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To assess whether antibiotic duration (AD) and one-year antibiotic-free days (AFD) are associated with key in-hospital and post-discharge outcomes among critically ill adults.
Design:
Prospective observational study.
Setting:
611-bed, quaternary care academic medical center in the United States.
Patients:
126 critically ill adults (mean age 68.1 ± 15.6 yr, 51.6% male, median APACHE II score 20.5 [IQR 15–25]); 71.4% met sepsis criteria.
Methods:
Secondary infection was defined as ≥3 consecutive antibiotic days within a year after the index sepsis admission. Multivariate analyses adjusted for age, APACHE II score, BMI, and glucocorticosteroid dose. Time-to-event analysis employed Cox proportional hazards modeling; cumulative infection burden was assessed via nonparametric tests using normalized antibiotic exposure (AD as a proportion of days alive).
Results:
Within 30 days, longer AD correlated with increased hospital stay; each additional antibiotic day added ∼0.93 hospital days (P < 0.001) in adjusted linear regression. AD did not predict one-year mortality (OR 1.01, P = 0.739) or readmission (OR 1.01, P = 0.771). Normalized antibiotic exposure significantly differed by cumulative secondary infection episodes (P = 0.0033), with higher exposure among patients experiencing two or more secondary infections (P = 0.026 and P = 0.036, respectively). Cox regression showed a significant association between AD and time to first secondary infection (HR 1.10, 95% CI: 1.04–1.15, P = 0.001), indicating that longer AD predisposed to secondary infection or recurrent antibiotic use.
Conclusions:
Extended AD, in critically ill patients, prolongs hospitalization without reducing mortality or readmission rates. These findings highlight the importance of robust antibiotic stewardship practices, where shorter, targeted regimens may minimize unintended complications.
Single-ended and balanced 90–120 GHz microstrip power amplifier MMICs have been designed for cost-sensitive 5G and 6G backhaul in a commercial 6-inch, 0.1-µm GaAs process. At 108 GHz, measured output power is 20.4 and 22.5 dBm, respectively. At 120 GHz, measured output is 12.6 and 17.4 dBm, respectively. This is the highest reported for GaAs, among the highest reported to date for microstrip MMIC amplifiers at these frequencies and competitive with more expensive InP and GaN processes. Measurement is compared with simulation.
People with schizophrenia die almost 20 years earlier than the general population, most commonly from avertable cardiometabolic disease. Existing pharmacological weight-loss agents including metformin have limited efficacy. Recently available glucagon-like peptide (GLP-1) receptor agonists such as semaglutide have shown promise for weight loss but have yet to be trialled in this population.
Aims
To examine the efficacy of semaglutide to ameliorate antipsychotic-induced obesity in people with schizophrenia who have been treated with clozapine for more than 18 weeks.
Method
This is a 36-week, double-blinded, randomised placebo-controlled trial. We will recruit 80 clozapine-treated patients with schizophrenia or schizoaffective disorder, aged 18–64 years, with a baseline body mass index ≥26 kg/m2, who will be randomised to subcutaneous semaglutide of 2.0 mg once a week or placebo for 36 weeks. The primary endpoint will be percentage change in body weight from baseline.
Results
This trial will assess the efficacy and side-effects of the GLP-1 receptor agonist semaglutide on body weight and provide evidence on the possible clinical utility of semaglutide in patients with inadequate response to metformin. The study is registered with the Australian New Zealand Clinical Trials Registry (www.anzctr.org.au) with clinical trial registration number ACTRN12621001539820.
Conclusion
This research could benefit individuals with schizophrenia who experience significant health issues, leading to premature mortality, owing to antipsychotic-induced weight gain. Study findings will be disseminated through peer-reviewed publications and conference presentations.
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
Children with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.
Materials and methods
We sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.
Results
A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.
Conclusions
The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
We summarize here data on in situ nitrate ion concentrations in snow pits and firn cores over the last ∼3 250 a. Nitrate fluctuations show seasonal, 11 and 22 a periodicities, and long-term changes both at South Pole station and Vostok. High nitrate levels conform to winter darkness and solar activity peaks. Long-term lows and highs conform to solar activity minima and maxima. The data available support the hypothesis that nitrate is fixed in the upper atmosphere by some solar-mediated phenomenon causing a periodicity in East Antarctica snow. Background levels and non-periodic spikes in nitrate come from other sources.
