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People with serious mental illness (SMI) experience higher mortality partially attributable to higher long-term condition (LTC) prevalence. However, little is known about multiple LTCs (MLTCs) clustering in this population.
Methods
People from South London with SMI and two or more existing LTCs aged 18+ at diagnosis were included using linked primary and mental healthcare records, 2012–2020. Latent class analysis (LCA) determined MLTC classes and multinominal logistic regression examined associations between demographic/clinical characteristics and latent class membership.
Results
The sample included 1924 patients (mean (s.d.) age 48.2 (17.3) years). Five latent classes were identified: ‘substance related’ (24.9%), ‘atopic’ (24.2%), ‘pure affective’ (30.4%), ‘cardiovascular’ (14.1%), and ‘complex multimorbidity’ (6.4%). Patients had on average 7–9 LTCs in each cluster. Males were at increased odds of MLTCs in all four clusters, compared to the ‘pure affective’. Compared to the largest cluster (‘pure affective’), the ‘substance related’ and the ‘atopic’ clusters were younger [odds ratios (OR) per year increase 0.99 (95% CI 0.98–1.00) and 0.96 (0.95–0.97) respectively], and the ‘cardiovascular’ and ‘complex multimorbidity’ clusters were older (ORs 1.09 (1.07–1.10) and 1.16 (1.14–1.18) respectively). The ‘substance related’ cluster was more likely to be White, the ‘cardiovascular’ cluster more likely to be Black (compared to White; OR 1.75, 95% CI 1.10–2.79), and both more likely to have schizophrenia, compared to other clusters.
Conclusion
The current study identified five latent class MLTC clusters among patients with SMI. An integrated care model for treating MLTCs in this population is recommended to improve multimorbidity care.
What explains the treatment of ethnic minorities in Southeast Asia? This Element conceptually disaggregates ethnicity into multiple constituent markers – specifically language, religion, and phenotype. By focusing on the interaction between these three ethnic markers, Liu and Ricks explore how overlap between these markers can affect whether a minority integrates within a broader ethnic identity; successfully extracts accommodation as unique group; or engages in a contentious and potentially violent relationship with the hegemon. The argument is tested through six case studies: (1) ethnic Lao in Thailand: integration; (2) ethnic Chinese in Thailand: integration; (3) ethnic Chinese in Malaysia: accommodation; (4) ethnic Malays in Singapore: accommodation; (5) ethnic Malays in Thailand: contention; and (6) ethnic Chinese in Indonesia: contention.
To determine the incidence of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection among healthcare personnel (HCP) and to assess occupational risks for SARS-CoV-2 infection.
Design:
Prospective cohort of healthcare personnel (HCP) followed for 6 months from May through December 2020.
Setting:
Large academic healthcare system including 4 hospitals and affiliated clinics in Atlanta, Georgia.
Participants:
HCP, including those with and without direct patient-care activities, working during the coronavirus disease 2019 (COVID-19) pandemic.
Methods:
Incident SARS-CoV-2 infections were determined through serologic testing for SARS-CoV-2 IgG at enrollment, at 3 months, and at 6 months. HCP completed monthly surveys regarding occupational activities. Multivariable logistic regression was used to identify occupational factors that increased the risk of SARS-CoV-2 infection.
Results:
Of the 304 evaluable HCP that were seronegative at enrollment, 26 (9%) seroconverted for SARS-CoV-2 IgG by 6 months. Overall, 219 participants (73%) self-identified as White race, 119 (40%) were nurses, and 121 (40%) worked on inpatient medical-surgical floors. In a multivariable analysis, HCP who identified as Black race were more likely to seroconvert than HCP who identified as White (odds ratio, 4.5; 95% confidence interval, 1.3–14.2). Increased risk for SARS-CoV-2 infection was not identified for any occupational activity, including spending >50% of a typical shift at a patient’s bedside, working in a COVID-19 unit, or performing or being present for aerosol-generating procedures (AGPs).
Conclusions:
In our study cohort of HCP working in an academic healthcare system, <10% had evidence of SARS-CoV-2 infection over 6 months. No specific occupational activities were identified as increasing risk for SARS-CoV-2 infection.
Substantial progress has been made in the standardization of nomenclature for paediatric and congenital cardiac care. In 1936, Maude Abbott published her Atlas of Congenital Cardiac Disease, which was the first formal attempt to classify congenital heart disease. The International Paediatric and Congenital Cardiac Code (IPCCC) is now utilized worldwide and has most recently become the paediatric and congenital cardiac component of the Eleventh Revision of the International Classification of Diseases (ICD-11). The most recent publication of the IPCCC was in 2017. This manuscript provides an updated 2021 version of the IPCCC.
