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Experimental studies suggest that abnormal levels of calcium, magnesium, and phosphorus are implicated in pancreatic carcinogenesis. We investigated the associations between intakes of these minerals and the risk of pancreatic cancer in a case-control study conducted in 1994-1998. Cases of pancreatic cancer (n150) were recruited from all hospitals in the metropolitan area of the Twin Cities and Mayo Clinic, Minnesota. Controls (n459) were randomly selected from the general population and frequency matched to cases by age, sex, and race. All dietary variables were adjusted for energy intake using the residual method prior to data analysis. Logistic regression was performed to evaluate the associations between intake of three nutrients examined and the risk of pancreatic cancer. Total intake of calcium (936 vs. 1026 mg/day) and dietary intake of magnesium (315 vs. 331 mg/day) and phosphorus (1350 vs. 1402 mg/day) were significantly lower in cases than in controls. After adjustment for confounders, there were not significant associations of total and dietary intakes of calcium, magnesium, and phosphorus with the risk of pancreatic cancer. In addition, no significant interactions exist between intakes of these minerals and total fat on pancreatic cancer risk. In conclusion, the present study does not suggest that intakes of calcium, magnesium, and phosphorus were significantly associated with the risk of pancreatic cancer.
To determine risk factors for carbapenemase-producing organisms (CPOs) and to determine the prognostic impact of CPOs.
A retrospective matched case–control study.
Inpatients across Scotland in 2010–2016 were included. Patients with a CPO were matched with 2 control groups by hospital, admission date, specimen type, and bacteria. One group comprised patients either infected or colonized with a non-CPO and the other group were general inpatients.
Conditional logistic regression models were used to identify risk factors for CPO infection and colonization, respectively. Mortality rates and length of postisolation hospitalization were compared between CPO and non-CPO patients.
In total, 70 CPO infection cases (with 210 general inpatient controls and 121 non-CPO controls) and 34 CPO colonization cases (with 102 general inpatient controls and 60 non-CPO controls) were identified. Risk factors for CPO infection versus general inpatients were prior hospital stay (adjusted odds ratio [aOR], 4.05; 95% confidence interval [CI], 1.52–10.78; P = .005), longer hospitalization (aOR, 1.07; 95% CI, 1.04–1.10; P < .001), longer intensive care unit (ICU) stay (aOR, 1.41; 95% CI, 1.01–1.98; P = .045), and immunodeficiency (aOR, 3.68; 95% CI, 1.16–11.66; P = .027). Risk factors for CPO colonization were prior high-dependency unit (HDU) stay (aOR, 11.46; 95% CI, 1.27–103.09; P = .030) and endocrine, nutritional, and metabolic (ENM) diseases (aOR, 3.41; 95% CI, 1.02–11.33; P = .046). Risk factors for CPO infection versus non-CPO infection were prolonged hospitalization (aOR, 1.02; 95% CI, 1.00–1.03; P = .038) and HDU stay (aOR, 1.13; 95% CI, 1.02–1.26; P = .024). No differences in mortality rates were detected between CPO and non-CPO patients. CPO infection was associated with longer hospital stay than non-CPO infection (P = .041).
A history of (prolonged) hospitalization, prolonged ICU or HDU stay; ENM diseases; and being immunocompromised increased risk for CPO. CPO infection was not associated with increased mortality but was associated with prolonged hospital stay.
