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Our population-based study objectives were to describe characteristics and outcomes of Escherichia coli bloodstream infections (BSIs), and to evaluate factors associated with outcomes. We included incident E. coli BSIs from western interior residents (British Columbia, Canada; 04/2010–03/2020). We obtained data including patient demographics, location of onset, infection focus, Charlson comorbidity index (CCI), antimicrobial resistance, 30-day all-cause mortality and length of hospital stay (LOS). Using multivariable logistic regression models fitted with generalised estimating equations, we estimated factors associated with 30-day mortality and long post-infection LOS (>75th percentile). We identified 1080 incident E. coli BSIs in 1009 patients. The crude incidence and 30-day mortality rates were 59.1 BSIs and 6.8 deaths/100 000 person-years, respectively. The 30-day case fatality risk was 11.5%. Compared to community-acquired E. coli BSIs, either healthcare-associated or nosocomial cases had higher odds of 30-day mortality. Older cases, non-urogenital BSI foci and CCI ⩾ 3 had higher odds of 30-day mortality compared to younger cases, urogenital foci and CCI < 3. In patients that survived to discharge, those with extended-spectrum β-lactamase (ESBL)-producing E. coli BSIs, nosocomial BSIs, and CCI ⩾ 3 had higher odds of long post-infection LOS compared to those with non-ESBL-producing, community-acquired and healthcare-associated, and CCI < 3. There is a substantial disease burden from E. coli BSIs.
There are research questions whose answers require record linkage of multiple databases that may be characterized by limited options for full data sharing. For this purpose, the Open Data Infrastructure for Social Science and Economic Innovations (ODISSEI) consortium has supported the development of the ODISSEI Secure Supercomputer (OSSC) platform that allows researchers to link cohort data to data from Statistics Netherlands and run large-scale analyses in a high-performance computing (HPC) environment. Here, we report a successful record linkage genomewide association (GWA) study on expenditure for total health, mental health, primary and hospital care, and medication. Record linkage for genotype data from 16,726 participants from the Netherlands Twin Register (NTR) with data from Statistics Netherlands was accomplished in the secure OSSC platform, followed by gene-based tests and estimation of total and single nucleotide polymorphism (SNP)-based heritability. The total heritability of expenditure ranged between 29.4% (SE 0.8) and 37.5% (SE 0.8), but GWA analyses did not identify SNPs or genes that were genomewide significantly associated with health care expenditure. SNP-based heritability was between 0.0% (SE 3.5) and 5.4% (SE 4.0) and was different from zero for mental health care and primary care expenditure. We conclude that successfully linking genotype data to administrative health care expenditure data from Statistics Netherlands is feasible and demonstrates a series of analyses on health care expenditure. The OSSC platform offers secure possibilities for analyzing linked data in large scale and realizing sample sizes required for GWA studies, providing invaluable opportunities to answer many new research questions.
ABSTRACT IMPACT: Being explicit about the prevention of falls throughout an older adults’ episode of care may further help reinforce the role of physical therapy providers in falls prevention and improve dissemination of this knowledge. OBJECTIVES/GOALS: The purpose of this study was to determine older adults’ awareness of and perspectives about the role of physical therapy providers for falls prevention and determine potential barriers and facilitators to utilization of preventive rehabilitation services METHODS/STUDY POPULATION: We used a qualitative descriptive phenomenological approach to emphasize participants’ perceptions and lived experiences. Four focus groups were conducted with 27 community-dwelling older adults (average age = 78 years). Focus groups were recorded, transcribed, condensed, and coded using thematic analysis. RESULTS/ANTICIPATED RESULTS: Surveys indicated 37% of participants experienced a fall in the last year and 26% reported suffering an injury. Four main themes and six subthemes surrounding older adults’ perceptions of physical therapy providers’ roles for falls prevention emerged: (1) Awareness of Falls Prevention (subthemes: I Don’t Think About It, I Am More Careful); (2) Being Able to Get Up from the Floor; (3) Limited Knowledge about the Role of Physical Therapy Providers in Falls Prevention (subtheme: Physical Therapy Services are for After a Fall, Surgery, or for a Specific Problem); and 4). Barriers to Participating in Preventive Physical Therapy Services (subthemes: Perceived Need and Costs, Access Requires a Doctor’s Prescription). DISCUSSION/SIGNIFICANCE OF FINDINGS: Older adults lack awareness about the role of physical therapy services in falls prevention, perceiving services are only to treat a specific problem or after a fall. Physical therapists should be explicit about the role of physical therapy in falls prevention for all older adults undergoing rehabilitation, regardless of the reason.
