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To determine the impact of a documented penicillin or cephalosporin allergy on the development of surgical site infections (SSIs).
Appropriate preoperative antibiotic prophylaxis reduces SSI risk, but documented antibiotic allergies influence the choice of prophylactic agents. Few studies have examined the relationship between a reported antibiotic allergy and risk of SSI and to what extent this relationship is modified by the antibiotic class given for prophylaxis.
We conducted a retrospective cohort study of adult patients undergoing coronary artery bypass, craniotomy, spinal fusion, laminectomy, hip arthroplasty and knee arthroplasty at 3 hospitals from July 1, 2013, to December 31, 2017. We built a multivariable logistic regression model to calculate the adjusted odds ratio (aOR) of developing an SSI among patients with and without patient-reported penicillin or cephalosporin allergies. We also examined effect measure modification (EMM) to determine whether surgical prophylaxis affected the association between reported allergy and SSI.
We analyzed 39,972 procedures; 1,689 (4.2%) with a documented patient penicillin or cephalosporin allergy, and 374 (0.9%) resulted in an SSI. Patients with a reported penicillin or cephalosporin allergy were more likely to develop an SSI compared to patients who did not report an allergy to penicillin or cephalosporins (adjusted odds ratio, 3.26; 95% confidence interval, 2.71–3.93). Surgical prophylaxis did not have significant EMM on this association.
Patients who reported a penicillin or cephalosporin allergy had higher odds of developing an SSI than nonallergic patients. However, the increase in odds is not completely mediated by the type of surgical prophylaxis. Instead, a reported allergy may be a surrogate marker for a more complicated patient population.
Anxiety disorders are among the most common psychiatric disorders worldwide. They often onset early in life, with symptoms and consequences that can persist for decades. This makes anxiety disorders some of the most debilitating and costly disorders of our time. Although much is known about the synaptic and circuit mechanisms of fear and anxiety, research on the underlying genetics has lagged behind that of other psychiatric disorders. However, alongside the formation of the Psychiatric Genomic Consortium Anxiety workgroup, progress is rapidly advancing, offering opportunities for future research.
Here we review current knowledge about the genetics of anxiety across the lifespan from genetically informative designs (i.e. twin studies and molecular genetics). We include studies of specific anxiety disorders (e.g. panic disorder, generalised anxiety disorder) as well as those using dimensional measures of trait anxiety. We particularly address findings from large-scale genome-wide association studies and show how such discoveries may provide opportunities for translation into improved or new therapeutics for affected individuals. Finally, we describe how discoveries in anxiety genetics open the door to numerous new research possibilities, such as the investigation of specific gene–environment interactions and the disentangling of causal associations with related traits and disorders.
We discuss how the field of anxiety genetics is expected to move forward. In addition to the obvious need for larger sample sizes in genome-wide studies, we highlight the need for studies among young people, focusing on specific underlying dimensional traits or components of anxiety.
This SHEA white paper identifies knowledge gaps and challenges in healthcare epidemiology research related to coronavirus disease 2019 (COVID-19) with a focus on core principles of healthcare epidemiology. These gaps, revealed during the worst phases of the COVID-19 pandemic, are described in 10 sections: epidemiology, outbreak investigation, surveillance, isolation precaution practices, personal protective equipment (PPE), environmental contamination and disinfection, drug and supply shortages, antimicrobial stewardship, healthcare personnel (HCP) occupational safety, and return to work policies. Each section highlights three critical healthcare epidemiology research questions with detailed description provided in supplementary materials. This research agenda calls for translational studies from laboratory-based basic science research to well-designed, large-scale studies and health outcomes research. Research gaps and challenges related to nursing homes and social disparities are included. Collaborations across various disciplines, expertise and across diverse geographic locations will be critical.
The design and the early commissioning of the ELI-Beamlines laser facility’s 30 J, 30 fs, 10 Hz HAPLS (High-repetition-rate Advanced Petawatt Laser System) beam transport (BT) system to the P3 target chamber are described in detail. It is the world’s first and with 54 m length, the longest distance high average power petawatt (PW) BT system ever built. It connects the HAPLS pulse compressor via the injector periscope with the 4.5 m diameter P3 target chamber of the plasma physics group in hall E3. It is the largest target chamber of the facility and was connected first to the BT system. The major engineering challenges are the required high vibration stability mirror support structures, the high pointing stability optomechanics as well as the required levels for chemical and particle cleanliness of the vacuum vessels to preserve the high laser damage threshold of the dielectrically coated high-power mirrors. A first commissioning experiment at low pulse energy shows the full functionality of the BT system to P3 and the novel experimental infrastructure.