Background: Quantitative evaluation of antibiotic spectrum is an important, underutilized metric in measuring antibiotic use (AU) and may assist antimicrobial stewards in identifying targets and strategy for intervention. We evaluated the spectrum of initial antibiotic choices by hospital location, day of the week, and time of day to determine whether these factors may be associated with broad-spectrum antibiotic choices. Methods: We identified all admissions with antibiotic exposure in medical and surgical wards and critical care units in a tertiary academic medical center between July 1, 2014, and July 1, 2019. The antibiotic spectrum index (ASI), proposed by Gerber et al, is a numeric score based on the number of pathogens covered by a particular agent. We defined ASI for initial antibiotic choice as follows: ASI for each unique antibiotic administered within 24 hours of the first antibiotic administration was summed and assigned to the administration time of the first dose. We categorized time into 4 distinct categories: weekday days (Monday–Friday, 7 a.m.–7 p.m.), weekday nights, weekend days, and weekend nights. Weekend time began 7 p.m. Friday and ended 7 a.m. Monday. We constructed heatmaps stratified by hospital location. Mann-Whitney U tests were applied to evaluate differences in the distributions of ASI using weekday days as a reference. Results: Data included 90,455 unique antibiotic admissions with initial antibiotic starts in medical and surgical wards and critical care units. Patterns of ASI for initial antibiotic choice varied between unit locations and time (Figs. 1 and 2). Mean and median ASIs for initial antibiotic choices were higher for medical ward and medical ICUs than for surgical wards and surgical ICUs. Initial antibiotic choices had higher ASIs during overnight hours for all units except the surgical ICU. Notable differences in ASIs were identified between weekday and weekend prescribing for surgical units, whereas medical units demonstrated less extreme differences. Conclusion: We observed a “weekend effect” across hospital units; the most extreme occurred in surgical wards. This observation may be due to differences in patient volume and rounding patterns. For example, hospitalist and critical care units have 7-day schedules, whereas surgical wards are highly influenced by operating room schedules. Antimicrobial stewardship teams may use these data to identify strategies targeting the most opportune time and place to intervene on the spectrum of initial antibiotic choice.
Background: In the state of Wisconsin, 3%–4% of bats submitted for rabies testing are positive. Inpatient bat encounters at 2 affiliated healthcare facilities at nearly the same time were brought to the attention of the infection prevention and control (IPC) team. The first bat was captured in a patient room and was submitted for testing. Postexposure prophylaxis (PEP) was initiated for 1 patient before the bat testing results came back negative. The second bat was found in a transplant unit hallway and was released before we could request testing. We observed significant variations in responses, including decision to administer PEP and submission of bats for rabies testing. The IPC team developed a protocol to minimize unnecessary PEP, to prevent nosocomial rabies infection from bat exposure, and to limit associated panic. Methods: A systematic literature review of multiple databases was performed. A search of nonscientific articles using Google was also performed to assess unpublished inpatient bat encounters. A workgroup was established including IPC staff, physicians, and facilities management. The county animal services department and the state public health department veterinarian were consulted to aid in development of a protocol. Results: Literature review yielded a single report of a bat discovered in a neonatal intensive care unit (NICU). A lack of protocol resulted in PEP administration to 7 neonates without observed exposure after the bat was released instead of being submitted for testing. Of the first 100 articles retrieved via Google search of “bat in hospital,” 9 pertained to nosocomial discovery of bats in 5 different states over the past 7 years. Encounters included infestations requiring unit shutdowns and PEP administration. One tertiary-care referral center reported 10 encounters per year but did not elaborate on associated procedures. The county animal services staff assisted in training maintenance and engineering services (MES) personnel on how to secure bats for testing and helped develop a “bat kit” with protective gear and equipment to do so safely. In the new protocol, an inpatient bat encounter prompts personnel to capture the bat and begin an investigation into known or potential occult exposure. Known or potential exposures merit submission of the bat for rabies testing, the results of which guide PEP recommendations. All encounters are investigated for point of entry or roost. Conclusions: Inpatient bat encounters are not uncommon. Encounters should prompt systematic assessment for exposures and an investigation of the root cause. Following a protocol may limit unnecessary PEP administration, prevent nosocomial transmission of rabies from bat to patient, and attenuate associated anxiety.
Incumbent city councillors have an almost insurmountable advantage in Canadian municipal elections. This article aims to improve our understanding of the municipal incumbency advantage by considering the ability of electors to correctly identify the two most competitive candidates in one's ward and the factors associated with being able to do so. Using survey data from the Canadian Municipal Election Study (CMES), we consider the case of the 2018 elections in Mississauga, a city with typically high rates of incumbent re-election. Survey respondents were asked to identify the two most competitive candidates in their local ward races. We find that comparatively few electors are able to recognize which challenger serves as the strongest threat to a sitting councillor, a finding that suggests that coordination problems may help to contribute to high rates of incumbent success. We identify several individual-level and ward-level correlates of correctly identifying the first-place and second-place finishers. We do note, however, that there is a significant amount of variation among the thousands of municipalities in Canada, so findings from this case should be tested in other settings, including larger or smaller cities where levels of information might be different.
