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New Zealand and Australian governments rely heavily on voluntary industry initiatives to improve population nutrition, such as voluntary front-of-pack nutrition labelling (Health Star Rating [HSR]), industry-led food advertising standards, and optional food reformulation programmes. Research in both countries has shown that food companies vary considerably in their policies and practices on nutrition(1). We aimed to determine if a tailored nutrition support programme for food companies improved their nutrition policies and practices compared with control companies who were not offered the programme. REFORM was a 24-month, two-country, cluster-randomised controlled trial. 132 major packaged food/drink manufacturers (n=96) and fast-food companies (n=36) were randomly assigned (2:1 ratio) to receive a 12-month tailored support programme or to the control group (no intervention). The intervention group was offered a programme designed and delivered by public health academics comprising regular meetings, tailored company reports, and recommendations and resources to improve product composition (e.g., reducing nutrients of concern through reformulation), nutrition labelling (e.g., adoption of HSR labels), marketing to children (reducing the exposure of children to unhealthy products and brands) and improved nutrition policy and corporate sustainability reporting. The primary outcome was the nutrient profile (measured using HSR) of company food and drink products at 24 months. Secondary outcomes were the nutrient content (energy, sodium, total sugar, and saturated fat) of company products, display of HSR labels on packaged products, company nutrition-related policies and commitments, and engagement with the intervention. Eighty-eight eligible intervention companies (9,235 products at baseline) were invited to participate, of whom 21 accepted and were enrolled in the REFORM programme (delivered between September 2021 and December 2022). Forty-four companies (3,551 products at baseline) were randomised to the control arm. At 24 months, the model-adjusted mean HSR of intervention company products was 2.58 compared to 2.68 for control companies, with no significant difference between groups (mean difference -0.10, 95% CI -0.40 to 0.21, p-value 0.53). A per protocol analysis of intervention companies who enrolled in the programme compared to control companies with no major protocol violation also found no significant difference (2.93 vs 2.64, mean difference 0.29, 95% CI -0.13 to 0.72, p-value 0.18). We found no significant differences between the intervention and control groups in any secondary outcome, except in total sugar (g/100g) where the sugar content of intervention company products was higher than that of control companies (12.32 vs 6.98, mean difference 5.34, 95% CI 1.73 to 8.96, p-value 0.004). The per-protocol analysis for sugar did not show a significant difference (10.47 vs 7.44, mean difference 3.03, 95% CI -0.48 to 6.53, p-value 0.09).In conclusion, a 12-month tailored nutrition support for food companies did not improve the nutrient profile of company products.
Background: Autonomic nervous system (ANS) dysfunction in people with epilepsy (PwE) is a likely contributor to sudden unexpected death in epilepsy (SUDEP). However, the nature of autonomic dysfunction among PwE remains poorly understood. We aimed to delineate self-reported ANS functioning among people with drug-resistant epilepsy, a patient group at increased risk for SUDEP. Methods: People with focal drug-resistant epilepsy undergoing stereoelectroencephalography at the Epilepsy Monitoring Unit in London, Ontario completed the Composite Autonomic Symptom Score (COMPASS-31), a widely used questionnaire for ANS function. Results: The mean total COMPASS-31 score (N=34; 13 females) was 27.36 (SD=13.77). There was no significant correlation between total COMPASS-31 score and current age (mean=32.71 years, SD=10.58; r(32)= -0.04) or age of epilepsy onset (mean=17.31 years, SD=8.26; r(30)=0). Females scored higher than males (t(32)=3.41, p<.05), but scores did not differ between participants with an epileptogenic zone in the temporal lobe(s) (N=20) and participants with multi-focal, extra-temporal or unknown epileptogenic zones (t(32)=0.18). Participants prescribed 2-3 sodium channel blocking anti-seizure medications (cardiotoxic; N=17), scored worse than participants on 0-1 sodium channel blockers (N=17) (t(32)= -2.15, p<.05). Conclusions: Autonomic testing should be a standard component of clinical care for people with drug-resistant epilepsy, especially for females and for those on sodium channel blockers.
