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Introduction: Although oral rehydration therapy is recommended for children with acute gastroenteritis (AGE) with none to some dehydration, intravenous (IV) rehydration is still commonly administered to these children in high-income countries. IV rehydration is associated with pain, anxiety, and emergency department (ED) revisits in children with AGE. A better understanding of the factors associated with IV rehydration is needed to inform knowledge translation strategies. Methods: This was a planned secondary analysis of the Pediatric Emergency Research Canada (PERC) and Pediatric Emergency Care Applied Research Network (PECARN) randomized, controlled trials of oral probiotics in children with AGE-associated diarrhea. Eligible children were aged 3-48 months and reported > 3 watery stools in a 24-hour period. The primary outcome was administration of IV rehydration at the index ED visit. We used mixed-effects logistic regression model to explore univariable and multivariable relationships between IV rehydration and a priori risk factors. Results: From the parent study sample of 1848 participants, 1846 had data available for analysis: mean (SD) age of 19.1 ± 11.4 months, 45.4% females. 70.2% (1292/1840) vomited within 24 hours of the index ED visit and 34.1% (629/1846) received ondansetron in the ED. 13.0% (240/1846) were administered IV rehydration at the index ED visit, and 3.6% (67/1842) were hospitalized. Multivariable predictors of IV rehydration were Clinical Dehydration Scale (CDS) score [compared to none: mild to moderate (OR: 8.1, CI: 5.5-11.8); severe (OR: 45.9, 95% CI: 20.1-104.7), P < 0.001], ondansetron in the ED (OR: 1.8, CI: 1.2-2.6, P = 0.003), previous healthcare visit for the same illness [compared to no prior visit: prior visit with no IV (OR: 1.9, 95% CI: 1.3-2.9); prior visit with IV (OR: 10.5, 95% CI: 3.2-34.8), P < 0.001], and country [compared to Canada: US (OR: 4.1, CI: 2.3-7.4, P < 0.001]. Significantly more participants returned to the ED with symptoms of AGE within 3 days if IV fluids were administered at the index visit [30/224 (13.4%) versus 88/1453 (6.1%), P < 0.001]. Conclusion: Higher CDS scores, antiemetic use, previous healthcare visits and country were independent predictors of IV rehydration which was also associated with increased ED revisits. Knowledge translation focused on optimizing the use of antiemetics (i.e. for those with dehydration) and reducing the geographic variation in IV rehydration use may improve the ED experience and reduce ED-revisits.
Substantial amounts of annual radiocarbon (14C) data have recently been produced with the purpose of increasing the time resolution of 14C records used for constructing the calibration curve and for studying the occurrence of abrupt cosmic-ray events. In this study, we investigate if it is possible to resolve sub-annual scale changes in the atmospheric 14C content by measuring radiocarbon in early-wood and late-wood fractions from Danish oak. The tree-ring samples span the period 1954–1970 CE, hereby covering the peak of the bomb pulse. A least squares test comparing the atmospheric 14C content and the new sub-annual 14C record from Danish tree rings reveals that by measuring early-wood and late-wood fractions, it may be possible to resolve sub-annual variations in past atmospheric 14C levels.
The Arizona Department of Health Services identified unusually high levels of influenza activity and severe complications during the 2015–2016 influenza season leading to concerns about potential increased disease severity compared with prior seasons. We estimated state-level burden and severity to compare across three seasons using multiple data sources for community-level illness, hospitalisation and death. Severity ratios were calculated as the number of hospitalisations or deaths per community case. Community influenza-like illness rates, hospitalisation rates and mortality rates in 2015–2016 were higher than the previous two seasons. However, ratios of severe disease to community illness were similar. Arizona experienced overall increased disease burden in 2015–2016, but not increased severity compared with prior seasons. Timely estimates of state-specific burden and severity are potentially feasible and may provide important information during seemingly unusual influenza seasons or pandemic situations.
Thrust-block naled in front of Kuannersuit Glacier, West Greenland, appears to have formed during the termination of a terrestrial surge event by a combination of enhanced winter runoff, rapid advance of the glacier terminus, and proglacial stress release by thrusting and stacking of naled blocks. This process is equivalent to the formation of thrust-block moraines. The thrust-block naled consists of at least seven thrust sheets, which are characterized by stratified ice with beds composed of a lower debris-rich lamina, an intermediate dispersed lamina and a top clean-ice lamina, and underlain by frozen outwash deposits. The thrust-block naled differs from basal stratified ice in the absence of internal deformation structures, a relatively low debris concentration, a clay-rich particle-size distribution and a preferential sorting of lighter minerals. The oxygen isotope composition of the thrust-block naled is indistinguishable from δ18O values from meteoric glacier ice and bulk meltwater, but different from basal stratified ice facies. The d–δD relationship indicates that thrust-block naled has been formed by freezing of successive thin layers of bulk waters with variable isotopic composition, whereas basal stratified ice has developed in a subglacial environment with regelation. This work shows that the association between proglacial naled and rapidly advancing glaciers may have significant consequences for the proglacial geomorphology and the interpretation of basal ice layers.
