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We implemented a preoperative staphylococcal decolonization protocol for colorectal surgeries if efforts to further reduce surgical site infections (SSIs).
Retrospective observational study.
Tertiary-care, academic medical center.
Adult patients who underwent colorectal surgery, as defined by National Healthcare Safety Network (NHSN), between July 2015 and June 2020. Emergent cases were excluded.
Simple and multivariable logistic regression were performed to evaluate the relationship between decolonization and subsequent SSI. Other predictive variables included age, sex, body mass index, procedure duration, American Society of Anesthesiology (ASA) score, diabetes, smoking, and surgical oncology service.
In total, 1,683 patients underwent nonemergent NHSN-defined colorectal surgery, and 33.7% underwent the staphylococcal decolonization protocol. SSI occurred in 92 (5.5%); 53 were organ-space infections and 39 were superficial wound infections. We detected no difference in overall SSIs between those decolonized and not decolonized (P = .17). However, superficial wound infections were reduced in the group that received decolonization versus those that did not: 7 (1.2%) of 568 versus 32 (2.9%) of 1,115 (P = .04).
Staphylococcal decolonization may prevent a subset of SSIs in patients undergoing colorectal surgery.
Background: Colorectal surgery is associated with a high risk of surgical site infections (SSIs), with an incidence ranging from 16.9% to 20%, and SSIs are associated with significant morbidity and mortality, prolonged length of hospitalization, and increased health care costs. Staphylococcal decolonization is an attempt to alter the microbiome to prevent staphylococcal and other skin flora from accessing the surgical site, and This practice effectively reduces SSIs in orthopedic, neurologic, and cardiac surgeries. A staphylococcal decolonization protocol was enacted in colorectal surgeries at our institution beginning in October 2016. We compared patient outcomes between patients who did and did not undergo preoperative staphylococcal decolonization. Methods: All patients undergoing nonemergent NHSN-defined colorectal procedures from July 2015 until June 2019 at a tertiary-care medical center were included in this retrospective study. Staphylococcal decolonization was performed using chlorhexidine 2% body wash solution, mupirocin nasal ointment, and chlorhexidine 0.12% oral rinse all twice daily for 5 days prior to surgery. All SSIs were defined by NSHN criteria. The primary outcome was SSI, and secondary outcomes were superficial wound infection (SIP) and organ-space infection (IAB). Predictive variables included decolonization status (yes or no), age, gender, body mass index, procedure duration, American Society of Anesthesiologists (ASA) score, diabetes, smoking, and surgical oncology service. Surgical antimicrobial prophylaxis with cefazolin and metronidazole OR cefoxitin, and chlorhexidine skin preparation were standard throughout the study period. Univariate analysis was performed using a χ2 or t test. Multivariable logistic regression was performed to control for all clinically important variables above. All statistical analyses were done using SAS version 9.4 software (Cary, NC). Results: In total, 1,139 patients underwent nonemergent colorectal surgery from July 2015 to June 2019. There were 74 SSIs: 42 IABs and 32 SIPs. Decolonization was performed in 332 of 1,139 cases (29%). There was no difference in overall SSIs between those decolonized and not decolonized (P = .50). However, SIPs were reduced in the group receiving decolonization: 1.2% (4 of 332) versus 3.5% (28 of 807) (P = .04. When controlling for known SSI risk factors, those not receiving decolonization remained at increased risk of SIPs (OR, 3.79; 95% CI, 1.14–12.61; P = .03. Conclusions: Staphylococcal decolonization may prevent a subset of SSIs in patients undergoing colorectal surgery.
Disclosures: Michelle Doll reports a research Grant from Molnlycke Healthcare.
We assessed the impact of an embedded electronic medical record decision-support matrix (Cerner software system) for the reduction of hospital-onset Clostridioides difficile. A critical review of 3,124 patients highlighted excessive testing frequency in an academic medical center and demonstrated the impact of decision support following a testing fidelity algorithm.
We investigated the impact of discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus infected or colonized patients on central-line associated bloodstream infection rates at an academic children’s hospital. Discontinuation of contact precautions with a bundled horizontal infection prevention platform resulted in no adverse impact on CLABSI rates.