A literature-based compilation of phylogenetic relationships and biometric measurements of 342 Cenozoic planktonic foraminiferal species suggests that the group shows a net increase in size through the Cenozoic, thus appearing to follow Cope's Rule of phyletic size increase. However, when the data are corrected for size-related biases, they do not support the hypothesis that this apparent trend is driven by an organismal adaptive advantage of larger size.
When the planktonic foraminifera return to their “primitive” globigerine morphology during the Eocene-Oligocene transition, there is no indication of size-dependent origination or extinction; however, when the extinction signal is decomposed into pseudoextinctions and true lineage terminations, a differential pulse of pseudoextinction is observed among the smaller forms. This observation suggests that smaller bodied species, rather than surviving stressful times with static morphologies, may evolve their way through times of crisis and go on to found lineages which, by virtue of their initial small size, are stochastically likely to increase in mean size during subsequent diversification. Thus, one general explanation for Cope's Rule might be that smaller bodied species are more adaptively responsive due to their tendency to have shorter generation times. During times of stress, this adaptive responsiveness may give them an advantage that is correlated with, but causally unrelated to, their size.
The evolutionary origin of Morozovella angulata from its immediate ancestor, Praemurica uncinata, is preserved in Paleocene sediments from the Gulf of Mexico. This event represents the beginning of the morozovellid radiation and marks the first appearance of keeled planktonic foraminifera after the Cretaceous/Tertiary extinction. Parallel biometric and isotopic analyses were performed on size-segregated specimens from a succession of stratigraphic horizons. The biometric data reveal a temporal pattern of variation consistent with paedomorphosis. The appearance of angulose juvenile chambers in the otherwise rounded ancestral form (Praemurica uncinata) results in an allometry that becomes more pronounced upsection. At the origin of M. angulata, the juvenile morphology of the ancestor is retained throughout the entire ontogeny. Isotopic analysis of this sequence reveals the gradual acquisition of an increasingly heavy adult δ13C signal relative to that of the juvenile, while the δ18O data display no temporal or size-related trends. The temporal increase seen in the slope of the δ13C/size relationship may reflect the evolution of an increased dependency on photosymbionts.
Background: Research suggests that core schemas are important in both the development and maintenance of psychosis. Aims: The aim of the study was to investigate and compare core schemas in four groups along the continuum of psychosis and examine the relationships between schemas and positive psychotic symptomatology. Method: A measure of core schemas was distributed to 20 individuals experiencing first-episode psychosis (FEP), 113 individuals with “at risk mental states” (ARMS), 28 participants forming a help-seeking clinical group (HSC), and 30 non-help-seeking individuals who endorse some psychotic-like experiences (NH). Results: The clinical groups scored significantly higher than the NH group for negative beliefs about self and about others. No significant effects of group on positive beliefs about others were found. For positive beliefs about the self, the NH group scored significantly higher than the clinical groups. Furthermore, negative beliefs about self and others were related to positive psychotic symptomatology and to distress related to those experiences. Conclusions: Negative evaluations of the self and others appear to be characteristic of the appraisals of people seeking help for psychosis and psychosis-like experiences. The results support the literature that suggests that self-esteem should be a target for intervention. Future research would benefit from including comparison groups of people experiencing chronic psychosis and people who do not have any psychotic-like experiences.
Circuits exhibit a variety of operational traits that are far from the behavior presented in introductory circuit design textbooks. Transistor characteristics curves vary significantly depending on how they are measured and on the history of electrical conditions. The characteristics are not always repeatable, which raises the dilemma of the choice of which characteristic to base a design upon.
The central idea behind pulse measurements is that the high-frequency characteristics of a device are a function of a quiescent operating condition. Pulse techniques attempt to determine these in an invariable operating condition. If short enough pulses are used, a pulse measurement at a specific condition of operation gives the characteristics that a high-frequency signal would encounter. This is a simple idea, but there is a practical limit to how short the pulses can be, so it is then necessary to draw upon radio-frequency techniques to probe past higher-frequency anomalies in the characteristics.