The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD), in collaboration with the World Health Organization (WHO), developed the paediatric and congenital cardiac nomenclature that is now within the eleventh version of the International Classification of Diseases (ICD-11). This unification of IPCCC and ICD-11 is the IPCCC ICD-11 Nomenclature and is the first time that the clinical nomenclature for paediatric and congenital cardiac care and the administrative nomenclature for paediatric and congenital cardiac care are harmonized. The resultant congenital cardiac component of ICD-11 was increased from 29 congenital cardiac codes in ICD-9 and 73 congenital cardiac codes in ICD-10 to 318 codes submitted by ISNPCHD through 2018 for incorporation into ICD-11. After these 318 terms were incorporated into ICD-11 in 2018, the WHO ICD-11 team added an additional 49 terms, some of which are acceptable legacy terms from ICD-10, while others provide greater granularity than the ISNPCHD thought was originally acceptable. Thus, the total number of paediatric and congenital cardiac terms in ICD-11 is 367. In this manuscript, we describe and review the terminology, hierarchy, and definitions of the IPCCC ICD-11 Nomenclature. This article, therefore, presents a global system of nomenclature for paediatric and congenital cardiac care that unifies clinical and administrative nomenclature.
The members of ISNPCHD realize that the nomenclature published in this manuscript will continue to evolve. The version of the IPCCC that was published in 2017 has evolved and changed, and it is now replaced by this 2021 version. In the future, ISNPCHD will again publish updated versions of IPCCC, as IPCCC continues to evolve.
Among 353 healthcare personnel in a longitudinal cohort in 4 hospitals in Atlanta, Georgia (May–June 2020), 23 (6.5%) had severe acute respiratory coronavirus virus 2 (SARS-CoV-2) antibodies. Spending >50% of a typical shift at the bedside (OR, 3.4; 95% CI, 1.2–10.5) and black race (OR, 8.4; 95% CI, 2.7–27.4) were associated with SARS-CoV-2 seropositivity.
To investigate the use of co-registration of the computerised tomography (CT) planning scan with transperineal ultrasound (TPUS) as an aid to the delineation of the clinical target volume (CTV), and the use of TPUS as a tool for inter- and intra-fractional monitoring in men with bilateral hip prostheses (b-P) undergoing prostate radiotherapy.
Materials and methods:
We marked the CTV of three patients with and without the co-registered TPUS images. A metal artefact reduction algorithm was utilised. Two patients were treated with intensity-modulated radiotherapy (IMRT) and one with volumetric-modulated arc therapy (VMAT). The inter- and intra-fractional monitoring details were reviewed retrospectively.
Results:
Clinician marking with TPUS/CT fusion improved the confidence of prostate CTV delineation leading to a consistent change in volumes across two observers. Inter- and intra-fractional monitoring was possible using TPUS as image guidance, as it is for those patients with non-prosthetic hips.
Findings:
Using TPUS in the radiotherapy workflow has enabled us to more confidently plan, treat and monitor patients with b-HP. Due to transperineal image acquisition, the ultrasound images are not affected by the presence of hip prostheses, which are outside the field of view.
Develop strong network of science teachers interested in promoting scientific research to their students.
Place students in an immersive summer research internship that, when possible, matches their career interests.
Expose students to the numerous career paths within the STEM field.
METHODS/STUDY POPULATION:
The program recruits socio-economically disadvantaged students and provides them a stipend, and also accepts students who can participate unpaid.
Local school teachers are engaged in a summer fellowship to learn biotechnologies and research. In Spring these teachers help recruit students and during the subsequent Fall help students with college and scholarship applications.
Students are placed in a variety of laboratories within the Schools of Medicine, Science, Dentistry, Public Health, Informatics, Health and Human Sciences, Engineering and Technology, especially in biomedical engineering. Students are also placed in industry laboratories such as Eli Lilly and the Indiana Bioscience Research Institute.
Long-term program follow-up is done through post-internship surveys to assess impact on graduate and professional school admission.
RESULTS/ANTICIPATED RESULTS:
Since the Indiana CTSI was established in 2008, 872 students have participated in the summer internship.
71% of past interns are underrepresented minorities in science or classified as disadvantaged by NIH criteria.
17% of students interned during grade 10, 72% during grade 11, and 11% during grade 12.
21% of students engage in the program for more than one year.
100% of past interns are currently enrolled in or have graduated college.
Over 60% of those with a bachelors degree proceed to graduate and professional schools and over 80% stay in STEM related fields. These rates are equal for interns from underrepresented minorities or those classified as disadvantaged by NIH criteria.
DISCUSSION/SIGNIFICANCE OF IMPACT:
Students engaged in the Indiana CTSI STEM program are progressing through the translational science pipeline based on their graduating from college and remaining in the STEM field.