Background: Mesial temporal lobe epilepsy (mTLE) is a heterogenous condition with variable post-surgical outcomes. Combining high resolution magnetic resonance imaging (MRI), stereoelectroencephalography (SEEG) and histology may establish different subtypes of mTLE. Methods: Retrospective analysis of patients with mTLE with 1) SEEG Patterns 2) MRI 3) Post temporal lobectomy tissue analysis 4) Engel Classification. HippUnfold method was used to segment hippocampus on MRI. Results: Of 109 patients investigated with SEEG, 11 patients were analyzed so far. Low voltage fast activity was seen in 215 seizures, low-frequency periodic spikes in 21, sharp activity at <13 Hz in 58, rhythmic spike sharp wave activity in 86, and other types were less frequent. MRI revealed unilateral mesial temporal sclerosis (MTS) in 6 (54.55%), bilateral MTS in 2 (18.18%), and was normal in 3 (27.27%) patients. Histopathology showed ILAE grade I in 3 (37.5 %), II in 4 (50 %), IV in 1 (12.5%) patient. 63.63% had Engel Class I at 6 months. HippUnfold analysis and SEEG electrode coregistration was done in one patient and will be attempted in the rest. Conclusions: Our study highlights a strong correlation between SEEG findings and histological analysis in mTLE. A multidimensional classification will help predict long term outcomes.
Mentored undergraduate research experiences (UREs) can play a critical role in developing science identity and skills, especially for students from historically underrepresented backgrounds. This study investigates science identity and responsibility for scientific roles among scholars in a program aiming to diversify the biomedical workforce. Scholars were placed in UREs at either their home institution (a minority-serving institution [MSI]) or at a research-intensive medical institution with a Clinical and Translational Science Award (CTSA).
Methods:
We analyze data from surveys administered annually to the scholars. We first compare changes in science identity for scholars placed at the MSI and the CTSA site from the term after the scholar started their URE to one year later. We then analyze differences in responsibility in scientific roles performed by scholars at the two institutions.
Results:
We found evidence of gains in science identity after a year for scholars placed at both institutions but of a somewhat larger magnitude at the CTSA site. However, no significant differences were observed across institutions on science identity at the endpoint. An exploration of scientific roles suggests that scholars at the CTSA site assumed more responsibility in roles related to data curation and analysis, while scholars at the MSI had higher responsibility for resource acquisition-related roles.
Conclusion:
These results suggest that CTSA site URE placements may offer distinct opportunities for both identity formation and skill development beyond placements at home institutions. Overall, these results suggest opportunities for partnerships between MSIs and CTSA sites in the training of biomedical researchers.
Cognitive behavioural therapists and practitioners often feel uncertain about how to treat post-traumatic stress disorder (PTSD) following rape and sexual assault. There are many myths and rumours about what you should and should not do. All too frequently, this uncertainty results in therapists avoiding doing trauma-focused work with these clients. Whilst understandable, this means that the survivor continues to re-experience the rape as flashbacks and/or nightmares. This article outlines an evidence-based cognitive behavioural therapy (CBT) approach to treating PTSD following a rape in adulthood. It aims to be a practical, ‘how to’ guide for therapists, drawing on the authors’ decades of experience in this area. We have included film links to demonstrate how to undertake each step of the treatment pathway. Our aim is for CBT practitioners to feel more confident in delivering effective trauma-focused therapy to this client group. We consider how to assess and formulate PTSD following a rape in adulthood, then how to deliver cognitive therapy for PTSD (CT-PTSD; Ehlers and Clark, 2000). We will cover both client and therapist factors when working with memories of rape, as well as legal, social, cultural and interpersonal considerations.
Key learning aims
To understand the importance of providing effective, trauma-focused therapy for survivors of rape in adulthood who are experiencing symptoms of PTSD.
