genetic variants. We performed genomewide association studies of susceptibility and mortality in septic shock using 493 patients with septic shock and 2442 population controls, and polygenic risk score analysis to assess genetic overlap between septic shock risk/mortality with clinically relevant traits. One variant, rs9489328, located in AL589740.1 noncoding RNA, was significantly associated with septic shock (p = 1.05 × 10–10); however, it is likely a false-positive. We were unable to replicate variants previously reported to be associated (p < 1.00 × 10–6 in previous scans) with susceptibility to and mortality from sepsis. Polygenic risk scores for hematocrit and granulocyte count were negatively associated with 28-day mortality (p = 3.04 × 10–3; p = 2.29 × 10–3), and scores for C-reactive protein levels were positively associated with susceptibility to septic shock (p = 1.44 × 10–3). Results suggest that common variants of large effect do not influence septic shock susceptibility, mortality and resolution; however, genetic predispositions to clinically relevant traits are significantly associated with increased susceptibility and mortality in septic individuals.
This chapter provides an overview of the use of affect-based interventions to change behavior. Affect is defined in terms of affect proper and affect processing; both of these terms are used regularly in research on affect interventions. The evidence of direct modification of these affect constructs is then reviewed. Based on this evidence, step-by-step guides to techniques focusing on changing two key aspects of affective processing are provided: changing affective attitudes and anticipated affect. The guides to these techniques include typical means of delivery, target audience, behaviors, enabling or inhibiting factors, training and skills required, intensiveness, typical materials needed, and typical examples of implementation. In addition, application of implementation intentions, fear appeals, evaluative conditioning, and exercise games as other ways to change affect as a means to changing behavior are reviewed. Finally, two additional intervention pathways that could have impact on behavior change are reviewed: direct modification of other sources of behavioral influence (e.g., traditional social cognitive factors) in order to overcompensate for the impact of affect and self-regulation of the intensity of the affect experience as a means of inhibiting its impact.
We evaluated whether a diagnostic stewardship initiative consisting of ASP preauthorization paired with education could reduce false-positive hospital-onset (HO) Clostridioides difficile infection (CDI).
Single center, quasi-experimental study.
Tertiary academic medical center in Chicago, Illinois.
Adult inpatients were included in the intervention if they were admitted between October 1, 2016, and April 30, 2018, and were eligible for C. difficile preauthorization review. Patients admitted to the stem cell transplant (SCT) unit were not included in the intervention and were therefore considered a contemporaneous noninterventional control group.
The intervention consisted of requiring prescriber attestation that diarrhea has met CDI clinical criteria, ASP preauthorization, and verbal clinician feedback. Data were compared 33 months before and 19 months after implementation. Facility-wide HO-CDI incidence rates (IR) per 10,000 patient days (PD) and standardized infection ratios (SIR) were extracted from hospital infection prevention reports.
During the entire 52 month period, the mean facility-wide HO-CDI-IR was 7.8 per 10,000 PD and the SIR was 0.9 overall. The mean ± SD HO-CDI-IR (8.5 ± 2.0 vs 6.5 ± 2.3; P < .001) and SIR (0.97 ± 0.23 vs 0.78 ± 0.26; P = .015) decreased from baseline during the intervention. Segmented regression models identified significant decreases in HO-CDI-IR (Pstep = .06; Ptrend = .008) and SIR (Pstep = .1; Ptrend = .017) trends concurrent with decreases in oral vancomycin (Pstep < .001; Ptrend < .001). HO-CDI-IR within a noninterventional control unit did not change (Pstep = .125; Ptrend = .115).
A multidisciplinary, multifaceted intervention leveraging clinician education and feedback reduced the HO-CDI-IR and the SIR in select populations. Institutions may consider interventions like ours to reduce false-positive C. difficile NAAT tests.
St Andrews was of tremendous significance in medieval Scotland. Its importance remains readily apparent in the buildings which cluster the rocky promontory jutting out into the North Sea: the towers and walls of cathedral, castle and university provide reminders of the status and wealth of the city in the Middle Ages. As a centre of earthly and spiritual government, as the place of veneration forScotland's patron saint and as an ancient seat of learning, St Andrews was the ecclesiastical capital of Scotland. This volume provides the first full study of this special and multi-faceted centre throughout its golden age. The fourteen chapters use St Andrews as a focus for the discussion of multiple aspects of medieval life in Scotland. They examine church, spirituality, urban society andlearning in a specific context from the seventh to the sixteenth century, allowing for the consideration of St Andrews alongside other great religious and political centres of medieval Europe.