The Fontan Outcomes Network was created to improve outcomes for children and adults with single ventricle CHD living with Fontan circulation. The network mission is to optimise longevity and quality of life by improving physical health, neurodevelopmental outcomes, resilience, and emotional health for these individuals and their families. This manuscript describes the systematic design of this new learning health network, including the initial steps in development of a national, lifespan registry, and pilot testing of data collection forms at 10 congenital heart centres.
Affect reactivity to stress may play a role in the development of internalizing symptoms during the college transition, a critical developmental juncture for Latinx adolescents, the largest ethnic minority group on college campuses. This study examined whether affect reactivity during high school is associated with internalizing symptoms in college and explored two potential protective factors, perceived family and peer support. Participants were 209 Latinx adolescents (Mage = 18.10; 64.4% female) who completed standard surveys and four diary assessments per day over 7 days (N > 4,500 momentary observations). First, to measure affect reactivity, we assessed whether perceived stress was associated with negative affect at the momentary level during high school (senior year). Second, we tested whether affect reactivity predicted internalizing symptoms during the first year of college. Third, we tested whether perceived family or peer support buffered the negative consequences of affect reactivity. Results indicated statistically significant within- and between-person associations between stress and negative affect. Moreover, affect reactivity significantly predicted depressive, but not anxiety, symptoms. Buffering was found for family, but not peer, support. Findings extend previous research by detecting associations between momentary affect reactivity and internalizing symptoms during a sociocultural shift in Latinx adolescents’ lives and have implications for culturally appropriate programs to prevent depressive symptoms.
Approximately, 1.7 million individuals in the United States have been infected with SARS-CoV-2, the virus responsible for the novel coronavirus disease-2019 (COVID-19). This has disproportionately impacted adults, but many children have been infected and hospitalised as well. To date, there is not much information published addressing the cardiac workup and monitoring of children with COVID-19. Here, we share the approach to the cardiac workup and monitoring utilised at a large congenital heart centre in New York City, the epicentre of the COVID-19 pandemic in the United States.
Hydrogen lithography has been used to template phosphine-based surface chemistry to fabricate atomic-scale devices, a process we abbreviate as atomic precision advanced manufacturing (APAM). Here, we use mid-infrared variable angle spectroscopic ellipsometry (IR-VASE) to characterize single-nanometer thickness phosphorus dopant layers (δ-layers) in silicon made using APAM compatible processes. A large Drude response is directly attributable to the δ-layer and can be used for nondestructive monitoring of the condition of the APAM layer when integrating additional processing steps. The carrier density and mobility extracted from our room temperature IR-VASE measurements are consistent with cryogenic magneto-transport measurements, showing that APAM δ-layers function at room temperature. Finally, the permittivity extracted from these measurements shows that the doping in the APAM δ-layers is so large that their low-frequency in-plane response is reminiscent of a silicide. However, there is no indication of a plasma resonance, likely due to reduced dimensionality and/or low scattering lifetime.
To understand hospital policies and practices as the COVID-19 pandemic accelerated, the Society for Healthcare Epidemiology of America (SHEA) conducted a survey through the SHEA Research Network (SRN). The survey assessed policies and practices around the optimization of personal protection equipment (PPE), testing, healthcare personnel policies, visitors of COVID-19 patients in relation to procedures, and types of patients. Overall, 69 individual healthcare facilities responded in the United States and internationally, for a 73% response rate.
