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Multiplex polymerase chain reaction (PCR) panels for stool testing may be used to diagnose Clostridioides difficile, which can circumvent more appropriate targeted C. difficile testing, resulting in treatment of incidentally detected colonization. We sought to reduce C. difficile diagnosis via a gastrointestinal pathogen panel (GIPP).
Design:
Quasi-experimental, pre/post, retrospective cohort study from January 1, 2022, to January 31, 2024.
Setting:
Mayo Clinic Arizona—a single academic medical center and associated clinics.
Patients:
Adult patients receiving C. difficile testing and/or treatment.
Methods:
Preferred C. difficile testing consisted of glutamate dehydrogenase and toxin antigen immunoassay, followed by toxin gene testing for discrepant results. The GIPP contained 22 targets during the baseline period with C. difficile removed during the postintervention period. Surveys were provided to provider and nursing groups, separately, to identify C. difficile ordering practices and knowledge gaps.
Results:
At baseline, from January 1, 2022, to January 31, 2023, 2,772 GIPPs were completed for 2,307 unique patients (∼7 per day), primarily for outpatients (1,805 of 2,772, 65%). The most common positive target was C. difficile (517 of 1,018, 51%), which resulted in treatment for C. difficile infection in 94.9% (337 of 355) of cases. Following GIPP C. difficile target removal, GIPP orders decreased from 3.23 to 2.7 per 1,000 patient visits (P < .001). Prescribing of C. difficile treatments decreased in the postintervention period in inpatient and outpatient settings. There were no cases of delayed C. difficile diagnosis during the postintervention period.
Conclusions:
Removing C. difficile from the GIPP resulted in effective diagnostic and antimicrobial stewardship without resulting in delayed diagnoses.
In 2023, both Democratic and Republican elected officials supported banning official use of the gender-neutral term “Latinx.” Using a nationally representative survey sample, this study examines whether opposition to the gender-neutral term “Latinx” suggests a potential wedge issue that cuts across partisanship. We find that opposition to “Latinx” is significantly higher among Republican partisans, those who disapprove of Joe Biden as president, and those with “colder” feelings toward Democrats. Opposition to “Latinx” generally converges with factors that predict existing partisan divisions; where it diverges, it does not affect respondent evaluations of Biden or feelings about Democrats. Based on these findings, we conclude that gender-neutral language currently shows little potential as a wedge issue.
The gut microbiome is impacted by certain types of dietary fibre. However, the type, duration and dose needed to elicit gut microbial changes and whether these changes also influence microbial metabolites remain unclear. This study investigated the effects of supplementing healthy participants with two types of non-digestible carbohydrates (resistant starch (RS) and polydextrose (PD)) on the stool microbiota and microbial metabolite concentrations in plasma, stool and urine, as secondary outcomes in the Dietary Intervention Stem Cells and Colorectal Cancer (DISC) Study. The DISC study was a double-blind, randomised controlled trial that supplemented healthy participants with RS and/or PD or placebo for 50 d in a 2 × 2 factorial design. DNA was extracted from stool samples collected pre- and post-intervention, and V4 16S rRNA gene sequencing was used to profile the gut microbiota. Metabolite concentrations were measured in stool, plasma and urine by high-performance liquid chromatography. A total of fifty-eight participants with paired samples available were included. After 50 d, no effects of RS or PD were detected on composition of the gut microbiota diversity (alpha- and beta-diversity), on genus relative abundance or on metabolite concentrations. However, Drichlet’s multinomial mixture clustering-based approach suggests that some participants changed microbial enterotype post-intervention. The gut microbiota and fecal, plasma and urinary microbial metabolites were stable in response to a 50-d fibre intervention in middle-aged adults. Larger and longer studies, including those which explore the effects of specific fibre sub-types, may be required to determine the relationships between fibre intake, the gut microbiome and host health.
Cognitive impairment, anxiety, depression, fatigue, and dependence in instrumental activities of daily living (ADL) are common after stroke; however, little is known about how these outcomes may differ following treatment with endovascular clot retrieval (ECR), intravenous tissue plasminogen activator (t-PA), or conservative management.
Methods:
Patients were recruited after acute treatment and invited to participate in an outcome assessment 90–120 days post-stroke. The assessment included a cognitive test battery and several questionnaires. The COVID-19 pandemic led to significant disruptions in recruitment and data collection, and the t-PA and conservative management groups were combined into a standard medical care (SMC) group.