The paper suggests an innovative design research and intervention approach using a poststructuralist organizational education perspective. The potential of a high impact trans-epistemic design process is shown for the field of industry 4.0 and the specific context of cognitive assistive systems (CASs). The multi-layered approach addresses the design of technical, social and educational complexity to implement CASs sustainably on the shopfloor and exploit their potential in industry 4.0. Finally, we will shed light on how the approach can enhance deep organizational transformation in industry.
Additive Manufacturing is doing its first steps in the production of spare parts. Usually the spares belong to legacy systems, and the tooling to produce them is no longer available. Re-designing spares that are designed for a previous industry mindset can be sometimes challenging. In this study a rather classic design approach is compared to a functional driven approach. Four case studies from different clients are reported, remarking the benefits and drawbacks of using design for additive manufacturing practices in Laser Powder Bed Fusion.
The topic of support structure design in the Design for Additive Manufacturing (DfAM) field is not addressed with the same relevance as the topic of part design. Therefore, this contribution investigates parameters for both the manufacturing and support structure design for the Laser Powder Bed Fusion (L-PBF) process. Matrices for cause-effect-relations of manufacturing and design parameters on build properties as well as correlations of them are presented. Based on these, recommendations for actions for experimental procedures are derived following the Design of Experiments method.
With design methodologies, as Integrated Product Development, industry is continuously looking to improve their product development processes. Staying ahead concurrence forces them to deliver new and more complex products in shorter time. When it comes to fast delivery and requirement changes, product development can be inspired by agile methods. Although the application is difficult, the idea to implement these methods for development of products other than software comes out. To ease its implementation, this paper proposes to use IPD as a framework for agile product development.
Negative computer attitude has been shown to be a possible co-variable in computerized examinations of psychiatric patients, affecting patient-computer interaction as well as reliability and validity of assessment (Weber et al. 2002, Acta Psychiatr.Scand., 105, 126-130).
It remains still uncertain if the psychological construct of computer attitude can be dependably measured in acute psychiatric inpatients or whether it is impeded by the effects of mental illness. For that reason a German translation of the Groningen Computer Attitude Scale (GCAS) was evaluated in 160 acute psychiatric inpatients under naturalistic conditions.
General test criteria (internal structure, item analysis, internal consistency, split half reliability) to a large extent corresponded to those formerly found in healthy subjects and psychiatric outpatients. The mean GCAS score was calculated as 56.2 ± 10.8 points and a significantly better computer attitude was found in male, better educated and younger patients. Some diverging correlation patterns were found in diagnostic subgroups, indicating a possible minor impact of mental disorder on computer attitude.
Overall, the GCAS was found to be a suitable instrument for measuring computer attitude in acute psychiatric inpatients. It should be used in identifying patients with a negative attitude to computers in order to ensure reliability and validity of computerized assessment.
Impairment of memory function in depressive patients is discussed controversially. At least memory impairment might be expected in more complex and effortful memory tasks.
80 patients with recurrent depressive disorder (ICD-10: F33) were compared to healthy controls in two computerized memory tasks (NEUROBAT verbal recognition and nonverbal free recall). Psychopathology (HDRS, BDI, mood scales) and computer attitude as well as computer experience were controlled as possible co-variables. A correlation between performance in computerized neuropsychological assessment and computer attitude had been found in former studies (Weber et al. 2002, Acta Psychiatr.Scand., 105, 126-130).
Unexpectedly in older patients poorer memory performance could be shown in the simple recognition task and not in the more effortful free recall. No correlations were found to depressive psychopathology. Significant correlations between computer experience and recognition task performance indicate that computer operation might be regarded as a relevant additional executive demand. The additional executive demand seems to cause a relevant inhibition of memory function in patients with lower degree of automation in computer operation.
The results of the present study confirm the well known difficulties in interpretation of neuropsychological test results in depression. The impairment by computer operation demands predominantly concerns female and older patients. Computer experience and computer attitude should be measured routinely concomitant to computerized neuropsychological assessment. Non-computerized tests should be used additionally in order to confirm results if necessary.
