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To assess the impact of a newly developed Central-Line Insertion Site Assessment (CLISA) score on the incidence of local inflammation or infection for CLABSI prevention.
A pre- and postintervention, quasi-experimental quality improvement study.
Setting and participants:
Adult inpatients with central venous catheters (CVCs) hospitalized in an intensive care unit or oncology ward at a large academic medical center.
We evaluated CLISA score impact on insertion site inflammation and infection (CLISA score of 2 or 3) incidence in the baseline period (June 2014–January 2015) and the intervention period (April 2015–October 2017) using interrupted times series and generalized linear mixed-effects multivariable analyses. These were run separately for days-to-line removal from identification of a CLISA score of 2 or 3. CLISA score interrater reliability and photo quiz results were evaluated.
Among 6,957 CVCs assessed 40,846 times, percentage of lines with CLISA score of 2 or 3 in the baseline and intervention periods decreased by 78.2% (from 22.0% to 4.7%), with a significant immediate decrease in the time-series analysis (P < .001). According to the multivariable regression, the intervention was associated with lower percentage of lines with a CLISA score of 2 or 3, after adjusting for age, gender, CVC body location, and hospital unit (odds ratio, 0.15; 95% confidence interval, 0.06–0.34; P < .001). According to the multivariate regression, days to removal of lines with CLISA score of 2 or 3 was 3.19 days faster after the intervention (P < .001). Also, line dwell time decreased 37.1% from a mean of 14 days (standard deviation [SD], 10.6) to 8.8 days (SD, 9.0) (P < .001). Device utilization ratios decreased 9% from 0.64 (SD, 0.08) to 0.58 (SD, 0.06) (P = .039).
The CLISA score creates a common language for assessing line infection risk and successfully promotes high compliance with best practices in timely line removal.
Abnormal effort-based decision-making represents a potential mechanism underlying motivational deficits (amotivation) in psychotic disorders. Previous research identified effort allocation impairment in chronic schizophrenia and focused mostly on physical effort modality. No study has investigated cognitive effort allocation in first-episode psychosis (FEP).
Cognitive effort allocation was examined in 40 FEP patients and 44 demographically-matched healthy controls, using Cognitive Effort-Discounting (COGED) paradigm which quantified participants’ willingness to expend cognitive effort in terms of explicit, continuous discounting of monetary rewards based on parametrically-varied cognitive demands (levels N of N-back task). Relationship between reward-discounting and amotivation was investigated. Group differences in reward-magnitude and effort-cost sensitivity, and differential associations of these sensitivity indices with amotivation were explored.
Patients displayed significantly greater reward-discounting than controls. In particular, such discounting was most pronounced in patients with high levels of amotivation even when N-back performance and reward base amount were taken into consideration. Moreover, patients exhibited reduced reward-benefit sensitivity and effort-cost sensitivity relative to controls, and that decreased sensitivity to reward-benefit but not effort-cost was correlated with diminished motivation. Reward-discounting and sensitivity indices were generally unrelated to other symptom dimensions, antipsychotic dose and cognitive deficits.
This study provides the first evidence of cognitive effort-based decision-making impairment in FEP, and indicates that decreased effort expenditure is associated with amotivation. Our findings further suggest that abnormal effort allocation and amotivation might primarily be related to blunted reward valuation. Prospective research is required to clarify the utility of effort-based measures in predicting amotivation and functional outcome in FEP.
Better understanding of interplay among symptoms, cognition and functioning in first-episode psychosis (FEP) is crucial to promoting functional recovery. Network analysis is a promising data-driven approach to elucidating complex interactions among psychopathological variables in psychosis, but has not been applied in FEP.
This study employed network analysis to examine inter-relationships among a wide array of variables encompassing psychopathology, premorbid and onset characteristics, cognition, subjective quality-of-life and psychosocial functioning in 323 adult FEP patients in Hong Kong. Graphical Least Absolute Shrinkage and Selection Operator (LASSO) combined with extended Bayesian information criterion (BIC) model selection was used for network construction. Importance of individual nodes in a generated network was quantified by centrality analyses.
