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Depression is an important, potentially modifiable dementia risk factor. However, it is not known whether effective treatment of depression through psychological therapies is associated with reduced dementia incidence. The aim of this study was to investigate associations between reduction in depressive symptoms following psychological therapy and the subsequent incidence of dementia.
National psychological therapy data were linked with hospital records of dementia diagnosis for 119808 people aged 65+. Participants received a course of psychological therapy treatment in Improving Access to Psychological Therapies (IAPT) services between 2012 and 2019. Cox proportional hazards models were run to test associations between improvement in depression following psychological therapy and incidence of dementia diagnosis up to eight years later.
Improvements in depression following treatment were associated with reduced rates of dementia diagnosis up to 8 years later (HR = 0.88, 95% CI 0.83–0.94), after adjustment for key covariates. Strongest effects were observed for vascular dementia (HR = 0.86, 95% CI 0.77–0.97) compared with Alzheimer's disease (HR = 0.91, 95% CI 0.83–1.00).
Reliable improvement in depression across psychological therapy was associated with reduced incidence of future dementia. Results are consistent with at least two possibilities. Firstly, psychological interventions to improve symptoms of depression may have the potential to contribute to dementia risk reduction efforts. Secondly, psychological therapies may be less effective in people with underlying dementia pathology or they may be more likely to drop out of therapy (reverse causality). Tackling the under-representation of older people in psychological therapies and optimizing therapy outcomes is an important goal for future research.
Describe the epidemiological and molecular characteristics of an outbreak of Klebsiella pneumoniae carbapenemase (KPC)–producing organisms and the novel use of a cohorting unit for its control.
A 566-room academic teaching facility in Milwaukee, Wisconsin.
Solid-organ transplant recipients.
Infection control bundles were used throughout the time of observation. All KPC cases were intermittently housed in a cohorting unit with dedicated nurses and nursing aids. The rooms used in the cohorting unit had anterooms where clean supplies and linens were placed. Spread of KPC-producing organisms was determined using rectal surveillance cultures on admission and weekly thereafter among all consecutive patients admitted to the involved units. KPC-positive strains underwent pulsed-field gel electrophoresis and whole-genome sequencing.
A total of 8 KPC cases (5 identified by surveillance) were identified from April 2016 to April 2017. After the index patient, 3 patients acquired KPC-producing organisms despite implementation of an infection control bundle. This prompted the use of a cohorting unit, which immediately halted transmission, and the single remaining KPC case was transferred out of the cohorting unit. However, additional KPC cases were identified within 2 months. Once the cohorting unit was reopened, no additional KPC cases occurred. The KPC-positive species identified during this outbreak included Klebsiella pneumoniae, Enterobacter cloacae complex, and Escherichia coli. blaKPC was identified on at least 2 plasmid backbones.
A complex KPC outbreak involving both clonal and plasmid-mediated dissemination was controlled using weekly surveillances and a cohorting unit.
Cardiac surgery-associated acute kidney injury is common. In order to improve our understanding of acute kidney injury, we formed the multi-centre Neonatal and Pediatric Heart and Renal Outcomes Network. Our main goals are to describe neonatal kidney injury epidemiology, evaluate variability in diagnosis and management, identify risk factors, investigate the impact of fluid overload, and explore associations with outcomes.
The Neonatal and Pediatric Heart and Renal Outcomes Network collaborative includes representatives from paediatric cardiac critical care, cardiology, nephrology, and cardiac surgery. The collaborative sites and infrastructure are part of the Pediatric Cardiac Critical Care Consortium. An acute kidney injury module was developed and merged into the existing infrastructure. A total of twenty-two participating centres provided data on 100–150 consecutive neonates who underwent cardiac surgery within the first 30 post-natal days. Additional acute kidney injury variables were abstracted by chart review and merged with the corresponding record in the quality improvement database. Exclusion criteria included >1 operation in the 7-day study period, pre-operative renal replacement therapy, pre-operative serum creatinine >1.5 mg/dl, and need for extracorporeal support in the operating room or within 24 hours after the index operation.