Results:
Sixty-two participants were included in the study (ECR = 31, SMC = 31). Mean age was 66.5 (20–86) years, and 35 (56.5%) participants were male. Participants treated with ECR had significantly higher National Institutes of Health Stroke Scale scores at presentation and significantly lower education. After adjusting for stroke severity, premorbid intellectual ability, and age, treatment with ECR was associated with significantly better performances on measures of cognitive screening, visual working memory, and verbal learning and memory. Participants treated with ECR also experienced less fatigue and were more likely to achieve independence in basic and instrumental ADLs. Despite this, cognitive impairment and fatigue were still common among participants treated with ECR and anxiety and depression symptoms were experienced similarly by both groups.
Conclusions:
Cognitive impairment and fatigue were less common but still prevalent following treatment with ECR. This has important practical implications for stroke rehabilitation, and routine assessment of cognition, emotion, and fatigue is recommended for all stroke survivors regardless of stroke treatment and functional outcome.
Social determinants of health (SDoH), such as socioeconomics and neighborhoods, strongly influence health outcomes. However, the current state of standardized SDoH data in electronic health records (EHRs) is lacking, a significant barrier to research and care quality.
Methods:
We conducted a PubMed search using “SDOH” and “EHR” Medical Subject Headings terms, analyzing included articles across five domains: 1) SDoH screening and assessment approaches, 2) SDoH data collection and documentation, 3) Use of natural language processing (NLP) for extracting SDoH, 4) SDoH data and health outcomes, and 5) SDoH-driven interventions.
Results:
Of 685 articles identified, 324 underwent full review. Key findings include implementation of tailored screening instruments, census and claims data linkage for contextual SDoH profiles, NLP systems extracting SDoH from notes, associations between SDoH and healthcare utilization and chronic disease control, and integrated care management programs. However, variability across data sources, tools, and outcomes underscores the need for standardization.
Discussion:
Despite progress in identifying patient social needs, further development of standards, predictive models, and coordinated interventions is critical for SDoH-EHR integration. Additional database searches could strengthen this scoping review. Ultimately, widespread capture, analysis, and translation of multidimensional SDoH data into clinical care is essential for promoting health equity.
A series of synthetic goethites containing varying amounts of Si and P dopants were characterized by X-ray powder diffraction, electron diffraction, microbeam electron diffraction, and Mössbauer spectroscopy. Very low level incorporation produced materials having structural and spectral properties similar to those of poorly crystalline synthetic or natural goethite. At higher incorporation levels, mixtures of noncrystalline materials were obtained which exhibited Mössbauer spectra typical of noncrystalline materials mixed with a superparamagnetic component. Microbeam electron diffraction indicated that these mixtures contained poorly crystalline goethite, poorly crystalline ferrihydrite, and a noncrystalline component. If the material was prepared with no aging of the alkaline Fe3+ solution before the addition of Na2HPO4 or Na2SiO3, materials were obtained containing little if any superparamagnetic component. If the alkaline Fe3+ solution was aged for 48 hr before the addition, goethite nuclei formed and apparently promoted the precipitation of a superparamagnetic phase. The Mössbauer-effect hyperfme parameters and the saturation internal-hyperfine field obtained at 4.2 K were typical of those of goethite; however, the Mössbauer spectra indicated that the ordering temperature, as reflected in the relaxation rate and/or the blocking temperature, decreased with increasing incorporation of Si and P. The complete loss of crystallinity indicates that Si and P did not substitute for Fe, but rather adsorbed on crystal-growth sites, thereby preventing uniform crystal growth.
Two 10-day in vitro experiments were conducted to investigate the relationship between nitrogen (N) isotope discrimination (δ15N) and ammonia (NH3) emissions from sheep manure. In Exp. 1, three different manure mixtures were set up: control (C); C mixed with lignite (C + L); and grape marc (GM), with 5, 4 and 5 replications, respectively. For C, urine and faeces were collected from sheep fed a diet of 550 g lucerne hay/kg, 400 g barley grain/kg and 50 g faba bean/kg; for C + L, urine and faeces were collected from sheep fed the C diet and 100 g ground lignite added to each incubation system at the start of the experiment; for GM, urine and faeces were collected from sheep fed a diet consisting of C diet with 200 g/kg of the diet replaced with GM. In Exp. 2, three different urine-faeces mixtures were set up: 2U:1F, 1.4U:1F and 1U:1F with urine to faeces ratios of 2:1, 1.4:1 and 1:1, respectively, each with 5 replications. Lignite in C + L led to significantly lower cumulative manure-N loss by 81 and 68% in comparison with C and GM groups, respectively (P = 0.001). Cumulative emitted manure NH3-N was lower in C + L than C and GM groups by 35 and 36%, respectively (P = 0.020). Emitted manure NH3-N was higher in 2U:1F compared to 1.4U:1F and 1U:1F by 18 and 26%, respectively (P < 0.001). This confirms the relationship between manure δ15N and cumulative NH3-N loss reported by earlier studies, which may be useful for estimating NH3 losses.