Our results showed that amotivation played the most central role and had the strongest associations with other variables in the network, as indexed by node strength. Amotivation and diminished expression displayed differential relationships with other nodes, supporting the validity of two-factor negative symptom structure. Psychosocial functioning was most strongly connected with amotivation and was weakly linked to several other variables. Within cognitive domain, digit span demonstrated the highest centrality and was connected with most of the other cognitive variables. Exploratory analysis revealed no significant gender differences in network structure and global strength.
Our results suggest the pivotal role of amotivation in psychopathology network of FEP and indicate its critical association with psychosocial functioning. Further research is required to verify the clinical significance of diminished motivation on functional outcome in the early course of psychotic illness.
The second Singapore Mental Health Study (SMHS) – a nationwide, cross-sectional, epidemiological survey - was initiated in 2016 with the intent of tracking the state of mental health of the general population in Singapore. The study employed the same methodology as the first survey initiated in 2010. The SMHS 2016 aimed to (i) establish the 12-month and lifetime prevalence and correlates of major depressive disorder (MDD), dysthymia, bipolar disorder, generalised anxiety disorder (GAD), obsessive compulsive disorder (OCD) and alcohol use disorder (AUD) (which included alcohol abuse and dependence) and (ii) compare the prevalence of these disorders with reference to data from the SMHS 2010.
Door-to-door household surveys were conducted with adult Singapore residents aged 18 years and above from 2016 to 2018 (n = 6126) which yielded a response rate of 69.0%. The subjects were randomly selected using a disproportionate stratified sampling method and assessed using World Health Organization Composite International Diagnostic Interview version 3.0 (WHO-CIDI 3.0). The diagnoses of lifetime and 12-month selected mental disorders including MDD, dysthymia, bipolar disorder, GAD, OCD, and AUD (alcohol abuse and alcohol dependence), were based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria.
The lifetime prevalence of at least one mood, anxiety or alcohol use disorder was 13.9% in the adult population. MDD had the highest lifetime prevalence (6.3%) followed by alcohol abuse (4.1%). The 12-month prevalence of any DSM-IV mental disorders was 6.5%. OCD had the highest 12-month prevalence (2.9%) followed by MDD (2.3%). Lifetime and 12-month prevalence of mental disorders assessed in SMHS 2016 (13.8% and 6.4%) was significantly higher than that in SMHS 2010 (12.0% and 4.4%). A significant increase was observed in the prevalence of lifetime GAD (0.9% to 1.6%) and alcohol abuse (3.1% to 4.1%). The 12-month prevalence of GAD (0.8% vs. 0.4%) and OCD (2.9% vs. 1.1%) was significantly higher in SMHS 2016 as compared to SMHS 2010.
The high prevalence of OCD and the increase across the two surveys needs to be tackled at a population level both in terms of creating awareness of the disorder and the need for early treatment. Youth emerge as a vulnerable group who are more likely to be associated with mental disorders and thus targeted interventions in this group with a focus on youth friendly and accessible care centres may lead to earlier detection and treatment of mental disorders.
The discovery of the first electromagnetic counterpart to a gravitational wave signal has generated follow-up observations by over 50 facilities world-wide, ushering in the new era of multi-messenger astronomy. In this paper, we present follow-up observations of the gravitational wave event GW170817 and its electromagnetic counterpart SSS17a/DLT17ck (IAU label AT2017gfo) by 14 Australian telescopes and partner observatories as part of Australian-based and Australian-led research programs. We report early- to late-time multi-wavelength observations, including optical imaging and spectroscopy, mid-infrared imaging, radio imaging, and searches for fast radio bursts. Our optical spectra reveal that the transient source emission cooled from approximately 6 400 K to 2 100 K over a 7-d period and produced no significant optical emission lines. The spectral profiles, cooling rate, and photometric light curves are consistent with the expected outburst and subsequent processes of a binary neutron star merger. Star formation in the host galaxy probably ceased at least a Gyr ago, although there is evidence for a galaxy merger. Binary pulsars with short (100 Myr) decay times are therefore unlikely progenitors, but pulsars like PSR B1534+12 with its 2.7 Gyr coalescence time could produce such a merger. The displacement (~2.2 kpc) of the binary star system from the centre of the main galaxy is not unusual for stars in the host galaxy or stars originating in the merging galaxy, and therefore any constraints on the kick velocity imparted to the progenitor are poor.