To be able to assess, formulate and treat PTSD following a rape in adulthood.
How to manage the dissociation common in this client group.
To be able to select and choose appropriate cognitive, behavioural and imagery techniques to help with feelings of shame, responsibility, anger, disgust, contamination and mistrust.
For therapists to learn how best to support their own ability to cope with working in a trauma-focused way with survivors of rape and sexual violence.
Despite many reports of similar effectiveness between oral and intravenous antibiotics for bone and joint infections, prescribing practice has been slow to change in the United States. We sought to determine if implementing an intravenous-to-oral treatment guideline could increase prescribing of oral antibiotic regimens at our center.
Design:
Retrospective, quasi-experimental study.
Setting:
Single US academic medical center.
Patients:
Patients with bone or joint infections managed by Infectious Disease providers from September 2020 to December 2022.
Intervention:
An intravenous-to-oral treatment guideline for patients with bone and joint infections.
Methods:
The prescribing rates of fully oral antibiotic regimens before and after implementation of the guideline were compared. Additionally, variables independently associated with oral antibiotic prescribing were identified by logistic regression.
Results:
There were 450 patients included: 213 before and 237 after implementation of the guideline. Oral antibiotic prescribing significantly increased following implementation of the treatment guideline to 59% from 33% of patients (difference 25.8%, 95% CI [16.7%, 34.4%]. In multivariable analysis, the post-intervention phase was associated with a significantly greater likelihood of oral antibiotic prescribing (aOR 2.89 [1.90, 4.45]). Other variables independently associated with oral antibiotic prescribing included male sex (aOR 1.88 [1.20, 2.98]), prosthetic joint infection (aOR 0.29 [0.17, 0.47]), and infection with Enterobacterales (aOR 2.86 [1.45, 5.92]), methicillin-sensitive Staphylococcus aureus [aOR 0.41 [0.26, 0.65]), or coagulase-negative staphylococci (aOR 0.34 [0.18, 0.62]).
Conclusions:
Implementation of a treatment guideline resulted in a significant increase in oral antibiotic prescribing. Antimicrobial stewardship programs should implement similar interventions to improve outpatient antibiotic utilization.
The hemlock woolly adelgid, Adelges tsugae Annand (Hemiptera: Adelgidae), has distinct native and invasive populations in Canada. On the country’s west coast, the adelgid is a native insect that feeds on western hemlock, Tsuga heterophylla (Rafinesque-Schmaltz) Sargent, and mountain hemlock, Tsuga mertensiana (Bongard) Carrière (Pinaceae). In eastern Canada, the adelgid is an invasive species that attacks and kills eastern hemlock, Tsuga canadensis (Linnaeus) Carrière (Pinaceae). We obtained all Canadian records of A. tsugae in institutional and public databases, developed updated range maps and phenologies for the species in British Columbia and eastern Canada, and developed dispersal estimates for populations in Nova Scotia. In British Columbia, A. tsugae’s observed distribution is centred around the Lower Mainland and on Vancouver Island but with populations in the British Columbia Interior and along the Pacific coast that have been poorly explored. In eastern Canada, the adelgid has invaded southern Nova Scotia, portions of the Niagara region in Ontario as far west as Hamilton, and at least one site on the north shore of Lake Ontario. No populations have been found in New Brunswick, Quebec, or Prince Edward Island, Canada. Finally, we estimated the rate of spread in Nova Scotia at 12.6 ± 8.2 to 20.5 ± 27.21 km/year.
Both the speed and accuracy of responding are important measures of performance. A well-known interpretive difficulty is that participants may differ in their strategy, trading speed for accuracy, with no change in underlying competence. Another difficulty arises when participants respond slowly and inaccurately (rather than quickly but inaccurately), e.g., due to a lapse of attention. We introduce an approach that combines response time and accuracy information and addresses both situations. The modeling framework assumes two latent competing processes. The first, the error-free process, always produces correct responses. The second, the guessing process, results in all observed errors and some of the correct responses (but does so via non-specific processes, e.g., guessing in compliance with instructions to respond on each trial). Inferential summaries of the speed of the error-free process provide a principled assessment of cognitive performance reducing the influences of both fast and slow guesses. Likelihood analysis is discussed for the basic model and extensions. The approach is applied to a data set on response times in a working memory test.