A new dating of the Bølling-Allerød period (Greenland Interstadial event 1) in the GRIP ice core is presented. Newly measured profiles of δD and δ18O, as well as existing profiles of Ca2+, NH4+, dust and NO3–, have been used for the dating. As seasonal variations can be observed in all six components, it was possible to simultaneously count annual layers in the profiles in order to obtain a multi-parameter dating. The new data presented in this study include a total of 36.85 m of stable-isotope profiles of 1 cm resolution from five sections of the Bølling-Allerød period in the GRIP ice core. The annual-layer counting suggests a duration of the complete Bølling-Allerød period, as revealed in the GRIP ice core, of 1627 ± 52 years. This estimate contrasts with an earlier finding from the same GRIP ice core, where the Bølling-Allerød was found to span 2168 years (Hammer, in press). This estimate was based on layer counting, using dust concentrations only.
Survey results suggest that prolonged administration of prophylactic antibiotics is common after mastectomy with reconstruction. We determined utilization, predictors, and outcomes of postdischarge prophylactic antibiotics after mastectomy with or without immediate breast reconstruction.
Commercially insured women aged 18–64 years coded for mastectomy from January 2004 to December 2011 were included in the study. Women with a preexisting wound complication or septicemia were excluded.
Predictors of prophylactic antibiotics within 5 days after discharge were identified in women with 1 year of prior insurance enrollment; relative risks (RR) were calculated using generalized estimating equations.
Overall, 12,501 mastectomy procedures were identified; immediate reconstruction was performed in 7,912 of these procedures (63.3%). Postdischarge prophylactic antibiotics were used in 4,439 procedures (56.1%) with immediate reconstruction and 1,053 procedures (22.9%) without immediate reconstruction (P<.001). The antibiotics most commonly prescribed were cephalosporins (75.1%) and fluoroquinolones (11.1%). Independent predictors of postdischarge antibiotics were implant reconstruction (RR, 2.41; 95% confidence interval [CI], 2.23–2.60), autologous reconstruction (RR, 2.17; 95% CI, 1.93–2.45), autologous reconstruction plus implant (RR, 2.11; 95% CI, 1.92–2.31), hypertension (RR, 1.05; 95% CI, 1.00–1.10), tobacco use (RR, 1.07; 95% CI, 1.01–1.14), surgery at an academic hospital (RR, 1.14; 95% CI, 1.07–1.21), and receipt of home health care (RR, 1.11; 95% CI, 1.04–1.18). Postdischarge prophylactic antibiotics were not associated with SSI after mastectomy with or without immediate reconstruction (both P>.05).
Prophylactic postdischarge antibiotics are commonly prescribed after mastectomy; immediate reconstruction is the strongest predictor. Stewardship efforts in this population to limit continuation of prophylactic antibiotics after discharge are needed to limit antimicrobial resistance.
Cantors made unparalleled contributions to the way time was understood and history was remembered in the medieval Latin West. The men and women who held this office in cathedrals and monasteries wereresponsible for calculating the date of Easter and the feasts dependent on it, for formulating liturgical celebrations season by season, managing the library and preparing manuscripts and other sources necessary to sustain the liturgical framework of time, and promoting the cults of saints. Crucially, their duties also often included committing the past to writing, from simple annals and chronicles to more fulsome histories, necrologies, and cartularies, thereby ensuring that towns, churches, families, and individuals could be commemorated for generations to come. The contributions hereseek to address the fundamental question of how the range of cantors' activities can help us to understand the many different ways in which the past was written and, in the liturgy, celebrated acrossthe middle ages. Cantors, as this volume makes clear, shaped the communal experience of the past in the Middle Ages; the essays are studies of constructions, both of the building blocks of time and ofthe people who made and performed them, in acts of ritual remembrance and in written records.
Contributors: Cara Aspesi, Alison I. Beach, Katie Ann-Marie Bugyis, Margot E. Fassler, David Ganz, James Grier, Paul Antony Hayward, A.B. Kraebel, Lori Kruckenberg, Rosamond McKitterick, Henry Parkes, Susan Rankin, C.C. Rozier, Sigbjoryn Olsen Sonnesyn, Teresa Webber, Lauren Whitnah,