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We aimed to describe the clinical characteristics of West Nile patients reported in Québec in 2012 and 2013 and to document physical, mental and functional status 24 months after symptom onset according to illness severity. The cases were recruited by a public health professional. Data were collected from public health files, medical records and two standardised phone questionnaires: the Short Form-36 and the Instrumental Activities of Daily Living. In all, 92 persons participated in the study (25 had West Nile fever (WNF), 18 had meningitis and 49 had encephalitis). Encephalitis participants were older, had more underlying medical conditions, more neurological symptoms, worse hospital course and higher lethality than meningitis or WNF participants. Nearly half of the surviving hospitalised encephalitis patients required extra support upon discharge. At 24-month follow-up, encephalitis and meningitis patients had a lower score in two domains of the mental component: mental health and social functioning (P = 0.0025 and 0.0297, respectively) compared with the norms based on age- and sex-matched Canadians. Physical status was not affected by West Nile virus (WNV) infection. In addition, 5/36 (15%) of encephalitis, 1/17 (6%) of meningitis and 1/23 (5%) of WNF participants had new functional limitations 24 months after symptom onset. In summary, mental and functional sequelae in encephalitis patients are likely to represent a source of long-term morbidity. Preventive measures should target patients at higher risk of severe illness after WNV infection.
Little is known about the association of cortical Aβ with depression and anxiety among cognitively normal (CN) elderly persons.
We conducted a cross-sectional study derived from the population-based Mayo Clinic Study of Aging in Olmsted County, Minnesota; involving CN persons aged ≥ 60 years that underwent PiB-PET scans and completed Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI). Cognitive diagnosis was made by an expert consensus panel. Participants were classified as having abnormal (≥1.4; PiB+) or normal PiB-PET (<1.4; PiB−) using a global cortical to cerebellar ratio. Multi-variable logistic regression analyses were performed to calculate odds ratios (OR) and 95% confidence intervals (95% CI) after adjusting for age and sex.
Of 1,038 CN participants (53.1% males), 379 were PiB+. Each one point symptom increase in the BDI (OR = 1.03; 1.00–1.06) and BAI (OR = 1.04; 1.01–1.08) was associated with increased odds of PiB-PET+. The number of participants with BDI > 13 (clinical depression) was greater in the PiB-PET+ than PiB-PET- group but the difference was not significant (OR = 1.42; 0.83–2.43). Similarly, the number of participants with BAI > 10 (clinical anxiety) was greater in the PiB-PET+ than PiB-PET− group but the difference was not significant (OR = 1.77; 0.97–3.22).
As expected, depression and anxiety levels were low in this community-dwelling sample, which likely reduced our statistical power. However, we observed an informative albeit weak association between increased BDI and BAI scores and elevated cortical amyloid deposition. This observation needs to be tested in a longitudinal cohort study.
We present techniques for obtaining large (∼100 L STP) samples of ancient air for analysis of 14C of methane (14CH4)and other trace constituents. Paleoatmospheric 14CH4 measurements should constrain the fossil fraction of past methane budgets, as well as provide a definitive test of methane clathrate involvement in large and rapid methane concentration ([CH4]) increases that accompanied rapid warming events during the last deglaciation. Air dating to the Younger Dryas–Preboreal and Oldest Dryas–Bølling abrupt climatic transitions was obtained by melt extraction from old glacial ice outcropping at an ablation margin in West Greenland. The outcropping ice and occluded air were dated using a combination of δ15N of N2, δ18O of O2, δ18Oice and [CH4] measurements. The [CH4] blank of the melt extractions was <4 ppb. Measurements of δ18O and δ15N indicated no significant gas isotopic fractionation from handling. Measured Ar/N2, CFC-11 and CFC-12 in the samples indicated no significant contamination from ambient air. Ar/N2, Kr/Ar and Xe/Ar ratios in the samples were used to quantify effects of gas dissolution during the melt extractions and correct the sample [CH4]. Corrected [CH4] is elevated over expected values by up to 132 ppb for most samples, suggesting some in situ CH4 production in ice at this site.
Preliminary results from a systematic search for nearby substellar objects in the IRAS data bases has revealed only a single candidate among the 12 μm sources in the region of the polar caps. This object appears to be a distant carbon star. All 5700 sources were positionally associated with stars or galaxies.
Risk adjustment is needed to fairly compare central-line–associated bloodstream infection (CLABSI) rates between hospitals. Until 2017, the Centers for Disease Control and Prevention (CDC) methodology adjusted CLABSI rates only by type of intensive care unit (ICU). The 2017 CDC models also adjust for hospital size and medical school affiliation. We hypothesized that risk adjustment would be improved by including patient demographics and comorbidities from electronically available hospital discharge codes.