England's primary care service for psychological therapy (Improving Access to Psychological Therapies [IAPT]) treats anxiety and depression, with a target recovery rate of 50%. Identifying the characteristics of patients who achieve recovery may assist in optimizing future treatment. This naturalistic cohort study investigated pre-therapy characteristics as predictors of recovery and improvement after IAPT therapy.
Methods
In a cohort of patients attending an IAPT service in South London, we recruited 263 participants and conducted a baseline interview to gather extensive pre-therapy characteristics. Bayesian prediction models and variable selection were used to identify baseline variables prognostic of good clinical outcomes. Recovery (primary outcome) was defined using (IAPT) service-defined score thresholds for both depression (Patient Health Questionnaire [PHQ-9]) and anxiety (Generalized Anxiety Disorder [GAD-7]). Depression and anxiety outcomes were also evaluated as standalone (PHQ-9/GAD-7) scores after therapy. Prediction model performance metrics were estimated using cross-validation.
Results
Predictor variables explained 26% (recovery), 37% (depression), and 31% (anxiety) of the variance in outcomes, respectively. Variables prognostic of recovery were lower pre-treatment depression severity and not meeting criteria for obsessive compulsive disorder. Post-therapy depression and anxiety severity scores were predicted by lower symptom severity and higher ratings of health-related quality of life (EuroQol questionnaire [EQ5D]) at baseline.
Conclusion
Almost a third of the variance in clinical outcomes was explained by pre-treatment symptom severity scores. These constructs benefit from being rapidly accessible in healthcare services. If replicated in external samples, the early identification of patients who are less likely to recover may facilitate earlier triage to alternative interventions.
Next generation high-power laser facilities are expected to generate hundreds-of-MeV proton beams and operate at multi-Hz repetition rates, presenting opportunities for medical, industrial and scientific applications requiring bright pulses of energetic ions. Characterizing the spectro-spatial profile of these ions at high repetition rates in the harsh radiation environments created by laser–plasma interactions remains challenging but is paramount for further source development. To address this, we present a compact scintillating fiber imaging spectrometer based on the tomographic reconstruction of proton energy deposition in a layered fiber array. Modeling indicates that spatial resolution of approximately 1 mm and energy resolution of less than 10% at proton energies of more than 20 MeV are readily achievable with existing 100 μm diameter fibers. Measurements with a prototype beam-profile monitor using 500 μm fibers demonstrate active readouts with invulnerability to electromagnetic pulses, and less than 100 Gy sensitivity. The performance of the full instrument concept is explored with Monte Carlo simulations, accurately reconstructing a proton beam with a multiple-component spectro-spatial profile.
The dynamic behaviour of granular media can be observed widely in nature and in many industrial processes. Yet, the modelling of such media remains challenging as they may act with solid-like and fluid-like properties depending on the rate of the flow and can display a varying apparent friction, cohesion and compressibility. Over the last two decades, the $\mu (I)$-rheology has become well established for modelling granular liquids in a fluid mechanics framework where the apparent friction $\mu$ depends on the inertial number $I$. In the geo-mechanics community, modelling the deformation of granular solids typically relies on concepts from critical state soil mechanics. Along the lines of recent attempts to combine critical state and the $\mu (I)$-rheology, we develop a continuum model based on modified cam-clay in an elastoplastic framework which recovers the $\mu (I)$-rheology under flow. This model permits a treatment of plastic compressibility in systems with or without cohesion, where the cohesion is assumed to be the result of persistent inter-granular attractive forces. Implemented in a two- and three-dimensional material point method, it allows for the trivial treatment of the free surface. The proposed model approximately reproduces analytical solutions of steady-state cohesionless flow and is further compared with previous cohesive and cohesionless experiments. In particular, satisfactory agreements with several experiments of granular collapse are demonstrated, albeit with shear bands which can affect the smoothness of the surface. Finally, the model is able to qualitatively reproduce the multiple steady-state solutions of granular flow recently observed in experiments of flow over obstacles.