A total of 2240 neonatal patients were enrolled across 22 centres. The incidence of acute kidney injury was 54% (stage 1 = 31%, stage 2 = 13%, and stage 3 = 9%).
Neonatal and Pediatric Heart and Renal Outcomes Network represents the largest multi-centre study of neonatal kidney injury. This new network will enhance our understanding of kidney injury and its complications.
Discrete mathematics has been rising in prominence in the past fifty years, both as a tool with practical applications and as a source of new and interesting mathematics. The topics in discrete mathematics have become so well developed that it is easy to forget that common threads connect the different areas, and it is through discovering and using these connections that progress is often made. For over fifty years, Ron Graham has been able to illuminate some of these connections and has helped to bring the field of discrete mathematics to where it is today. To celebrate his contribution, this volume brings together many of the best researchers working in discrete mathematics, including Fan Chung, Erik D. Demaine, Persi Diaconis, Peter Frankl, Alfred W. Hales, Jeffrey C. Lagarias, Allen Knutson, Janos Pach, Carl Pomerance, N. J. A. Sloane, and of course, Ron Graham himself.
We proffer a contemporary solution to the so-called Fermi Paradox, which is concerned with conflict between Copernicanism and the apparent paucity of evidence for intelligent alien civilizations. In particular, we argue that every community of organisms that reaches its space-faring age will (1) almost immediately use its rocket-building computers to reverse-engineer its genetic chemistry and (2) self-destruct when some individual uses said technology to design an omnicidal pathogen. We discuss some of the possible approaches to prevention with regard to Homo sapiens’ vulnerability to bioterrorism, particularly on a short-term basis.
Environmental monitoring is of fundamental importance to natural resource
managers, scientists, and human society in general – consider the
inarguable importance of quantifying changes in climate, air and water quality,
surface and ground water dynamics, and similar attributes. However, monitoring
studies also have the potential to be a significant waste of time and money
(see, for example, discussions by Legg and Nagy 2006). To have value, a
monitoring program needs to produce information of sufficient accuracy relevant
to a clearly defined purpose, and to do so cost-effectively. Yet, even in the
short term, natural populations and systems are inherently variable and usually
difficult to study. Adding in a multi-year (usually multi-decade) focus creates
many additional challenges and scales of uncertainty – and increases the
potential amount of time and money wasted if these challenges are not adequately
addressed. Many monitoring efforts have failed or will fail due to poorly
defined objectives and inadequate designs (Yoccoz et al. 2001,
Noon 2003, Legg and Nagy 2006, Lindenmayer and Likens 2010a). Yet, statisticians
and ecologists have developed, and continue to develop, a rich body of knowledge
and practical methods for addressing these challenges, and have applied these
methods successfully at a variety of scales for a diversity of attributes.
Our goal for this volume is to help make some key components of this
knowledge base, as well as new extensions, readily available and accessible
to quantitative and applied natural resource scientists and managers,
program managers, students, and consulting biometricians involved with
environmental monitoring worldwide.
To provide useful and meaningful information, long-term ecological programs need to implement solid and efficient statistical approaches for collecting and analyzing data. This volume provides rigorous guidance on quantitative issues in monitoring, with contributions from world experts in the field. These experts have extensive experience in teaching fundamental and advanced ideas and methods to natural resource managers, scientists and students. The chapters present a range of tools and approaches, including detailed coverage of variance component estimation and quantitative selection among alternative designs; spatially balanced sampling; sampling strategies integrating design- and model-based approaches; and advanced analytical approaches such as hierarchical and structural equation modelling. Making these tools more accessible to ecologists and other monitoring practitioners across numerous disciplines, this is a valuable resource for any professional whose work deals with ecological monitoring. Supplementary example software code is available online at www.cambridge.org/9780521191548.