Knowledge, attitudes and practices (KAP) of the population regarding severe fever with thrombocytopenia syndrome (SFTS) in endemic areas of Lu'an in China were assessed before and after an intervention programme. The pre-intervention phase was conducted using a sample of 425 participants from the 12 selected villages with the highest rates of endemic SFTS infection. A predesigned interview questionnaire was used to assess KAP. Subsequently, an intervention programme was designed and applied in the selected villages. KAP was re-assessed for each population in the selected villages using the same interview questionnaire. Following 2 months of the programme, 339 participants had completed the re-assessed survey. The impact of the intervention programme was evaluated using suitable statistical methods. A significant increase in the KAP and total KAP scores was noted following the intervention programme, whereas the proportion of correct knowledge, the positive attitudes and the effective practices toward SFTS of respondents increased significantly. The intervention programme was effective in improving KAP level of SFTS in populations that were resident in endemic areas.
In anticipation of the launch of the Earth Observing System (EOS) Terra, and the Aqua spacecraft in 1999 and 2000, respectively, efforts are ongoing to determine errors of satellite-derived snow-cover maps. EOS Moderate Resolution Imaging Spectrora-diometer (MODIS) and Advanced Microwave Scanning Radiometer-E (AMSR-E) snow-cover products will be produced. For this study we compare snow maps covering the same study areas in Canada and the United States, acquired from different sensors using different snow-mapping algorithms. Four locations are studied: (1) Saskatchewan, Canada; (2) New England (New Hampshire, Vermont and Massachusetts) and eastern New York; (3) central Idaho and western Montana; and (4) North and South Dakota. Snow maps were produced using a prototype MODIS snow-mapping algorithm from Landsat Thematic Mapper (TM) scenes of each study area at 30 m and when the TM data were degraded to 1 km resolution. U.S. National Operational Hydrologic Remote Sensing Center (NOHRSC) 1km resolution snow maps were also used, as were snow maps derived from 0.5° × 0.5° resolution Special Sensor Microwave Imager (SSM/I) data. A land-cover map derived from the International Geosphere-Biosphere Program land-cover map of North America was also registered to the scenes. The TM, NOHRSC and SSM/ I snow maps, and land-cover maps were compared digitally. In most cases, TM-derived maps show less snow cover than the NOHRSC and SSM/I maps because areas of incomplete snow cover in forests (e.g. tree canopies, branches and trunks) are seen in the TM data but not in the coarser-resolution maps which may map the areas as completely snow-covered. The snow maps generally agree with respect to the spatial variability of the snow cover. The 30 m resolutionTM data provide the most accurate snow maps, and are thus used as the baseline for comparison with the other maps. Results show that the changes in amount of snow cover, as compared to to the 30 m resolution TM maps, are lowest using the TM 1km resolution maps, at 0–40%. The greatest change (>100%) is found in the New England study area, probably due to the presence of patchy snow cover. A scene with patchy snow cover is more difficult to map accurately than is a scene with a well-defined snowline such as is found on the North and South Dakota scene where the changes were 0–40%. There are also some important differences in the amount of snow mapped using the two different SSM/I algorithms because they utilize different channels.
There are several hemispheric-scale satellite-derived snow-cover maps available, but none has been fully validated. For the period 23 October–25 December 2000, we compare snow maps of North America derived from the Moderate Resolution Imaging Spectroradiometer (MODIS) and operational snow maps from the U.S. National Oceanic and Atmospheric Administration (NOAA) National Operational Hydrologic Remote Sensing Center (NOHRSC), both of which rely on satellite data from the visible and near-infrared parts of the spectrum; we also compare MODIS maps with Defense Meteorological Satellite Program (DMSP) Special Sensor Microwave/Imager (SSM/I) passive-microwave snow maps for the same period. The maps derived from visible and near-infrared data are more accurate for mapping snow cover than are the passive-microwave-derived maps, but discrepancies exist as to the location and extent of the snow cover even between operational snow maps. The MODIS snow-cover maps show more snow in each of the 8 day periods than do the NOHRSC maps, in part because MODIS maps the effects of fleeting snowstorms due to its frequent coverage. The large (~30 km) footprint of the SSM/I pixel, and the difficulty in distinguishing wet and shallow snow from wet or snow-free ground, reveal differences up to 5.33 x 106 km2 in the amount of snow mapped using MODIS vs SSM/I data. Algorithms that utilize both visible and passive-microwave data, which would take advantage of the all-weather mapping capability of the passive-microwave data, will be refined following the launch of the Advanced Microwave Scanning Radiometer (AMSR) in the fall of 2001.