Affective responses to the menstrual cycle vary widely. Some individuals experience severe symptoms like those with premenstrual dysphoric disorder, while others have minimal changes. The reasons for these differences are unclear, but prior studies suggest stressor exposure may play a role. However, research in at-risk psychiatric samples is lacking.
Methods
In a large clinical sample, we conducted a prospective study of how lifetime stressors relate to degree of affective change across the cycle. 114 outpatients with past-month suicidal ideation (SI) provided daily ratings (n = 6187) of negative affect and SI across 1–3 menstrual cycles. Participants completed the Stress and Adversity Inventory (STRAIN), which measures different stressor exposures (i.e. interpersonal loss, physical danger) throughout the life course, including before and after menarche. Multilevel polynomial growth models tested the relationship between menstrual cycle time and symptoms, moderated by stressor exposure.
Results
Greater lifetime stressor exposure predicted a more pronounced perimenstrual increase in active SI, along with marginally significant similar patterns for negative affect and passive SI. Additionally, pre-menarche stressors significantly increased the cyclicity of active SI compared to post-menarche stressors. Exposure to more interpersonal loss stressors predicted greater perimenstrual symptom change of negative affect, passive SI and active SI. Exploratory item-level analyses showed that lifetime stressors moderated a more severe perimenstrual symptom trajectory for mood swings, anger/irritability, rejection sensitivity, and interpersonal conflict.
Conclusion
These findings suggest that greater lifetime stressor exposure may lead to heightened emotional reactivity to ovarian hormone fluctuations, elevating the risk of psychopathology.
The composition and physical properties of three clay soils were altered by introducing aluminum under an electro-chemical gradient in order to evaluate the role of pH in controlling changes in soil composition and the feasibility of pH buffering during electrochemical treatment.
Both X-ray diffraction and selective chemical extraction methods were used to determine the distribution and mode of occurrence of aluminum in the treated samples. Aluminum was detected in the treated samples in both exchangeable form and as a hydroxy-aluminum interlayer. Aluminum oxide minerals such as gibbsite were not detected in any of the treated samples. Mineralization by aluminum ions was speeded and intensified in bentonite soils by buffering the catholyte with carbon dioxide.
Plasticity of bentonite soil samples from South Dakota was reduced markedly by electrochemical treatment, whereas the plasticity of an illite soil from Illinois and an illite-montmorillonite soil from Mississippi were relatively unaffected. Nearly all treated samples exhibited some degree of electrochemical induration or mineralization. Induration was most pronounced in bentonite soil samples with high water contents and alkaline pH largely because of hydroxy-aluminum interlayering in the ciay. On the other hand interlayering was negligible in illite soil samples with low pH; the main effect of electrochemical treatment in this case was the addition of aluminum in exchange sites.