ABSTRACT IMPACT: This study will be used to culturally tailor interventions to reduce maternal and infant health disparities in a Marshallese community. OBJECTIVES/GOALS: Inadequate prenatal care is associated with adverse birth outcomes including preterm births, low birth weight infants, and neonatal mortality. Marshallese Pacific Islanders are less likely to receive early and consistent prenatal care compared to other racial/ethnic groups and are thus at a higher risk for maternal and infant health disparities. METHODS/STUDY POPULATION: This article used a qualitative comparative analysis method to compare and contrast the perceived barriers to prenatal care for the prospective of Marshallese mothers and Maternal Health Care Providers (MHCPs). RESULTS/ANTICIPATED RESULTS: Marshallese mothers and MHCPs identified the same structural barriers to prenatal care: health insurance, transportation, and language. The socio-cultural barriers to prenatal care were depicted quite differently by Marshallese mothers verses MHCPs. DISCUSSION/SIGNIFICANCE OF FINDINGS: While the description of structural barriers were consistent among Marshallese mothers and MHCPs, the socio-cultural barriers and the value assigned to those barriers was quite different. Understanding the perspectives from both lenses is an important step towards addressing the barriers to prenatal care among Marshallese.
This essay explores a host of war-wrought cultural changes that postwar literature documented, celebrated, and critiqued. Literature itself changed in response to World War I and helped remake the social world in its wake in diverse and contradictory ways. Writers celebrated postwar modernity and freedom, but also articulated pessimism and developed new genres to convey the experience of violence. Writers discussed include John Dos Passos, Willa Cather, F. Scott Fitzgerald, Nella Larsen, Claude McKay, Ernest Hemingway, Dashiell Hammett, and more.
The period of American neutrality during the first three years of World War I (1914-1917) was marked by widespread disagreement. Widespread propaganda advocated neutrality as well as intervention on either side. Propaganda advocating different positions nevertheless tended to use some of the same—often gendered and sexualized—imagery to solicit and channel American emotions. Once the US declared war, the creation of a state-sanctioned propaganda agency, The Committee on Public Information (CPI), produced a flow of information that was both intense and univocal in its support for the war. Meanwhile, legislative acts legalized censorship, enabling the Post Office, government at all levels, and even non-state actors to police speech, jail and attack pacifists, and limit dissenting publications. The widespread use of media to secure public consent for and participation in the war effort is an element of modern, total war. The media landscape was permanently changed. Propaganda moved through social channels and frequently targeted and depended upon women to both relay and follow its messages; after the war, largely as a result, women gained the vote. Other legacies were more negative. Some modernist writers and artists would denounce martial (ab)uses of language and to adopt new strategies (including irony) to undermine notions of linguistic and political certainties.
The key aim of this special issue is to make developmental theory proposals concrete enough to evaluate with empirical data. With this in mind, I discuss proposals from the “Universal Grammar + statistics” (UG+stats) perspective for learning several morphology and syntax phenomena. I briefly review why UG has traditionally been part of many developmental theories of language, as well as common statistical learning approaches that are part of UG+stats proposals. I then discuss each morphology or syntax phenomenon in turn, giving an overview of relevant UG+stats proposals for that phenomenon, specific predictions made by each proposal, and what we currently know about how those predictions hold up. I conclude by briefly discussing where we seem to be when it comes to how well UG+stats proposals help us understand the development of morphology and syntax knowledge.
