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Cinq générations doivent actuellement cohabiter sur le marché du travail, ce qui peut entraîner plusieurs bénéfices, mais également un risque de tensions et de conflits susceptibles de nuire à la collaboration des équipes de travail et à la santé des personnes vieillissantes. La coopération intergénérationnelle au travail (CIT) a été relevée dans la littérature comme une avenue intéressante pour diminuer le risque de conflits intergénérationnels, mais elle demeure peu concrètement définie. Cette étude vise à proposer une définition opérationnelle du concept de coopération intergénérationnelle au travail à l’aide de la méthode d’analyse de Walker and Avant (2019). Quarante-huit manuscrits ont été répertoriés, permettant d’identifier huit attributs caractérisant la CIT, sept antécédents et six conséquents du concept. Cette étude fait ressortir le rôle des différents acteurs dans la CIT, met en lumière les bénéfices de la CIT et permet de considérer son rôle en prévention des lésions professionnelles.
In major depressive disorder (MDD), only ~35% achieve remission after first-line antidepressant therapy. Using UK Biobank data, we identify sociodemographic, clinical, and genetic predictors of antidepressant response through self-reported outcomes, aiming to inform personalized treatment strategies.
Methods
In UK Biobank Mental Health Questionnaire 2, participants with MDD reported whether specific antidepressants helped them. We tested whether retrospective lifetime response to four selective serotonin reuptake inhibitors (SSRIs) (N = 19,516) – citalopram (N = 8335), fluoxetine (N = 8476), paroxetine (N = 2297) and sertraline (N = 5883) – was associated with sociodemographic (e.g. age, gender) and clinical factors (e.g. episode duration). Genetic analyses evaluated the association between CYP2C19 variation and self-reported response, while polygenic score (PGS) analysis assessed whether genetic predisposition to psychiatric disorders and antidepressant response predicted self-reported SSRI outcomes.
Results
71%–77% of participants reported positive responses to SSRIs. Non-response was significantly associated with alcohol and illicit drug use (OR = 1.59, p = 2.23 × 10−20), male gender (OR = 1.25, p = 8.29 × 10−08), and lower-income (OR = 1.35, p = 4.22 × 10−07). The worst episode lasting over 2 years (OR = 1.93, p = 3.87 × 10−16) and no mood improvement from positive events (OR = 1.35, p = 2.37 × 10−07) were also associated with non-response. CYP2C19 poor metabolizers had nominally higher non-response rates (OR = 1.31, p = 1.77 × 10−02). Higher PGS for depression (OR = 1.08, p = 3.37 × 10−05) predicted negative SSRI outcomes after multiple testing corrections.
Conclusions
Self-reported antidepressant response in the UK Biobank is influenced by sociodemographic, clinical, and genetic factors, mirroring clinical response measures. While positive outcomes are more frequent than remission reported in clinical trials, these self-reports replicate known treatment associations, suggesting they capture meaningful aspects of antidepressant effectiveness from the patient’s perspective.
We compared two Candida auris screening strategies in high-risk patients.
The positivity rates for point prevalence survey (PPS) and admission screening were similar: 3.9% versus 3.4%, respectively, P = 1.00. Approximately 3% of high-risk patients are colonized, thus there is a need for a universal infection prevention approach for C. auris.
In June of 2024, Becton Dickinson experienced a blood culture bottle shortage for their BACTEC system, forcing health systems to reduce usage or risk exhausting their supply. Virginia Commonwealth University Health System (VCUHS) in Richmond, VA decided that it was necessary to implement austerity measures to preserve the blood culture bottle supply.
Setting:
VCUHS includes a main campus in Richmond, VA as well as two affiliate hospitals in South Hill, VA (Community Memorial Hospital (CMH)) and Tappahannock Hospital in Tappahannock, VA. It also includes a free-standing Emergency Department in New Kent, VA.
Patients:
Blood cultures from both pediatric and adult patients were included in this study.
Interventions:
VCUHS intervened to decrease blood culture utilization across the entire health system. Interventions included communication of blood culture guidance as well as an electronic health record order designed to guide providers and discourage wasteful ordering.
Results:
Post-implementation analyses showed that interventions reduced overall usage by 35.6% (P < .0001) and by greater than 40% in the Emergency Departments. The impact of these changes in utilization on positivity were analyzed, and it was found that the overall positivity rate increased post-intervention from 8.8% to 12.1% (P = .0115) and in the ED specifically from 10.2% to 19.5% (P < .0001).
Conclusions:
These findings strongly suggest that some basic stewardship interventions can significantly change blood culture practice in a manner that minimizes the impact on patient care.
The study objective was to develop and validate a clinical decision support system (CDSS) to guide clinicians through the diagnostic evaluation of hospitalized individuals with suspected pulmonary tuberculosis (TB) in low-prevalence settings.