Sperlingite, (H2O)K(Mn2+Fe3+)(Al2Ti)(PO4)4[O(OH)][(H2O)9(OH)]⋅4H2O, is a new monoclinic member of the paulkerrite group, from the Hagendorf-Süd pegmatite, Oberpfalz, Bavaria, Germany. It was found in corrosion pits of altered zwieselite, in association with columbite, hopeite, leucophosphite, mitridatite, scholzite, orange–brown zincoberaunite sprays and tiny green crystals of zincolibethenite. Sperlingite forms colourless prisms with pyramidal terminations, which are predominantly only 5 to 20 μm in size, rarely to 60 μm and frequently are multiply intergrown and are overgrown with smaller crystals. The crystals are flattened on {010} and slightly elongated along [100] with forms {010}, {001} and {111}. Twinning occurs by rotation about c. The calculated density is 2.40 g⋅cm–3. Optically, sperlingite crystals are biaxial (+), α = 1.600(est), β = 1.615(5), γ = 1.635(5) (white light) and 2V (calc.) = 82.7°. The optical orientation is X = b, Y = c and Z = a. Neither dispersion nor pleochroism were observed. The empirical formula from electron microprobe analyses and structure refinement is A1[(H2O)0.96K0.04]Σ1.00A2(K0.52□0.48)Σ1.00M1(Mn2+0.60Mg0.33Zn0.29Fe3+0.77)Σ1.99M2+M3(Al1.05Ti4+1.33Fe3+0.62)Σ3.00(PO4)4X[F0.19(OH)0.94O0.87]Σ2.00[(H2O)9.23(OH)0.77]Σ10.00⋅3.96H2O. Sperlingite has monoclinic symmetry with space group P21/c and unit-cell parameters a = 10.428(2) Å, b = 20.281(4) Å, c = 12.223(2) Å, β = 90.10(3)°, V = 2585.0(8) Å3 and Z = 4. The crystal structure was refined using synchrotron single-crystal data to wRobs = 0.058 for 5608 reflections with I > 3σ(I). Sperlingite is the first paulkerrite-group mineral to have co-dominant divalent and trivalent cations at the M1 sites; All other reported members have Mn2+ or Mg dominant at M1. Local charge balance for Fe3+ at M1 is achieved by H2O → OH– at H2O coordinated to M1.
Unhealthy food environments are major drivers of obesity and diet-related diseases(1). Improving the healthiness of food environments requires a widespread organised response from governments, civil society, and industry(2). However, current actions often rely on voluntary participation by industry, such as opt-in nutrition labelling schemes, school/workplace food guidelines, and food reformulation programmes. The aim of the REFORM study is to determine the effects of the provision of tailored support to companies on their nutrition-related policies and practices, compared to food companies that are not offered the programme (the control). REFORM is a two-country, parallel cluster randomised controlled trial. 150 food companies were randomly assigned (2:1 ratio) to receive either a tailored support intervention programme or no intervention. Randomisation was stratified by country (Australia, New Zealand), industry sector (fast food, other packaged food/beverage companies), and company size. The primary outcome is the nutrient profile (measured using Health Star Rating [HSR]) of foods and drinks produced by participating companies at 24 months post-baseline. Secondary outcomes include company nutrition policies and commitments, the nutrient content (sodium, sugar, saturated fat) of products produced by participating companies, display of HSR labels, and engagement with the intervention. Eighty-three eligible intervention companies were invited to take part in the REFORM programme and 21 (25%) accepted and were enrolled. Over 100 meetings were held with company representatives between September 2021 and December 2022. Resources and tailored reports were developed for 6 touchpoints covering product composition and benchmarking, nutrition labelling, consumer insights, nutrition policies, and incentives for companies to act on nutrition. Detailed information on programme resources and preliminary 12-month findings will be presented at the conference. The REFORM programme will assess if provision of tailored support to companies on their nutrition-related policies and practices incentivises the food industry to improve their nutrition policies and actions.