Detrimental effects of ultraviolet (UV) light on living organisms are well understood, little is known about the effects of blue light irradiation. Although a recent study revealed that blue light caused more harmful effects on insects than UV light and blue light irradiation killed insect pests of various orders including Diptera, the effects of blue light on physiology of insects are still largely unknown. Here we studied the effects of blue light irradiation on cuticular melanin in larval and the immune response in adult stage of Bactrocera dorsalis. We also evaluated the effects of blue light exposure in larval stage on various age and mass at metamorphosis and the mediatory role of cuticular melanin in carryover effects of larval stressors across metamorphosis. We found that larvae exposed to blue light decreased melanin contents in their exoskeleton with smaller mass and delayed metamorphosis than insects reared without blue light exposure. Across metamorphosis, lower melanotic encapsulation response and higher susceptibility to Beauveria bassiana was detected in adults that had been exposed to blue light at their larval stage, thereby constituting the first evidence that blue light impaired adult immune function in B. dorsalis as a carryover effect of larval exposure.
Given the concerns regarding the adverse health outcomes associated with weight gain and metabolic syndrome in relation to use of second-generation antipsychotics (SGAs), we aimed in this study to explore whether the increase in the use of SGAs would have any impacts on the trend of excess mortality in people with schizophrenia and bipolar disorder (BPD).
Two nationwide samples of individuals with schizophrenia and BPD were identified in Taiwan's National Health Insurance Research Database in 2003 and in 2008, respectively. Age- and gender-standardized mortality ratios (SMRs) were calculated for each of the 3-year observation periods. The SMRs were compared between the calendar year cohorts, by disease group, and by causes of death.
The mortality gap for people with schizophrenia decreased slightly, revealing an SMR of 3.40 (95% CI 3.30–3.50) for the 2003 cohort and 3.14 (3.06–3.23) for the 2008 cohort. The mortality gap for BPD individuals remained relatively stable with only those aged 15–44 years having an SMR rising significantly from 7.04 (6.38–7.76) to 9.10 (8.44–9.79). Additionally, in this group of BPD patients aged 15–44 years, the natural-cause-SMR increased from 5.65 (4.93–6.44) to 7.16 (6.46–7.91).
Compared with the general population, the gap in the excess mortality for people with schizophrenia reduced slightly. However, the over 200% difference between the cohorts in the excess mortality for BPD individuals aged 15–44 years could be a warning sign. Future research to further examine the related factors underlying those changes is warranted.
The snow-pack on the Arctic Coastal Plain of Alaska has a well-developed depth-hoar layer which forms each year at the base of the snow-pack due to upward vapor transfer resulting from a temperature gradient in the snow-pack. The thickness of the depth-hoar layer tends to increase inland where greater temperature extremes (in particular, lower minimum temperatures) permit larger temperature gradients to develop within the snow-pack. Brightness temperature (TB) data were analyzed from October through May for four winters using the 37 GHz horizontally polarized Nimbus-7 Scanning Multichannel Microwave Radiometer (SMMR). By mid-winter each year, a decrease in TB of approximately 20K was found between coastal and inland sites on the Arctic Coastal Plain of Alaska. Modeling has indicated that a thicker depth-hoar layer in the inland sites could be responsible for the lower TBs. The large grain-sizes of the depth-hoar crystals scatter the upwelling radiation moreso than do smaller crystals, and greater scattering lowers the microwave TB. Using a two-layered radiative transfer model, the crystal diameter in the top layer was assumed to be 0.50 mm. The crystals in the depth-hoar layer may be 5–10 mm in diameter but the effective crystal diameter used in the radiative-transfer model is 1.40 mm. The crystal size used in the model had to be adjusted downward, relative to the actual crystal size, because the hollow, cup-shaped depth-hoar crystals are not as effective at scattering the microwave radiation as are spherical crystals that are assumed in the model. In the model, when the thickness of the depth-hoar layer was increased from 5 cm to 10 cm, a 21K decrease in TB resulted. This is comparable to the decrease in TB observed from coastal to inland sites in the study area.