Furthermore the inhibition of distinct cognitive functions by additional executive demands might be regarded as a neuropsychological dimension of depressive psychopathology.
In alcoholism, one relevant mechanism contributing to relapse is the exposure to stimuli that are associated with alcohol intake. Such conditioned cues can elicit conditioned responses like alcohol craving and consumption. In the last decade, considerable progress has been made in identifying basic neuronal mechanisms that underlie cue-induced alcohol craving.
We explored whether functional brain activation during exposure to alcohol-associated stimuli is related to the prospective relapse risk in detoxified alcohol-dependent patients.
46 alcohol-dependent and 46 healthy volunteers participated in a fMRI study using a cue reactivity paradigm, in which visual alcohol-related and control stimuli were presented. Patients were followed for 3 months. Afterwards data was analysed regarding the subsequent relapse, resulting in 16 abstainers and 30 relapsers.
Alcohol-related versus neutral stimuli activated a frontocortical-limbic network including inferior, medial and middle frontal gyrus as well as putamen in the group of patients relative to healthy controls. Moreover, abstainers showed a stronger activation in orbitofrontal cortex as well as midbrain during the presentation of alcohol-related cues whereas relapsers revealed a stronger activation of cingulate gyrus.
This study suggests that cue-induced activation of orbitofrontal cortex and dopaminergic innervated midbrain is negatively associated with the prospective relapse risk in alcohol-dependent patients. This could indicate a more pronounced and conscious processing of alcohol cues which might serve as a warning signal and a behavioural controlling function. In contrast, prospective relapsers showed a stronger activation of cingulate gyrus, a region involved in the attribution of motivational value.
The weight gain prevalence in child and adolescents is rapidly increasing and presents a major health problem with also the psychiatric impact. In Switzerland, one child of five is in weight excess. The parents of the obese adolescents are also in sufferance.
In 2007, the Federal Commission aprouved the project of the Swiss Society of the Pediatrics, applied in the Geneva University Hospitals as Contrepoids - pediatric weight management programe. It includes the psycho-educative groups (14 to 18 groups), one or two sport activities a weak and the “parents” groups (8–14 groups).
The effect of these programs is measured mainly by the weight evolution.
As far as we know, there are no other criteria of the evaluation of these programs. Or, it is known that just à small number of these children regain their normal weight.
To explore the parents’ representations of te wheight problem after one year To evaluate if this changement of the representations has un effect in the well being of the adolescents, their parents and their family relations.
Two focus groups were conducted at the end of a one year Family-Based Behavioural Treatment (FBBT) for obese teenagers (12–18 years), involving 16 parents. Four Open-ended questions were used.
Parents reported that the participation in a group program allowed them to reduce their sense of isolation. It helped them to decrease their sense of guilt and also in the transition from childhood to adolescence. Less attention was payed to the diet.
Constituting 2% of the population, PWDID are a vulnerable group with a higher prevalence of mental disorders than the general population. ICD diagnostic criteria often rely on adequate cognitive functioning and hence diagnosis of mental disorders in PWDID can be difficult, consequently leading to inequity of treatment, prognosis and stigma. Our study critically analysed the available evidence base and explored the feasibility of applying modified diagnostic criteria within the context of cumulative iterative iteration. We present the outcome using diagnosis of DID and anxiety disorder as examples.
Address current shortcomings in ICD classification regarding PWDID by contributing effectively to the WHO ICD-11 consultation process in collaboration with international stakeholders.
Facilitate accessibility of ICD-11 criteria for diagnosis of mental disorders capable of engendering robust evidence based epidemiological data and healthcare in PWDID.
We evaluated current evidence via a systematic literature search utilising PRISMA guidelines and developed pragmatic guidelines to adapt ICD diagnostic criteria in PWDID. A brief screener [Glasgow Level of Ability and Development Scale (GLADs)] for detecting DID was also studied internationally within the context of clinical utility (n = 136).
The evidence base relating to mental disorders in PWDID is poor, significantly hampered by difficulties in applicability of diagnostic criteria. The GLADs appears to be a promising screening tool with good clinical utility for detecting disorders of intellectual development (DID) particularly where resources are scarce.
Pragmatic modifications to ICD-11 diagnostic criteria and the GLADS tool facilitates its clinical utility for PWDID and contributes significantly to enhancing research based evidence, and, ultimately their health access and well-being.
Disclosure of interest
The authors have not supplied their declaration of competing interest.