The Research Domain Criteria initiative was launched by the US National Institute of Mental Health to establish a multi-level framework for understanding psychological constructs relevant to human psychiatric disorders, and identified ‘effort valuation/willingness to work’ as a clinically useful construct worthy of further study. This construct encompasses the processes by which the cost(s) of obtaining an outcome are calculated, and the tendency to overcome response costs to obtain a reinforcer. The current study aims to examine effort valuation as a correlate of psychopathology in children and adults, and the moderating effects of sex on this relationship.
Participants were 1215 children aged 6–12 and their parents (n = 1044). All participants completed the Effort Expenditure for Rewards Task as a measure of effort expenditure. Child psychopathology was measured via the Child Behavior Checklist, while adult psychopathology was measured via the Adult Self Report. Additionally, the Social Adjustment Inventory for Children and Adolescents and Injury Behavior Checklist were used to examine child social impairments/problem behaviors.
In children, significant interactions between reward sensitivity and sex were observed in association with anxiety and thought problems, specifically at low reward sensitivity levels. In adults, main effects of effort expenditure were seen in drug and alcohol abuse, where higher effort was associated with higher degrees of abuse.
These results establish effort valuation as a relevant psychological construct for understanding psychopathology, but with different profiles of associated psychopathology across sex in children and adults.
This study investigated the reciprocal relationship between parental caregiving and labour force participation to determine whether (1) caregiving related to subsequent employment; (2) employment related to subsequent caregiving; (3) caregiving and labour force participation had a reciprocal relationship across time; and (4) gender differences existed in these relationships. A cross-lagged panel design was applied with structural equation modeling. The study sample included adult children aged 51 or older with living parents or parents-in-law. No reciprocal relationship was found between caregiving and labour force participation, but gender differences were evident. Women caregivers in 2006 were less likely to be working in 2008, whereas employment status was not related to subsequent caregiving. In contrast, men working in 2008 were less likely to be caregiving in 2010, whereas caregiving was not related to subsequent employment status. Findings suggest that gender plays an important role in the relationship between caregiving and labour force participation.
Late-life depression may increase the risk of incident dementia, in
particular of Alzheimer's disease and vascular dementia.
To conduct a systematic review and meta-analysis to evaluate the risk of
incident all-cause dementia, Alzheimer's disease and vascular dementia in
individuals with late-life depression in population-based prospective
A total of 23 studies were included in the meta-analysis. We used the
generic inverse variance method with a random-effects model to calculate
the pooled risk of dementia, Alzheimer's disease and vascular dementia in
older adults with late-life depression.
Late-life depression was associated with a significant risk of all-cause
dementia (1.85, 95% CI 1.67-2.04, P< 0.001), Alzheimer's disease
(1.65, 95% CI 1.42-1.92, P<0.001) and vascular dementia (2.52, 95% CI
1.77-3.59, P<0.001). Subgroup analysis, based on five studies, showed
that the risk of vascular dementia was significantly higher than for
Alzheimer's disease (P=0.03).
Late-life depression is associated with an increased risk for all-cause
dementia, vascular dementia and Alzheimer's disease. The present results
suggest that it will be valuable to design clinical trials to investigate
the effect of late-life depression prevention on risk of dementia, in
particular vascular dementia and Alzheimer's disease.
The real-time electronic performance of a gallium nitride nanowire-based field effect transistor was investigated at five-minute intervals over thirty minutes of continuous irradiation by Xenon-124 relativistic heavy ions. An initial current surge that resulted in device improvement rather than device failure was observed. The current surge, and subsequent electronic behavior, was modeled using a combined thermionic emission-tunnelling approach, leading to information about barrier height, carrier concentrations, expected temperature behavior, and tunnelling.
Background: Subthreshold depressive symptoms are common in older adults. The threshold for the clinical significance of such symptoms is unclear. Mechanisms linking depressed mood to increased risk of disability need further investigation.
Methods: Among older adults who did not meet criteria for depression, respondents reporting no anhedonia and dysphoria over the past two weeks were compared to respondents reporting occasional symptoms with respect to self-reported disability and cognitive, psychomotor, and physical performance tests.