In this study a new microwave snow retrieval algorithm was developed to account for the effects of atmospheric emission on microwave radiation over high-elevation land areas. This resulted in improved estimates of snow-covered area in western China when compared with the meteorological station data and with snow maps derived from visible imagery from the Defense Meteorological Satellite Program satellite. Some improvement in snow-depth estimation was also achieved, but a useful level of accuracy will require additional modifications tested against more extensive ground data.
During April 1995, a field and aircraft experiment was conducted in central Alaska in support of the Moderate Resolution Imaging Spectroradiometer (MODIS) snow-mapping project. The MODIS Airborne Simulator (MAS), a 50 channel spectroradiometer, was flown on board the NASA ER-2 aircraft. An objective of the mission was to determine the accuracy of mapping snow in different surface covers using an algorithm designed to map global snow cover after the launch of MODIS in 1998. The surface cover in this area of central Alaska is typically spruce, birch, aspen, mixed forest and muskeg. Integrated reflectance, Ri was calculated from the visible/near-infrared channels of the MAS sensor. The Ri was used to estimate different vegetation-cover densities because there is an inverse relationship between vegetation-cover density and albedo in snow-covered terrain. A vegetation-cover density map was constructed using MAS data acquired on 13 April 1995 over central Alaska. In the part of the scene that was mapped as having a vegetation-cover density of < 50%, the snow-mapping algorithm mapped 96.41% snow cover. These areas are generally composed of muskeg and mixed forests and include frozen lake. In the part of the scene that was estimated to have a vegetation-cover density of ≥50%, the snow-mapping algorithm mapped 71.23% snow cover. These areas are generally composed of dense coniferous or deciduous forests. Overall, the accuracy of the snow-mapping algorithm is > 87.41% for a 13 April MAS scene with a variety of surface covers (coniferous and deciduous and mixed forests, muskeg, tundra and frozen lake).
Better understanding of the complex interplay among key determinants of functional outcome is crucial to promoting recovery in psychotic disorders. However, this is understudied in the early course of illness. We aimed to examine the relationships among negative symptoms, neurocognition, general self-efficacy and global functioning in first-episode psychosis (FEP) patients using structural equation modeling (SEM).
Three hundred and twenty-one Chinese patients aged 26–55 years presenting with FEP to an early intervention program in Hong Kong were recruited. Assessments encompassing symptom profiles, functioning, perceived general self-efficacy and a battery of neurocognitive tests were conducted. Negative symptom measurement was subdivided into amotivation and diminished expression (DE) domain scores based on the ratings in the Scale for the Assessment of Negative Symptoms.
An initial SEM model showed no significant association between functioning and DE which was removed from further analysis. A final trimmed model yielded very good model fit (χ2 = 15.48, p = 0.63; comparative fit index = 1.00; root mean square error of approximation <0.001) and demonstrated that amotivation, neurocognition and general self-efficacy had a direct effect on global functioning. Amotivation was also found to mediate a significant indirect effect of neurocognition and general self-efficacy on functioning. Neurocognition was not significantly related to general self-efficacy.
Our results indicate a critical intermediary role of amotivation in linking neurocognitive impairment to functioning in FEP. General self-efficacy may represent a promising treatment target for improvement of motivational deficits and functional outcome in the early illness stage.