Dynamic processes and interactions in active elements produce seemingly complicated electrical characteristics that are best explored with pulse and RF techniques. These processes can be traced to mechanisms of self-heating by power dissipation, bias-dependent change in trapped charges, and to impact ionization and breakdown.
This chapter covers a set of topics that provide a foundation for understanding the pulse measurement technique augmented with RF measurements. Pulse characterization techniques dovetail with RF and nonlinear techniques to explore transistor dynamics for small-signal and nonlinear applications.
Background: A cognitive model of psychosis suggests that appraisals of psychotic-like experiences (PLEs), and the subsequent responses adopted, are responsible for the maintenance of distress and disability associated with psychosis. Aims: This study aimed to investigate whether it is possible to manipulate appraisals of an anomalous experience in people at risk of psychosis and whether this affects levels of distress. Method: Participants who had experienced an “at risk mental state” (ARMS) within the past year, were randomized to one of two groups and received either negative or neutral information pertaining to an anomalous experience (a card trick). Participants completed a questionnaire measuring PLEs, then completed pre and post measures of distress and anxiety in relation to the card trick. Participants were also asked to rate a series of psychotic or non-psychotic appraisals regarding how they thought the card trick worked. Results: Data analysis revealed that distress and anxiety were not related to the information group assigned (our experimental manipulation was unsuccessful). However, when analyzed as one group, higher conviction in non-psychotic appraisals was found to be related to lower levels of distress and state anxiety. Conclusions: The findings provide some validation for a relationship between appraisals and distress. Clinical implications, methodological limitations and possible future research directions are discussed.
We have found the central star of Abell 70 (PN G038.1–25.4, hereafter A 70) to be a binary consisting of a G8 IV-V secondary and a hot white dwarf. The secondary shows enhanced Ba II and Sr II features, firmly classifying it as a barium star. The nebula is found to have Type-I chemical abundances with helium and nitrogen enrichment, which combined with future abundance studies of the central star, will establish A 70 as a unique laboratory for studying s-process AGB nucleosynthesis.
Background. There have been recent advances in the ability to identify people at high risk of developing psychosis. This has led to interest in the possibility of preventing the development of psychosis and provides the opportunity to investigate psychological mechanisms that may confer vulnerability to psychosis.
Method. Fifty-eight patients at ultra-high risk of developing a first episode of psychosis were compared with 56 non-patients matched for age and occupational status on measures of meta-cognition, schizotypal traits, dysfunctional attitudes and distress.
Results. Analyses of covariance revealed that people at high risk of developing psychosis scored higher on measures of cognitive vulnerability, including negative meta-cognitive beliefs, beliefs about rejection and criticism from others, and discrepancies in self-perception, schizotypal traits and general mental distress. Correlational analyses revealed that negative meta-cognitive beliefs, dysfunctional attitudes and beliefs about rejection and criticism from others were positively associated with several dimensions of symptomatology in at-risk mental states (ARMS) patients.
Conclusions. Cognitive and personality factors appear to characterize people at high-risk of developing psychosis and are associated with their distressing experiences. The clinical implications of these findings are discussed.
Advances in the ability to identify people at high risk of developing psychosis have generated interest in the possibility of preventing psychosis.
Aims
To evaluate the efficacy of cognitive therapy for the prevention of transition to psychosis.
Method
A randomised controlled trial compared cognitive therapy with treatment as usual in 58 patients at ultra-high risk of developing a first episode of psychosis. Therapy was provided over 6 months, and all patients were monitored on a monthly basis for 12 months.
Results
Logistic regression demonstrated that cognitive therapy significantly reduced the likelihood of making progression to psychosis as defined on the Positive and Negative Syndrome Scale over 12 months. In addition, it significantly reduced the likelihood of being prescribed antipsychotic medication and of meeting criteria for a DSM – IV diagnosis of a psychotic disorder. Analysis of covariance showed that the intervention also significantly improved positive symptoms of psychosis in this population over the 12-month period.
Conclusions
Cognitive therapy appears to be an acceptable and efficacious intervention for people at high risk of developing psychosis.