Methods:
The “TBorNotTB” CDSS was developed using a modified Delphi method. The CDSS assigns points based on epidemiologic risk factors, TB history, symptoms, chest imaging, and sputum/bronchoscopy results. Below a set point threshold, airborne isolation precautions are automatically discontinued; otherwise, additional evaluation, including infection control review, is recommended. The model was validated through retrospective application of the CDSS to all individuals hospitalized in the Mass General Brigham system from July 2016 to December 2022 with culture-confirmed pulmonary TB (cases) and equal numbers of age and date of testing-matched controls with three negative respiratory mycobacterial cultures.
Results:
104 individuals with TB (cases) and 104 controls were identified. Prior residence in a highly endemic country, positive interferon release assay, weight loss, absence of symptom resolution with treatment for alternative diagnoses, and findings concerning for TB on chest imaging were significant predictors of TB (all P < 0.05). CDSS contents and scoring were refined based on the case–control analysis. The final CDSS demonstrated 100% sensitivity and 27% specificity for TB with an AUC of 0.87.
Conclusions:
The TBorNotTB CDSS demonstrated modest specificity and high sensitivity to detect TB even when AFB smears were negative. This CDSS, embedded into the electronic medical record system, could help reduce risks of nosocomial TB transmission, patient-time in airborne isolation, and person-time spent reviewing individuals with suspected TB.
This thirteen-year ethnography investigates how two Wall Street banks instantiated dualism in practice and what the evolving consequences were for bankers and the organizations that they joined after their careers at the banks. The banks dualistically split visible controls that targeted the mind, such as autonomy and work-life balance narratives, from unobtrusive controls that targeted the body, bypassed the mind, and intensified the pace of work in ways that bankers experienced as self-chosen. These practices caused evolving forms of dualistic embodiment. During the first four years, bankers identified with their minds and treated their bodies as unproblematic objects. Starting with year 4, body breakdowns occurred; the body imposed itself as an antagonist. Desperate to perform, bankers pushed harder, which caused more severe breakdowns that eventually forced some to treat the body as a knowledgeable subject that can direct action. The bankers implemented the banks’ practices in the organizations they joined subsequently, intending to enhance autonomy, but unintentionally replicating indiscriminate overwork for all participants. As they experienced more severe breakdowns, some bankers followed their bodies’ guidance into new ways of living. Dualism thus followed a dialectic pattern, first intensifying the body repression until breakdowns turned passive bodies into revolutionary forces.
This interdisciplinary study contributes to the understanding of the use of raw materials and pottery production techniques in Late Punic–Late Republican Malta, focusing on the Tas-Silġ sanctuary and the Żejtun Villa. Plates, bowls and cooking vessels were described typologically, and their fabrics were characterised using polarised light microscopy and Energy Dispersive X-Ray Fluorescence. The aims were to classify these vessels into integrated and coherent fabric groups based on all analyses, to better understand the local production of vessels and to assess a possible local provenance.
Four integrated fabric groups were identified and represent local productions using distinct raw materials or production techniques. These groups can be distinguished typologically, macroscopically, petrographically and chemically. Multivariate techniques, including the chemical analysis of Maltese clays, were produced to enhance the fabric classification and discuss their raw materials. The raw materials identified are consistent with what is known in Maltese geology. One group is distinctive, and the results suggest the possible use of a previously unidentified raw material, Terra Rossa, found over the Upper Coralline Limestone. This new classification provides the basis for further studies of Late Punic–Roman sites in the Maltese islands and the future identification of imports and exports from the Maltese islands.
Candida auris is an emerging pathogen responsible for healthcare-associated infections and outbreaks. This organism has a high tolerance to both high temperatures and high salinity. We describe our experience with a C. auris outbreak in an 8-bed inpatient burn unit at an academic medical center.
Alpine plant species are particularly vulnerable to climate change. Temperature fluctuations are projected to be most severe at high elevations. Even small shifts in temperature have major consequences on phenology, reproduction, and community composition. Early life stages are arguably the most important processes in the fitness of an individual plant and the dynamics and persistence of plant populations. These initial developmental stages are expected to be more vulnerable to changes in climate than adult life stages. To understand how early life stages of alpine plant species will respond to warming temperatures, seeds and seedlings of two species were exposed to three different temperature regimes. Temperatures were based on current and projected conditions under low and high emission scenarios. Two rare alpine species performed better under warmer temperatures at both the germination and seedling stages. The results show that early life stages of alpine plants may not be at high risk from warming temperatures; however, there are many other shifting climatic factors to consider, resulting from climate change beyond temperature alone.
We offer in this chapter an overview of the state of research on organization members’ responses to organizational change since the publication of the first edition of the book. We also review this edition’s structure and content.