The RNAse III endonuclease DICER is a key regulator of microRNA (miRNA) biogenesis and is frequently down-regulated in a variety of malignancies. We characterized the role of Dicer in glioblastoma (GB), specifically demonstrating its effects on the ability of glioma stem-like cells to form tumors in a mouse model of GB. DICER silencing in glioma stem-like cells (GSCs) reduced their stem cell characteristics, while tumors arising from these cells were more aggressive, larger in volume, and displayed a higher proliferation index and lineage differentiation. The resulting tumors, however, were more sensitive to radiation treatment. Our results demonstrate that DICER affects the tumorigenic potential of GSCs, providing a platform for analysis of specific relevant miRNAs and development of potentially novel therapies against GB.
Conventional and accelerator mass spectrometry (AMS) radiocarbon, TL, OSL, and IRSL dating results on samples from the cores D100 and I70 from Ejina Basin, one of the most important inland basins in arid-hyperarid NW China, show that it is difficult to determine the ages of sediments at different depths. AMS ages of core D100 samples demonstrate that the sediments at depths from 10 to 90 m were formed between 14 to 30 kyr BP. The inverted ages from both the D100 and I70 cores imply that there was a strong reworking of the sediments during and after deposition processes. The inverted ages also indicate drastic fluctuations of groundwater bearing soluble organic matters, which might be related to neotectonic activities and climate changes during the period. Consequently, it is impossible to establish an accurate and reliable chronology for the cores based only on these dates. All AMS ages, if they are reliable and acceptable, indicate a high deposition rate (5∼8 mm/yr), and since all TL, OSL, and IRSL ages are much older than those given by AMS, it makes these methods questionable for determining the ages of lacustrine-fluvial-alluvial deposits.
Relapse is distressingly common after the first episode of psychosis, yet it is poorly understood and difficult to predict. Investigating changes in cognitive function preceding relapse may provide new insights into the underlying mechanism of relapse in psychosis. We hypothesized that relapse in fully remitted first-episode psychosis patients was preceded by working memory deterioration.
Visual memory and verbal working memory were monitored prospectively in a 1-year randomized controlled trial of remitted first-episode psychosis patients assigned to medication continuation (quetiapine 400 mg/day) or discontinuation (placebo). Relapse (recurrence of positive symptoms of psychosis), visual (Visual Patterns Test) and verbal (Letter–Number span test) working memory and stressful life events were assessed monthly.
Remitted first-episode patients (n = 102) participated in the study. Relapsers (n = 53) and non-relapsers (n = 49) had similar baseline demographic and clinical profiles. Logistic regression analyses indicated relapse was associated with visual working memory deterioration 2 months before relapse [odds ratio (OR) 3.07, 95% confidence interval (CI) 1.19–7.92, P = 0.02], more stressful life events 1 month before relapse (OR 2.11, 95% CI 1.20–3.72, P = 0.01) and medication discontinuation (OR 5.52, 95% CI 2.08–14.62, P = 0.001).
Visual working memory deterioration beginning 2 months before relapse in remitted first-episode psychosis patients (not baseline predictor) may reflect early brain dysfunction that heralds a psychotic relapse. The deterioration was found to be unrelated to a worsening of psychotic symptoms preceding relapse. Testable predictors offer insight into the brain processes underlying relapse in psychosis.
A nationwide population-based cohort was used to examine the severity of liver cirrhosis and risk of mortality from oral cancer.
The cohort consisted of 3583 patients with oral cancer treated by surgery between 2008 and 2011 in Taiwan. They were grouped on the basis of normal liver function (n = 3471), cirrhosis without decompensation (n = 72) and cirrhosis with decompensation (n = 40). The primary endpoint was mortality. Hazard ratios of death were also determined.
The mortality rates in the respective groups were 14.8 per cent, 20.8 per cent and 37.5 per cent at one year (p < 0.001). The adjusted hazard ratios of death at one year for each group compared to the normal group were 2.01 (p = 0.021) for cirrhotic patients without decompensation, 4.84 (p < 0.001) for those with decompensation and 2.65 (p < 0.001) for those receiving chemotherapy.
Liver cirrhosis can be used to predict one-year mortality in oral cancer patients. Chemotherapy should be used with caution and underlying co-morbidities should be managed in cirrhotic patients to reduce mortality risk.