Optical Photothermal Infrared (O-PTIR) spectroscopy is a new technique for measuring submicron spatial resolution IR spectra with little or no sample preparation. This speeds up analysis times benefiting high-volume manufacturers through gaining insight into process contamination that occurs during development and on production lines. The ability to rapidly obtain far-field non-contact IR spectra at high spatial resolution facilitates the chemical identification of small organic contaminants that are not possible to measure with conventional Fourier transform infrared (FT-IR) microspectroscopy. The unique pump-probe system architecture also facilitates submicron simultaneous IR + Raman microscopy from the same spot with the same spatial resolution. With these unique capabilities, O-PTIR is finding utilization in the high-volume and high-value industries of high-tech componentry (memory storage, electronics, displays, etc.).
First episode psychosis (FEP) patients who use cannabis experience more frequent psychotic and euphoric intoxication experiences compared to controls. It is not clear whether this is consequent to patients being more vulnerable to the effects of cannabis use or to their heavier pattern of use. We aimed to determine whether extent of use predicted psychotic-like and euphoric intoxication experiences in patients and controls and whether this differs between groups.
We analysed data on patients who had ever used cannabis (n = 655) and controls who had ever used cannabis (n = 654) across 15 sites from six countries in the EU-GEI study (2010–2015). We used multiple regression to model predictors of cannabis-induced experiences and to determine if there was an interaction between caseness and extent of use.
Caseness, frequency of cannabis use and money spent on cannabis predicted psychotic-like and euphoric experiences (p ⩽ 0.001). For psychotic-like experiences (PEs) there was a significant interaction for caseness × frequency of use (p < 0.001) and caseness × money spent on cannabis (p = 0.001) such that FEP patients had increased experiences at increased levels of use compared to controls. There was no significant interaction for euphoric experiences (p > 0.5).
FEP patients are particularly sensitive to increased psychotic-like, but not euphoric experiences, at higher levels of cannabis use compared to controls. This suggests a specific psychotomimetic response in FEP patients related to heavy cannabis use. Clinicians should enquire regarding cannabis related PEs and advise that lower levels of cannabis use are associated with less frequent PEs.
The ‘jumping to conclusions’ (JTC) bias is associated with both psychosis and general cognition but their relationship is unclear. In this study, we set out to clarify the relationship between the JTC bias, IQ, psychosis and polygenic liability to schizophrenia and IQ.
A total of 817 first episode psychosis patients and 1294 population-based controls completed assessments of general intelligence (IQ), and JTC, and provided blood or saliva samples from which we extracted DNA and computed polygenic risk scores for IQ and schizophrenia.
The estimated proportion of the total effect of case/control differences on JTC mediated by IQ was 79%. Schizophrenia polygenic risk score was non-significantly associated with a higher number of beads drawn (B = 0.47, 95% CI −0.21 to 1.16, p = 0.17); whereas IQ PRS (B = 0.51, 95% CI 0.25–0.76, p < 0.001) significantly predicted the number of beads drawn, and was thus associated with reduced JTC bias. The JTC was more strongly associated with the higher level of psychotic-like experiences (PLEs) in controls, including after controlling for IQ (B = −1.7, 95% CI −2.8 to −0.5, p = 0.006), but did not relate to delusions in patients.
Our findings suggest that the JTC reasoning bias in psychosis might not be a specific cognitive deficit but rather a manifestation or consequence, of general cognitive impairment. Whereas, in the general population, the JTC bias is related to PLEs, independent of IQ. The work has the potential to inform interventions targeting cognitive biases in early psychosis.
This introduction outlines the scope of the book titled “Challenges in Tackling Antimicrobial Resistance: Economic and Policy Responses”, and then summarises the main messages of each chapter which focus on the following big questions around AMR policy. What is the evidence on the rise of AMR and its health and economic impact? How can it be most effectively addressed in the community and in hospitals? What role is played by antimicrobial use in the food and livestock sector and what can be done about it? How can the discovery of new antibiotics be reinvigorated to replace those rendered ineffective by resistance? What needs to be done to develop new diagnostic tests so that infections can be speedily identified or ruled out and unnecessary antibiotic use avoided? Can more use be made of vaccines to tackle AMR? How have civil society movements contributed to policy development in the fight against AMR? What does the international community need to do in terms of global collective action to tackle AMR?