To evaluate the effect of a transdiagnostic cognitive behavioural therapy (tCBT) protocol in an individual delivery format, adapted from a protocol that has been extensively evaluated in a group delivery format.
tCBT was provided to a cohort (N = 18) of adults with a range of anxiety disorders (55.6% male; M age = 40.6, SD = 17.6), at a speciality anxiety disorder research clinic. A within-subjects repeated measures design was employed. Pre-to-post-treatment diagnostic assessments were analysed through repeated measures analysis of variance, and session-by-session self-reported measures of anxiety, depression, and quality of life were modelled through mixed-effect regression modelling (MRM) to maximise the sample of treatment initiators.
Significant and large reductions for clinician-rated primary diagnosis severity (Hedges g = 1.63), and overall clinical global impressions (g = 1.43) were observed, and self-reported anxiety and depression symptoms showed significant reductions over the course of treatment with medium-to-large effect sizes (g = 0.66 and 0.74, respectively). Significant improvement to quality of life was also observed with medium effect size (g = 0.53).
There is now preliminary support for the use of an adaptation of an established group-based tCBT protocol for use with individuals. Implications and recommendations for future investigations are provided.
Northwest Arkansas, particularly Benton and Washington counties, is one of the highest COVID-19 hot spots in the United States (US), with more than half of all reported cases in this area identifying as Latinx or Pacific Islander, even though these communities account for less than 20% of the overall population. The University of Arkansas for Medical Sciences (UAMS) leveraged their existing relationship with 18 key community partners. Partners collaboratively developed a COVID-19 Response Strategy to ensure coordinated effort for Latinx and Pacific Islander communities with four interrelated strategies: health education, testing, contact tracing, and supported quarantine/case management.
Food insecurity is associated with a greater risk of depression among low-income adults in the USA. Members of food-insecure households have lower diet diversity than their food-secure counterparts. This study examined whether diet diversity moderates the association between food insecurity and depression.
Multiple logistic regression was conducted to examine independent associations between food insecurity and depression, between diet diversity and depression, and the moderating effect of diet diversity in the food insecurity–depression link.
Cross-sectional data from the National Health and Nutrition Examination Survey (2013–2014).
2636 low-income adults aged 18 years and older.
There was a positive association between food insecurity and depression among low-income adults. Diet diversity was not associated with depression. Diet diversity had a moderating effect on the association between food insecurity and depression among low-income adults.
Food insecurity is independently associated with depression among low-income adults in the USA. However, this association differs across levels of diet diversity. Longitudinal studies are needed to confirm the role diet diversity may play in the pathway between food insecurity and depression.
As editors and authors, we reflect on this project, conceptualized to blend the salient clinical and exciting scientific advances that are on full display, from common to unique, in the field of inherited metabolic movement disorders. It is the province of the neurologist (pediatric and adult), geneticist, movement disorder specialist, developmentalist, radiologist, pathologist, physiatrist, therapist, educator, parent, advocate … indeed, the scope of this work is beyond provincial but instead universal. We have endeavored to encapsulate in this monograph a comprehensive approach to the somewhat peculiar but frankly permeating intersection of the inherited errors of metabolism and movement disorders.
Inherited metabolic movement disorders are an important and evolving group of disorders that bridge two subspecialty areas: childhood-onset movement disorders and inborn errors of metabolism. Individually, many of these disorders are rare but in aggregate they represent a substantial clinical burden. It is in their complex nature that they require a multidisciplinary approach that includes pediatricians, neurologists, and geneticists among others.
Gamma-aminobutyric acid (GABA) is the major inhibitory neurotransmitter in the brain. The primary precursor of GABA is glutamate, the major excitatory neurotransmitter in the brain. Glutamate is converted into GABA via glutamate decarboxylase (GAD). GABA-transaminase (GABA-T) metabolizes GABA to succinic semialdehyde, which is rapidly metabolized to succinic acid by succinic semialdehyde dehydrogenase (SSADH) and then enters the tricarboxylic acid (TCA) cycle (Figure 23.1).