Michael Brown is Professor of Medieval Scottish History, University of St Andrews; Katie Stevenson is Keeper of Scottish History and Archaeology, National Museums Scotland and Senior Lecturer in Late Medieval History, University of St Andrews.
Contributors: Michael Brown, Ian Campbell, David Ditchburn, Elizabeth Ewan, Richard Fawcett, Derek Hall, Matthew Hammond, Julian Luxford, Roger Mason, Norman Reid, Bess Rhodes, Catherine Smith, Katie Stevenson, Simon Taylor, Tom Turpie.
The optimal perioperative feeding strategies for neonates with CHD are unknown. In the present study, we describe the current feeding practices across a multi-institutional cohort.
Inclusion criteria for this study were as follows: all neonates undergoing cardiac surgery admitted to the cardiac ICU for ⩾24 hours preoperatively between October, 2013 and July, 2014 in the Pediatric Cardiac Critical Care Consortium registry.
The cohort included 251 patients from eight centres. The most common diagnoses included the following: hypoplastic left heart syndrome (17%), coarctation/aortic arch hypoplasia (18%), and transposition of the great arteries (22%); 14% of the patients were <37weeks of gestational age. The median total hospital length of stay was 21 days (interquartile range (IQR) 14–35) and overall mortality was 8%. Preoperative feeding occurred in 133 (53%) patients. The overall preoperative feeding rates across centres ranged from 29 to 79%. Postoperative feeds started on median day 2 (IQR 1–4); for patients with hypoplastic left heart syndrome postoperative feeds started on median day 4. Postoperative feeds were initiated in 89 (35%) patients before extubation (range across centres: 21–61%). The median cardiac ICU discharge feeding volume was 108 cc/kg/day, varying across centres. The mean discharge weight was 280 g above birth weight, ranging from +100 to 430 g across centres. A total of 110 (44%) patients had discharge feeding tubes, ranging from 6 to 80% across centres, and 40/110 patients had gastrostomy/enterostomy tubes placed. In addition, eight (3.2%) patients developed necrotising enterocolitis – three preoperatively and five postoperatively.
In this cohort, neonatal feeding practices and outcomes appear to vary across diagnostic groups and institutions. Only half of the patients received preoperative enteral nutrition; almost half had discharge feeding tubes. Multi-institutional collaboration is necessary to determine feeding strategies associated with best clinical outcomes.
The multicomponent Dry Creek site, located in the Nenana Valley, central Alaska, is arguably one of the most important archaeological sites in Beringia. Original work in the 1970s identified two separate cultural layers, called Components 1 and 2, thought to date to the terminal Pleistocene and suggesting that the site was visited by Upper Paleolithic huntergatherers between about 13,000 and 12,000 calendar years before present (cal B.P.). The oldest of these became the typeassemblage for the Nenana complex. Recently, some have questioned the geoarchaeological integrity of the site's early deposits, suggesting that the separated cultural layers resulted from natural postdepositional disturbances. In 2011, we revisited Dry Creek to independently assess the site's age and formation. Here we present our findings and reaffirm original interpretations of clear separation of two terminal Pleistocene cultural occupations. For the first time, we report direct radiocarbon dates on cultural features associated with both occupation zones, one dating to 13,485-13,305 and the other to 11,060-10,590 cal B.P.
I mentioned to a friend that I was going to try and write about Bertolucci's La luna, a film shot mostly in Rome and released in 1979.
He said, ‘But that's a terrible film. It's so literal. It knows everything it's doing’. I said that that was what I was going to try to write about. He replied, ‘Then you'll just be explaining why it's a bad film’. Although I might admit to loving this film, I can also admit that it may in fact, be a bad film: for instance, it seems a series of parts, rather, perhaps, than an integrated (not to say organic) whole. But my own partiality towards it extends from its own – its own partiality. In part, what I want to explore here is partiality itself, the cathexis, prioritization and, finally, the fetishism of parts of films, of parts of Rome, of parts in films where parts of Rome become visible, oft en fleetingly. La luna is hardly a film about Rome. But in watching it, we are thrown about and around Rome; we are made to lurch from here to there and back. Something feels important about where and when Rome appears, or is made to appear (both happen) in this film.