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Enrollment into a prospective cohort study of mother–preterm infant dyads during the COVID-19 pandemic progressed slower than anticipated. Enrollment occurred during the first week after preterm birth, while infants were still hospitalized. We hypothesized that slower enrollment was attributable to mothers testing positive for COVID-19 as hospital policies restricted them from entering the neonatal intensive care unit, thus reducing interactions with research staff. However, only 4.5% of 245 screened mothers tested COVID-19 positive. Only 24.9% of those screened, far fewer than anticipated, were eligible for enrollment. Assumptions about pandemic-related enrollment barriers were not substantiated in this pediatric cohort.
Clostridioides difficile infection (CDI) is a common nosocomial infection and is associated with a high healthcare burden due to high rates of recurrence. In 2021 the IDSA/SHEA guideline update recommended fidaxomicin (FDX) as first-line therapy. Our medical center updated our institutional guidelines to follow these recommendations, prioritizing FDX use among patients at high risk for recurrent CDI (rCDI).
Methods:
This pre- post- quasi-experimental study included patients with a presumptive diagnosis of CDI at risk for recurrence (age >/= 65 years, immunocompromised, severe CDI) that received vancomycin (VAN) or FDX between October 2019 to October 2022. Patients who received bezlotoxumab, had fulminant CDI, or received <10 days of the same antibiotic for their full treatment course were excluded. Patients were evaluated for rCDI within 8 weeks of completion of therapy, subsequent episodes of CDI within 12 months, and CDI-related admissions within 30 days.
Results:
Of 397 CDI regimens evaluated, 196 received VAN and 201 received FDX. Rates of rCDI (9.2% vs 10%, P = 0.86), subsequent CDI within 12 months of therapy completion of therapy (19.4% vs 26%, P = 0.12) and 30-day CDI-related readmissions (3% vs 4.5%, P = 0.6) were similar between patients who received VAN versus FDX.
Conclusion:
Outcomes were similar between patients treated with FDX and VAN for the treatment of CDI among those at high risk for rCDI, using our outlined criteria. Although we observed a trend toward lower rates of rCDI among immunocompromised patients, this finding was not significant. Further investigation is needed to determine which patients with CDI may benefit from FDX.
Lough Hyne (LH) Marine Nature Reserve in Ireland is a globally recognised biodiversity hotspot that hosts mesophotic-like communities in shallow water, however, major changes have occurred to most of the rocky cliff (>6 m) communities in one or more events between 2010 and 2015. To provide insights into these changes, we compared the sponge assemblage composition on the undersides of different sized, shallow (<1 m) subtidal boulders between 2000 and 2022 at two sites in LH. We also measured sponge species richness at seven sites in 2018. We found that unlike earlier reports from the deeper subtidal reef sponge assemblages, there was no evidence for changes in sponge assemblage composition on the undersides of boulders at either site. We also found high levels of sponge species richness at all seven sites sampled in 2018. We did find differences in sponge assemblages between sites and for different boulder sizes, which we propose is a result of site-specific environmental conditions and disturbance and size–area relationships. Since we found no changes in the shallow subtidal sponge assemblages between 2000 and 2022, our results support the hypothesis that changes to the deeper subtidal sponge assemblages at LH are driven by local processes associated with deeper water in LH, potentially related to the seasonal oxythermocline that forms within LH. Given the national and global importance of LH, understanding the drivers of change is critical to determine if management actions can prevent any future alterations to the LH sponge assemblages and support wider mesophotic community management.
Medical Emergencies in A Mental Health Setting (MEAMS) was a proposed high-fidelity simulation training course specifically designed for the mental health multidisciplinary team (MDT). A team of resus officers, mental health nurses and psychiatric doctors worked to create scenarios reflecting the emergencies encountered in mental health. It aimed to gives staff simulated experience in approaching and managing a verity of complex emergencies, including physical health, as well as communication scenarios. Specifically the aims were: (1) Determine if course was perceived to benefit staff, (2) Determine if course subjectively increased staff knowledge and confidence in mental health emergencies, (3) Review for continued areas of improvement
Methods
The full day sessions were carried out in the Electroconvulsive therapy (ECT) suite, with it being modified into an immersive environment similar to wards or clinics. The faculty of medical resus officers, mental health nurses and psychiatric consultants ran the courses, with participants joining from across the MDT including nursing staff, junior doctors, consultants, students and nursing assistants.