The eight well-known food security indicators were developed in 1997 using a stepwise process that involved five focus group interviews (one Māori, one Pakeha, two Pacific, and one mixed ethnicity) of 8-16 people, all of whom were either on a low income or were government beneficiaries(1). As part of the development of the tools and methods for a future New Zealand National Nutrition Survey, these eight indicators were considered for inclusion. The Māori and Technical Advisory Groups convened for the development of the National Nutrition Survey foresaw issues with the interpretation of some of the questions given the changes in the food environment and sources of food assistance in the last 25 years and recommended that cognitive testing should be conducted to see if changes were required. Participants were recruited through two community organisations, a local marae, and community Facebook pages. Participants were given the option of participating in a one-on-one interview or as part of a focus group. During each session, participants were asked five (three original and two new) questions relating to food security (running out of basics, use of food assistance, household food preparation and storage resources). After each question, the participants were asked a series of additional probing questions to ascertain whether they had interpreted the question as intended. All interviews were audio recorded and transcribed, and a qualitative analysis was performed on the transcripts to determine areas of concern with each question. A total of 46 participants completed the cognitive testing of the food security questions, including 26 aged 18-64 years, and 20 aged 65+ years. Participants also spanned a range of ethnicities including 8 Māori, 15 Pasifika, 15 Asian, and 8 New Zealand European or Other. Just over half of the participants (n=24) reported themselves to be financially secure, 16 participants reported that their financial security was borderline, 1 participant reported that they were not at all financially secure, and 5 participants declined to answer. Variable interpretations of terms by participants were found in all questions that were tested. Therefore, answers to the food security questions may have not reflected the actual experience of participants. This study also identified other dimensions of food security not assessed by the current eight indicators (e.g., lack of time, poor accessibility). These findings indicate that the food security questions need to be improved to ensure they are interpreted as intended and that new questions are needed that considers all dimensions of food insecurity (i.e., access, availability, utilisation, and stability). These new and amended questions should be cognitively tested in groups that are more likely to be experiencing food insecurity.
National nutrition surveys play a pivotal role in shaping public health policies and programmes by providing valuable insights into dietary intake and the nutritional wellbeing of a population. A team from the University of Auckland and Massey University worked alongside the Ministry of Health and the Ministry for Primary Industries to develop the methods and tools for a future New Zealand Nutrition Survey. Throughout these developmental stages, we partnered and engaged with Māori as tangata whenua, and other key ethnic groups in Aotearoa - New Zealand, ensuring that their unique dietary practices and preferences were accurately captured. This presentation centres on the adaptation of Intake24, an innovative web-based 24-hour dietary recall tool, to optimize dietary data collection within the New Zealand context. The adaptation process involved several key steps including rationalisation of a New Zealand-specific food list, incorporating cultural dishes, adding new portion size estimation aids, and further customisation of the user interface(1). We provide new insights into the user experience and the tool’s functionality, sharing findings from field testing and valuable user feedback. This approach ensures collection of dietary data that is truly representative of the New Zealand population and acknowledges the rich diversity and dietary nuances within the country. As such, this adapted New Zealand version of Intake24 could serve as an essential tool for use in a future National Nutrition Survey or other research initiatives to collect accurate, culturally sensitive, and actionable nutrition data providing evidence to inform future public health programmes and policies.
To compare outcomes between patients discharged on intravenous (IV) versus oral (PO) antibiotics for the treatment of orthopedic infections, after creation of an IV-to-PO guideline, at a single academic medical center in the United States.
Methods:
This was a retrospective, propensity score matched, cohort study of adult patients hospitalized for orthopedic infections from September 30, 2020, to April 30, 2022. Patients discharged on PO antibiotics were matched to patients discharged on IV antibiotics. The primary outcome was one-year treatment failure following discharge. Secondary outcomes were incidence of 60-day treatment failure, adverse drug events (ADE), readmissions, infectious disease clinic “no-show” rates, and emergency department (ED) encounters.
Results:
Ninety PO-treated patients were matched to 90 IV-treated patients. Baseline characteristics were similar in the two groups after matching. There was no significant difference in the proportions of patients on PO versus IV antibiotics experiencing treatment failure at one year (26% vs 31%, P = .47). There were no significant differences for any secondary outcomes: treatment failure within 60 days (13% vs 14%, P = 1.00), ADE (13% vs 11%, P = .82), unplanned readmission (17% vs 21%, P = .57), or ED encounters (9% vs 18%, P = .54). Survival analyses identified no significant differences in time-to-event between PO and IV treatment for any of the outcomes assessed.
Conclusions:
There were no appreciable differences in outcomes between patients discharged on PO compared to IV regimens. Antimicrobial stewardship interventions to increase prescribing of PO antibiotics for the treatment of orthopedic infections should be encouraged.