The thermal effects, as well as the survivability and origins of microorganisms in Cretaceous rocks, are evaluated from the timing and extent of the smectite to illite transformation in Cretaceous bentonites collected from cores outside the thermal aureole of the Pliocene Cerro Negro volcanic neck. Overall, randomly ordered mixed-layered illite-smectite (I-S) is the predominant clay mineral in these bentonites, and the K-Ar ages of I-S range from 36 to 48 Ma (21 analyses, two additional analyses were outside this range). Increased temperature from burial is thought to be the primary factor forming I-S in these bentonites. Kinetic model calculations of the smectite to illite transformation are also consistent with I-S formed by burial without any appreciable thermal effects due to the emplacement of Cerro Negro. In a core angled toward Cerro Negro, the percentages of illite layers in I-S from the bentonite closest to Cerro Negro are slightly higher (32-37%) than in most other bentonites in this study. The K-Ar ages of the closest I-S are slightly younger as a group (38-43 Ma; Average = 41 Ma; N = 4) than those of I-S further from Cerro Negro in the same core (41-48 Ma; Average = 44 Ma; N = 6). A small amount of illite in this I-S may have formed by heat from the emplacement of Cerro Negro, but most illite formed from burial. Vitrinite reflectance, however, appears to record the effects of heating from Cerro Negro better than I-S. Tentatively, the temperature of this heat pulse, based on vitrinite data alone, ranged from 100 to 125°C and this is most evident in the CNAR core. The upper temperature, 125°C, approximates the sterilization temperatures for most microorganisms, and these temperatures probably reduced a significant portion of the microbial population. Thermophiles may have survived the increased temperatures from the combined effects of burial and the intrusion of Cerro Negro.
Our health system implemented a novel clinical decision-support system to reduce unnecessary duplicate nasal methicillin-resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) orders. In an 8-month period, the rate of duplicate MRSA PCR orders within 7 days declined from 4.7% (370 of 7,861) to 1.2% (120 of 9,833).
Chapter 5 gives an extended empirical example of the Benford agreement procedure for assessing the validity of social science data. The example uses country-level data collected and estimated by the Sea Around Us organization on the dollar values of reported and unreported fish landings from 2010 to 2016. We report Benford agreement analyses for the Sea Around Us data (1) by reporting status, (2) by decade, (3) for a large fishing region of 22 West African countries, and (4) foreach of the 22 individual countries in West Africa.
Chapter 4 begins with a discussion of the types and kinds of data most suitable for an analysis that uses the Benford probability distribution. Next we describe an R computer program – program Benford – designed to evaluate observed data for agreement with the Benford probability distribution; and we give an example of output from the program using a typical dataset. We then move to an overview of our workflow of Benford agreement analyses where we outline our process for assessing the validity of data using Benford agreement analyses. We end the chapter with a discussion of the concept of Benford validity, which we will employ in subsequent chapters.
Chapter 7 takes a closer look at some of the Sea Around Us fish-landings data that we assessed for Benford agreement in Chapter 5. We chose these data because of the mixed agreement findings among them: while the full dataset and several sets of subgroups indicated that the data exhibited Benford validity, when we analyzed West African countries individually, a number of them were found to have unacceptable Benford agreement and therefore problematic Benford validity. We present ways in which researchers can assess the impact of unacceptable Benford agreement on their analyses.
Chapter 3 describes and illustrates the Benford probability distribution. A brief summary of the origin and evolution of the Benford distribution is drawn and the development and assessment of various measures of goodness of fit between an empirical distribution and the Benford distribution are described and illustrated. These masures are Pearson’s chi-squared, Wilks’ likelihood-ratio, Hardy and Ramanujan’s partition theory, Fisher’s exact test, Kuiper’s measure, Tam Cho and Gaines’ d measure, Cohen’s w measure, and Nigrini’s MAD measure.
Chapter 6 provides a second empirical example of the Benford agreement procedure: here we analyze new daily COVID-19 cases at the US state level and at the global level across nations. Both the state-level and the global analyses consider time as a variable. Specifically we examine, (1) for the United States, new reports of COVID-19 between January 22, 2020 and November 16, 2021 at the state level, and (2) for the cross-national data, new reports of COVID-19 between February 24, 2020 and January 13, 2022. At the state level, we report Benford agreement analyses for (1) the full dataset, (2) cases grouped alphabetically, (3) cases grouped regionally, (4) cases grouped by days of the week, and (5) cases grouped by their governor’s party (Republican or Democratic). We then turn our Benford agreement analysis to global cross-national COVID-19 data to assess whether Benford agreement of COVID-19 varies across countries.