Using a cohort design across 22 hospitals, we analyzed data from ICU patients admitted between January 2012 and December 2013. Demographics and International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) discharge codes were obtained for each patient, and CLABSIs were identified by trained infection preventionists. Models adjusting only for ICU type and for ICU type plus patient case mix were built and compared using discrimination and standardized infection ratio (SIR). Hospitals were ranked by SIR for each model to examine and compare the changes in rank.
Overall, 85,849 ICU patients were analyzed and 162 (0.2%) developed CLABSI. The significant variables added to the ICU model were coagulopathy, paralysis, renal failure, malnutrition, and age. The C statistics were 0.55 (95% CI, 0.51–0.59) for the ICU-type model and 0.64 (95% CI, 0.60–0.69) for the ICU-type plus patient case-mix model. When the hospitals were ranked by adjusted SIRs, 10 hospitals (45%) changed rank when comorbidity was added to the ICU-type model.
Our risk-adjustment model for CLABSI using electronically available comorbidities demonstrated better discrimination than did the CDC model. The CDC should strongly consider comorbidity-based risk adjustment to more accurately compare CLABSI rates across hospitals.
To assess the impact of farm management on herd fertility, a survey of 105 beef farms in Northern Ireland was conducted to establish the relationship between management variables and fertility. Each herd's average calving interval (CI) and the proportion of cows with a CI > 450 days (extended calving interval, ECI) was calculated to establish herd fertility. The relationship between each response variable (CI and proportion ECI) and each explanatory variable (respondents’ answers to questionnaire) was examined using univariate linear regression analyses. All response variables found to be associated with the explanatory variables were modelled against each group in turn using a fully automated multivariate stepwise regression algorithm employing the method of forward selection with backward elimination. The optimum 365-day CI and a proportion of 0 cows per hundred calved ECI targets were not widely attained in the current study. The distribution of CI and proportion ECI in the current study suggests more realistic targets would be a 379-day CI and 5 cows per hundred calved with ECI in commercial beef breeding herds. Six management factors were found to be associated with herd fertility: herd vaccination, bull selection, fertility management, breeding female management, perception of extension service (rural education provided by the government) and record keeping. It was found that respondents who vaccinated cows had a reduction of 5 cows per hundred calved in the proportion of cows with ECI, and as the number of vaccines administered to a cow increased, the CI decreased. Regular vaccination of breeding bulls was associated with a 9-day reduction in CI. Bull selection strategy had several associations with herd fertility; most notable was that respondents who used visual selection rather than estimated breeding values (EBVs) to select bulls were found to have a 15-day longer CI and 7 cows per hundred calved higher proportion of cows with ECI. For each 0·01 increase in the proportion of cows served by artificial insemination, CI increased by 0·16 days. Respondents who rated their beef breeding herd fertility as ‘very good’ had lower ECI and CI than those who rated beef breeding herd fertility as poor or satisfactory. Condition scoring of cows at weaning lowered ECI by 5 cows per hundred calved. Those who perceived the extension service to be very useful had the lowest CI and lowest ECI. Respondents who did not keep a record of CI to assess herd fertility had an 11-day longer CI and 6 cows per hundred calved higher proportion ECI than those who did not. In conclusion, the survey found a number of important variables linked to improved fertility including selecting sires based on EBVs and using a robust vaccination programme.
An extensive survey of [CII] line emission has been made with a balloon-borne infrared telescope. It has been found that the emission is diffuse and ubiquitously distributed in general interstellar space.
Rural communities face barriers to disaster preparedness and considerable risk of disasters. Emergency preparedness among rural communities has improved with funding from federal programs and implementation of a National Incident Management System. The objective of this project was to design and implement disaster exercises to test decision making by rural response partners to improve regional planning, collaboration, and readiness. Six functional exercises were developed and conducted among three rural Nebraska (USA) regions by the Center for Preparedness Education (CPE) at the University of Nebraska Medical Center (Omaha, Nebraska USA). A total of 83 command centers participated. Six functional exercises were designed to test regional response and command-level decision making, and each 3-hour exercise was followed by a 3-hour regional after action conference. Participant feedback, single agency debriefing feedback, and regional After Action Reports were analyzed. Functional exercises were able to test command-level decision making and operations at multiple agencies simultaneously with limited funding. Observations included emergency management jurisdiction barriers to utilization of unified command and establishment of joint information centers, limited utilization of documentation necessary for reimbursement, and the need to develop coordinated public messaging. Functional exercises are a key tool for testing command-level decision making and response at a higher level than what is typically achieved in tabletop or short, full-scale exercises. Functional exercises enable evaluation of command staff, identification of areas for improvement, and advancing regional collaboration among diverse response partners.
ObaidJM, BaileyG, WheelerH, MeyersL, MedcalfSJ, HansenKF, SangerKK, LoweJJ. Utilization of Functional Exercises to Build Regional Emergency Preparedness among Rural Health Organizations in the US. Prehosp Disaster Med. 2017;32(2):224–230.