Results: Of 312 community-resident participants without dementia, 35.3% (n = 110) reported one or both of the two depressive symptoms at mild severity (no more than “several days” in the past two weeks). Older adults with mild depressive symptoms reported more physician-diagnosed medical conditions (2.2 vs. 1.8, p < 0.01) and mobility problems (3.0 vs. 1.8, 0–7 scale, p < 0.001), and were slower in gait (0.80 vs. 0.73 m/sec, p < 0.01) and speed of cognitive processing (Trail B, 166.1 vs. 184.7 sec, p < 0.001). In regression models that adjusted for sociodemographic and medical status, subthreshold symptoms were not a significant correlate of slowing in gait speed or cognitive performance. However, subthreshold depressive symptoms were associated with self-reported mobility limitation in models that adjusted for observed performance.
Conclusions: Mild depressive symptoms in this sample were not an independent correlate of slowed performance. However, the presence of mild depressive symptoms was associated with poorer appraisal of mobility after adjustment for objective measures of mobility.
Biodiversity is the variability among living organisms, from genes to the biosphere. The value of biodiversity is multifold, from preserving the integrity of the biosphere as a whole, to providing food and medicines, to spiritual and aesthetic well-being.
One of the major drivers of biodiversity loss in Europe is atmospheric deposition of reactive nitrogen (Nr).
This chapter focuses on Nr impacts on European plant species diversity; in particular, the number and abundance of different species in a given area, and the presence of characteristic species of sensitive ecosystems.
We summarise both the scientific and the policy aspects of Nr impacts on diversity and identify, using a range of evidence, the most vulnerable ecosystems and regions in Europe.
Key findings/state of knowledge
Reactive nitrogen impacts vegetation diversity through direct foliar damage, eutrophication, acidification, and susceptibility to secondary stress.
Species and communities most sensitive to chronically elevated Nr deposition are those that are adapted to low nutrient levels, or are poorly buffered against acidification. Grassland, heathland, peatland, forest, and arctic/montane ecosystems are recognised as vulnerable habitats in Europe; other habitats may be vulnerable but are still poorly studied.
It is not yet clear if different wet-deposited forms of Nr (e.g. nitrate, NO3− versus ammonium, NH4+) have different effects on biodiversity. However, gaseous ammonia (NH3) can be particularly harmful to vegetation, especially lower plants, through direct foliar damage.
Evaluation of a dietary Na reduction trial in a community setting.
Community-based randomized trial. Ten-week nutrition intervention activities focused on lifestyle modification to decrease dietary Na intake, under the supervision of a registered dietitian. Twenty-four hour urine specimens were collected at baseline and follow-up visits to determine 24 h urinary Na excretion.
The University of Pittsburgh Center for Healthy Aging, Key to Life Nutrition Program.
Hypertensive adults at least 65 years of age.
Mean age of participants was 75 years. Twenty-four hour mean urinary Na excretion at baseline was 3174 mg/d. This reduced to 2944 mg/d (P = 0·30) and 2875 mg/d (P ≤ 0·03) at 6- and 12-month follow-ups, respectively. In a sub-sample (urine volume of ≥1000 ml, baseline to 12 months), mean urinary Na excretion decreased from 3220 mg/d to 2875 mg/d (P ≤ 0·02).
Significant reductions in mean 24 h urinary Na were reported, but results fell short of the recommended guidelines of 1500 mg/d for at-risk individuals. Our results reiterate the difficulty in implementing these guidelines in community-based programmes. More aggressive public health efforts, food industry support and health policy changes are needed to decrease Na levels in older adults to the recommended guidelines.
IQ and Global Inequality is a sequel to the authors' earlier IQ and the Wealth of Nations wherein they argued that “… national differences in intelligence are an important factor contributing to differences in national wealth and rates of economic growth” (p. 2). Or, later more precisely stated, that “… national IQ is the single most powerful explanatory variable, but because the explained part of the variation does not rise higher than 40–60 percent, this explanation leaves room for other explanatory factors”(p. 13). Not surprisingly, even so qualified, this thesis triggered a “mixed reception.” As the authors relate with refreshing candor, some of the reviewers denounced them for “jumping to conclusions,” took issue with their “relatively weak statistical evidence and dubious presumptions,” found the study “neither methodologically nor theoretically convincing,” and dismissed the evidence as “virtually meaningless” (p. 3).