Recently, John Doe, an undocumented immigrant who was detained by United States Immigration and Customs Enforcement (ICE), was admitted to a hospital off-site from a detention facility. Custodial officers accompanied Mr. Doe into the exam room and refused to leave as physicians examined him. In this analysis, we examine the ethical dilemmas this case brings to light concerning the treatment of patients in immigration detention and their rights to privacy. We analyze what US law and immigration detention standards allow regarding immigration enforcement or custodial officers’ presence in medical exams and documentation of detainee health information. We describe the ethical implications of the presence of officers in medical exam rooms, including its effects on the quality of the patient-provider relationship, patient privacy and confidentiality, and provider's ability to provide ethical care. We conclude that the presence of immigration enforcement or custodial officers during medical examination of detainees is a breach of the right to privacy of detainees who are not an obvious threat to the public. We urge ICE and the US Department of Homeland Security to clarify standards for and tighten enforcement around when officers are legally allowed to be stationed in medical exam rooms and document detainees’ information.
Antipseudomonal carbapenems are an important target for antimicrobial stewardship programs. We evaluated the impact of formulary restriction and preauthorization on relative carbapenem use for medical and surgical intensive care units at a large, urban academic medical center using interrupted time-series analysis.
Process-tracing has grown in popularity among qualitative researchers. However, unlike statistical models and estimators—or even other topics in qualitative methods—process-tracing is largely bereft of guidelines, especially when it comes to teaching. We address this shortcoming by providing a step-by-step checklist for developing a research design to use process-tracing as a valid and substantial tool for hypothesis testing. This practical guide should be of interest for both research application and instructional purposes. An online appendix containing multiple examples facilitates teaching of the method.
An internationally approved and globally used classification scheme for the diagnosis of CHD has long been sought. The International Paediatric and Congenital Cardiac Code (IPCCC), which was produced and has been maintained by the International Society for Nomenclature of Paediatric and Congenital Heart Disease (the International Nomenclature Society), is used widely, but has spawned many “short list” versions that differ in content depending on the user. Thus, efforts to have a uniform identification of patients with CHD using a single up-to-date and coordinated nomenclature system continue to be thwarted, even if a common nomenclature has been used as a basis for composing various “short lists”. In an attempt to solve this problem, the International Nomenclature Society has linked its efforts with those of the World Health Organization to obtain a globally accepted nomenclature tree for CHD within the 11th iteration of the International Classification of Diseases (ICD-11). The International Nomenclature Society has submitted a hierarchical nomenclature tree for CHD to the World Health Organization that is expected to serve increasingly as the “short list” for all communities interested in coding for congenital cardiology. This article reviews the history of the International Classification of Diseases and of the IPCCC, and outlines the process used in developing the ICD-11 congenital cardiac disease diagnostic list and the definitions for each term on the list. An overview of the content of the congenital heart anomaly section of the Foundation Component of ICD-11, published herein in its entirety, is also included. Future plans for the International Nomenclature Society include linking again with the World Health Organization to tackle procedural nomenclature as it relates to cardiac malformations. By doing so, the Society will continue its role in standardising nomenclature for CHD across the globe, thereby promoting research and better outcomes for fetuses, children, and adults with congenital heart anomalies.
Two broad aims drive weed science research: improved management and improved
understanding of weed biology and ecology. In recent years, agricultural
weed research addressing these two aims has effectively split into separate
subdisciplines despite repeated calls for greater integration. Although some
excellent work is being done, agricultural weed research has developed a
very high level of repetitiveness, a preponderance of purely descriptive
studies, and has failed to clearly articulate novel hypotheses linked to
established bodies of ecological and evolutionary theory. In contrast,
invasive plant research attracts a diverse cadre of nonweed scientists using
invasions to explore broader and more integrated biological questions
grounded in theory. We propose that although studies focused on weed
management remain vitally important, agricultural weed research would
benefit from deeper theoretical justification, a broader vision, and
increased collaboration across diverse disciplines. To initiate change in
this direction, we call for more emphasis on interdisciplinary training for
weed scientists, and for focused workshops and working groups to develop
specific areas of research and promote interactions among weed scientists
and with the wider scientific community.
This review article provides a reading guide to scholarly literature published in English about Nepal's political transformation since 2006, when Nepal's decade-long civil conflict between Maoist and state forces formally ended. The article is structured around four major themes: (1) the Maoist insurgency or ‘People's War’; (2) state formation and transformation; (3) identity politics; and (4) territorial and ecological consciousness. We also address the dynamics of migration and mobility in relation to all of these themes. Ultimately, we consider the Maoist movement as one element in a much broader process of transformation, which with the benefit of hindsight we can situate in relation to several other contemporaneous trajectories, including: democratization, identity-based mobilization, constitutional nationalism, international intervention, territorial restructuring, migration and the remittance economy, and the emergence of ecological and other new forms of consciousness. By looking across the disciplines at scholarship published on all of these themes, we aim to connect the dots between long-standing disciplinary traditions of scholarship on Nepal and more recent approaches to understanding the country's transformation.