The polar mesopause region (80-100 km) is the coldest region of the Earth's atmosphere and is expected to be sensitive to global change. Reported increases in observations of polar mesospheric clouds over the last 100 years have been postulated to be related to decreased temperatures (associated with tropospheric warming) and increased water vapour at mesospheric altitudes (a result of increased methane concentrations in the troposphere). The temperature of this region can be monitored by spectroscopic techniques utilising hydroxyl (OH) emissions which originate near 87 km. The Australian Antarctic Division, Atmospheric and Space Physics group has been analyzing OH (6-2) band spectra recorded with a Czerny—Turner scanning spectrometer at Davis Station, Antarctica (68.6° S, 78.0° E) to optimise temperature determinations for climate change studies. A number of difficulties were encountered, some of which have been overcome and all of which can be overcome. The mid-winter average temperature of the OH layer for May-July 1990 has been measured as 224 ±2 K. The equivalent value for 1996 is 215±2 K. Possible reasons for the difference are discussed.
Spectroscopic observations of CII line emission at 157.7 μm have been made of the Galactic Center region with a Fabry-Perot spectrometer onboard a balloon telescope. Strong emission has been detected ubiquitously in a wide area extending between ± 0.7° in galactic longitude. A ring-like structure is suggested from the double lobed distribution of the emission around the Galactic Center.
This report outlines a 3-year health care coalition effort to advance and test community capacity for a large-scale hospital evacuation. The multi-year effort utilized a variety workshops, seminars, webinars, tabletops, functional exercises, and culminated with a full-scale exercise testing hospital evacuation. While most hospital evacuation exercises focus on internal movement of patients, this exercise process tested command-level decision making and it tested external partners such as transportation agencies, law enforcement, receiving hospitals, and local emergency management. This process delivered key coalition-building activities and offered a variety of training and exercise opportunities to assist a number of organizations, all at different stages of hospital evacuation planning. The 2012 Hospital Preparedness Program outlined the incorporation of health care coalition activities to transform individual organization preparedness to community-level readiness. This report outlines a health care coalition effort to deliver training and exercises to advance community capacity for a large-scale hospital evacuation.
LoweJJ, HansenKF, SangerKK, ObaidJM. A 3-year Health Care Coalition Experience in Advancing Hospital Evacuation Preparedness. Prehosp Disaster Med. 2016;31(6):658–662.
Anorexia nervosa (AN) is a serious illness leading to substantial morbidity and mortality. The treatment of AN very often is protracted; repeated hospitalizations and lost productivity generate substantial economic costs in the health care system. Therefore, this study aimed to determine the differential cost-effectiveness of out-patient focal psychodynamic psychotherapy (FPT), enhanced cognitive–behavioural therapy (CBT-E), and optimized treatment as usual (TAU-O) in the treatment of adult women with AN.
The analysis was conducted alongside the randomized controlled Anorexia Nervosa Treatment of OutPatients (ANTOP) study. Cost-effectiveness was determined using direct costs per recovery at 22 months post-randomization (n = 156). Unadjusted incremental cost-effectiveness ratios (ICERs) were calculated. To derive cost-effectiveness acceptability curves (CEACs) adjusted net-benefit regressions were applied assuming different values for the maximum willingness to pay (WTP) per additional recovery. Cost–utility and assumptions underlying the base case were investigated in exploratory analyses.
Costs of in-patient treatment and the percentage of patients who required in-patient treatment were considerably lower in both intervention groups. The unadjusted ICERs indicated FPT and CBT-E to be dominant compared with TAU-O. Moreover, FPT was dominant compared with CBT-E. CEACs showed that the probability for cost-effectiveness of FTP compared with TAU-O and CBT-E was ⩾95% if the WTP per recovery was ⩾€9825 and ⩾€24 550, respectively. Comparing CBT-E with TAU-O, the probability of being cost-effective remained <90% for all WTPs. The exploratory analyses showed similar but less pronounced trends.
Depending on the WTP, FPT proved cost-effective in the treatment of adult AN.
We present the first results from multi-site observations of the δ Scuti star XX Pyx (CD–24°7599). The observations were carried out as the 17th run of the Delta Scuti Network. We collected 583 hr of B, V time-series photometry, resulting in a detection level (4σ) in the amplitude spectrum of 0.5 mmag. We detect 6 new pulsation frequencies, bringing the total number of frequencies known in this star up 19.
A newly designed, 100 mm2, silicon drift detector has been installed on an aberration-corrected scanning transmission electron microscope equipped with an ultra-high resolution pole piece, without requiring column modifications. With its unique, windowless design, the detector’s active region is in close proximity to the sample, resulting in a dramatic increase in count rate, while demonstrating an increased sensitivity to low energy X-rays and a muted tilt dependence. Numerous examples of X-ray energy dispersive spectrometry are presented on relevant materials such as AlxGa1−xN nanowires, perovskite oxides, and polycrystalline CdTe thin films, across both varying length scales and accelerating voltages.