The morning program, run by resus officers, provided education in life support, initial assessment of the unwell patient and intraosseous access. The afternoon contained various scenarios, including for example managing neuroleptic malignant syndrome. Scenarios were observed via video link by faculty, with constructive feedback and debriefs provided.
Quantitative data of knowledge and confidence was obtained pre and post sessions using Likert scales. Qualitative information regarding future proposed scenarios, areas of improvement and areas of notable value was gathered.
Results
36 staff attended the program, run over 4 days. Average knowledge and confidence (scored out of 10) improved from 4.9 pre-session to 8.1 post-session. All 36 staff felt the session was beneficial. Particular positive feedback on scenario realism, MDT working, safe/ supportive teaching and the resus faculty teaching was highlighted.
Areas for improvement highlighted included running sessions more often, widening accessibility to more staff and teaching on resus medications and fluids. A variety of further scenarios were suggested, for example management of withdrawal seizure.
Conclusion
MEAMS was felt to achieve its aims, and demonstrated clear subjective increase in staff knowledge and confidence regarding common emergencies seen in mental health settings. Further sessions and wider accessibility to the mental health MDT is anticipated to continually benefit staff. Taking on qualitative feedback, the faculty aims to continually adapt the program to provide the best possible training and education, adapting and creating new relevant scenarios.
Organisms have been observing the behavior of other organisms for as long as there have been organisms. As humans, we are especially good at paying attention to cues from other humans and are acutely aware that people differ from each other. Astute observers of animal behavior have long noticed that individuals behave differently from one another, and a quick scan of popular YouTube channels devoted to individual pet cats strongly suggests that interest in the uniqueness of individual animals remains strong. What might be more surprising is that individual variation in nonhuman animals is no longer considered a mere curiosity in scientific circles: Over the past fifteen and more years individual variation in nonhuman animals (so called “animal personality”) has attracted the attention of animal behaviorists, who are now pursuing it as a serious research topic.
The aim of the present study was to determine the efficacy of a small-group reading instruction program that was delivered over two school terms to Australian students in Years 3 through 6. A large cohort (n = 239) of primary school children was assessed on their literacy skills before and after receiving ‘MacqLit’, a phonics-based program designed for older struggling readers. Parametric and nonparametric difference tests were used to compare results at pre- and postintervention time points. Statistically significant improvements with large effect sizes were observed on all raw score measures of word reading, nonword reading, passage reading and spelling. Statistically significant improvements were also observed on standard score measures of nonword reading and passage reading, suggesting the gains were greater than what might be expected to have resulted from typical classroom instruction. The results indicate that older middle primary school-aged students may benefit from phonics-based, small-group reading instruction.
To assess patterns and levels of dietary supplement use among Australian Defence Forces, previously deployed to the Middle East Area of Operations.
Design
A cross-sectional study. Participants of a large survey self-completed questions about dietary supplement use, health status, personal and job-related characteristics, and lifestyle factors. Frequency of current use of supplements was assessed in three categories (bodybuilding, energy and weight loss).
Setting
Middle East Area of Operations post-deployment health survey.
Subjects
Current and ex-serving Australian Defence Force personnel (n 14 032) who deployed to the Middle East between 2001 and 2009.
Results
Bodybuilding supplements were used by 17·5 % of participants, energy supplements by 24·5 % and weight-loss supplements by 7·6 %. Overall, 32·3 % of participants used any of these supplements. Bodybuilding and energy supplements were more often used by men, younger persons and those in the Army, while weight-loss supplements were more commonly used by women and Navy personnel. Supplements in all three categories were more commonly used by persons in lower ranks, active service and combat roles. Users of bodybuilding supplements had healthier lifestyles and better health status, while users of energy and weight-loss supplements had less healthy lifestyles and poorer mental and physical health status. Overall, 11·7 % of participants used supplements containing caffeine and 3·6 % used a creatine-containing product.
Conclusions
Use of dietary supplements among Australian Defence Force personnel is common, and patterned by lifestyle factors and health status.
Drawing on recent quantitative and qualitative research, we consider lessons of the Scottish policy of free personal care for older people. The policy is embedded in political debates about devolution and interacts with various changing policies on care and support for older people. Evaluation is complicated by these interactions and by gaps in relevant data, especially concerning costs. Operationally, policy implementation has presented varying difficulties for local authorities. For clients and informal carers it remains popular, but is part of a service-led model of provision which does not reflect their own views of their care and support needs.
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