Patients with candidemia are at risk for other invasive infections, such as methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI).
OBJECTIVE
To identify the risk factors for, and outcomes of, BSI in adults with Candida spp. and MRSA at the same time or nearly the same time.
DESIGN
Population-based cohort study.
SETTING
Metropolitan Atlanta, March 1, 2008, through November 30, 2012.
PATIENTS
All residents with Candida spp. or MRSA isolated from blood.
METHODS
The Georgia Emerging Infections Program conducts active, population-based surveillance for candidemia and invasive MRSA. Medical records for patients with incident candidemia were reviewed to identify cases of MRSA coinfection, defined as incident MRSA BSI 30 days before or after candidemia. Multivariate logistic regression was performed to identify factors associated with coinfection in patients with candidemia.
RESULTS
Among 2,070 adult candidemia cases, 110 (5.3%) had coinfection within 30 days. Among these 110 coinfections, MRSA BSI usually preceded candidemia (60.9%; n=67) or occurred on the same day (20.0%; n=22). The incidence of coinfection per 100,000 population decreased from 1.12 to 0.53 between 2009 and 2012, paralleling the decreased incidence of all MRSA BSIs and candidemia. Thirty-day mortality was similarly high between coinfection cases and candidemia alone (45.2% vs 36.0%, P=.10). Only nursing home residence (odds ratio, 1.72 [95% CI, 1.03–2.86]) predicted coinfection.
CONCLUSIONS
A small but important proportion of patients with candidemia have MRSA coinfection, suggesting that heightened awareness is warranted after 1 major BSI pathogen is identified. Nursing home residents should be targeted in BSI prevention efforts.
Infect. Control Hosp. Epidemiol. 2015;36(11):1298–1304
Studies on the role of diet in the development of chronic diseases often rely on self-report surveys of dietary intake. Unfortunately, many validity studies have demonstrated that self-reported dietary intake is subject to systematic under-reporting, although the vast majority of such studies have been conducted in industrialised countries. The aim of the present study was to investigate whether or not systematic reporting error exists among the individuals of African ancestry (n 324) in five countries distributed across the Human Development Index (HDI) scale, a UN statistic devised to rank countries on non-income factors plus economic indicators. Using two 24 h dietary recalls to assess energy intake and the doubly labelled water method to assess total energy expenditure, we calculated the difference between these two values ((self-report − expenditure/expenditure) × 100) to identify under-reporting of habitual energy intake in selected communities in Ghana, South Africa, Seychelles, Jamaica and the USA. Under-reporting of habitual energy intake was observed in all the five countries. The South African cohort exhibited the highest mean under-reporting ( − 52·1 % of energy) compared with the cohorts of Ghana ( − 22·5 %), Jamaica ( − 17·9 %), Seychelles ( − 25·0 %) and the USA ( − 18·5 %). BMI was the most consistent predictor of under-reporting compared with other predictors. In conclusion, there is substantial under-reporting of dietary energy intake in populations across the whole range of the HDI, and this systematic reporting error increases according to the BMI of an individual.
Discussing Luc Boltanski's research is a particularly delicate task for the person who co-authored works and articles with him that have given rise to a new sociological paradigm and led to the creation of the Groupe de Sociologie Politique et Morale. I could have avoided the difficulty by choosing a masterwork of his that is quite different from the works we wrote together, such as the admirable La condition fœtale (Boltanski, 2004). Yet, I have chosen instead to confront it in the spirit of the long, friendly, and ongoing conversation between us, renewed this past year. I would like to bring to light differences which, though invisible in works that fully integrate our perspectives on a single object of study, may yet be discerned in our respective earlier and later writings. I have chosen to take up the question of enlarging critique, in connection with our respective explorations of critical tests and what they contribute to critical theory.
In the first part, I evoke the before and after of the ‘critical reality test’ concept that Luc and I modelled in Economies of Worth (Boltanski and Thévenot, 1987; hereafter EW; original title Economies de la grandeur) and in On Justification (Boltanski and Thévenot, 2006 [1991]; hereafter OJ). Here, ‘before’ and ‘after’ are to be understood in two ways: what happens before and after the critical test, and what can be contributed by analytical categories related to the test model and developed by each of us in works either preceding or following our collaboration. The second part approaches the language that is appropriate for expressing what is experienced in such trying moments. This leads to an encounter with literary works that brings us back to Boltanski, in this case to his theatrical work.
1. Before and after the ‘Critical Reality Test’
After analysing in detail the various ties between sociology and criticism, Boltanski, in On Critique (hereafter OC), enlarges the model of critical test that we put forward in EW, distinguishing three types of test (Boltanski, 2011 [2009]).