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Diagnostic stewardship of urine cultures from patients with indwelling urinary catheters may improve diagnostic specificity and clinical relevance of the test, but risk of patient harm is uncertain.
Methods:
We retrospectively evaluated the impact of a computerized clinical decision support tool to promote institutional appropriateness criteria (neutropenia, kidney transplant, recent urologic surgery, or radiologic evidence of urinary tract obstruction) for urine cultures from patients with an indwelling urinary catheter. The primary outcome was a change in catheter-associated urinary tract infection (CAUTI) rate from baseline (34 mo) to intervention period (30 mo, including a 2-mo wash-in period). We analyzed patient-level outcomes and adverse events.
Results:
Adjusted CAUTI rate decreased from 1.203 to 0.75 per 1,000 catheter-days (P = 0.52). Of 598 patients triggering decision support, 284 (47.5%) urine cultures were collected in agreement with institutional criteria and 314 (52.5%) were averted. Of 314 patients whose urine cultures were averted, 2 had a subsequent urine culture within 7 days that resulted in a change in antimicrobial therapy and 2 had diagnosis of bacteremia with suspected urinary source, but there were no delays in effective treatment.
Conclusion:
A diagnostic stewardship intervention was associated with an approximately 50% decrease in urine culture testing for inpatients with a urinary catheter. However, the overall CAUTI rate did not decrease significantly. Adverse outcomes were rare and minor among patients who had a urine culture averted. Diagnostic stewardship may be safe and effective as part of a multimodal program to reduce unnecessary urine cultures among patients with indwelling urinary catheters.
Echinococcosis is a parasitic invasion caused by a cestode of the genus Echinococcus. Kyrgyzstan is a country in Central Asia known for an extremely high incidence of echinococcosis. A total of 10 093 subjects were screened in the Osh, Naryn and Batken regions of Kyrgyzstan in 2015–2017 by ultrasound and questioned for potential risk factors. Cystic echinococcosis (CE) prevalence (combined newly diagnosed and post-surgery cases) ranged between 0.2 and 25.2% across the study regions. Typical factors, such as dog or livestock ownership, weakly affected CE risk (odds ratio [OR] = 1.18–1.83). Use of water from a well and owning a cat had a greater effect on CE risk (OR = 2.02–2.28). The risk factors of CE were highly dissimilar among the study regions, with patterns not always compatible with classical biohelminthosis transmission routes (no risk from livestock in certain areas, significant risk from using well water, owning cats). Therefore, the CE epidemic in Kyrgyzstan is not holistic in terms of potential mechanisms and risk factors, and certain areas can greatly benefit from preventive measures that will have limited efficiency elsewhere.
We synthesize sea-level science developments, priorities and practitioner needs at the end of the 10-year World Climate Research Program Grand Challenge ’Regional Sea-Level Change and Coastal Impacts’. Sea-level science and associated climate services have progressed but are unevenly distributed. There remains deep uncertainty concerning high-end and long-term sea-level projections due to indeterminate emissions, the ice sheet response and other climate tipping points. These are priorities for sea-level science. At the same time practitioners need climate services that provide localized information including median and curated high-end sea-level projections for long-term planning, together with information to address near-term pressures, including extreme sea level-related hazards and land subsidence, which can greatly exceed current rates of climate-induced sea-level rise in some populous coastal settlements. To maximise the impact of scientific knowledge, ongoing co-production between science and practitioner communities is essential. Here we report on recent progress and ways forward for the next decade.
We present deep near-infrared $K_\textrm{s}$-band imaging for 35 of the 53 sources from the high-redshift ($z \gt 2$) radio galaxy candidate sample defined in Broderick et al. (2022, PASA, 39, e061). These images were obtained using the High-Acuity Widefield K-band Imager (HAWK-I) on the Very Large Telescope. Host galaxies are detected for 27 of the sources, with $K_\textrm{s} \approx 21.6$–23.0 mag (2$^{\prime\prime}$ diameter apertures; AB). The remaining eight targets are not detected to a median $3\unicode{x03C3}$ depth of $K_\textrm{s} \approx 23.3$ mag (2$^{\prime\prime}$ diameter apertures). We examine the radio and near-infrared flux densities of the 35 sources, comparing them to the known $z \gt 3$ powerful radio galaxies with 500-MHz radio luminosities $L_{500\,\textrm{MHz}} \gt 10^{27}$ W Hz$^{-1}$. By plotting 150-MHz flux density versus $K_\textrm{s}$-band flux density, we find that, similar to the sources from the literature, these new targets have large radio to near-infrared flux density ratios, but extending the distribution to fainter flux densities. Five of the eight HAWK-I deep non-detections have a median $3\unicode{x03C3}$ lower limit of $K_\textrm{s} \gtrsim 23.8$ mag (1$.\!^{\prime\prime}$5 diameter apertures); these five targets, along with a further source from Broderick et al. (2022, PASA, 39, e061) with a deep non-detection ($K_\textrm{s} \gtrsim 23.7$ mag; $3\unicode{x03C3}$; 2$^{\prime\prime}$ diameter aperture) in the Southern H-ATLAS Regions $K_\textrm{s}$-band Survey, are considered candidates to be ultra-high-redshift ($z \gt 5$) radio galaxies. The extreme radio to near-infrared flux density ratios ($\gt 10^5$) for these six sources are comparable to TN J0924$-$2201, GLEAM J0856$+$0223 and TGSS J1530$+$1049, the three known powerful radio galaxies at $z \gt 5$. For a selection of galaxy templates with different stellar masses, we show that $z \gtrsim 4.2$ is a plausible scenario for our ultra-high-redshift candidates if the stellar mass $M_\textrm{*} \gtrsim 10^{10.5}$ M$_\odot$. In general, the 35 targets studied have properties consistent with the previously known class of infrared-faint radio sources. We also discuss the prospects for finding more UHzRG candidates from wide and deep near-infrared surveys.
To address the global challenge of plastic waste, 175 UN Member States are negotiating a legally binding instrument, the Plastic Treaty, aimed at ending plastic pollution. This ambitious framework, targeting both terrestrial and marine sources, is being developed through Intergovernmental Negotiating Committee meetings scheduled to conclude by 2025. Amidst uncertainties and power dynamics influencing state positions, this research identifies 10 critical, yet unresolved, points within the treaty negotiations (i.e., the scope of the treaty, equity and differentiation, involvement of non-state actors, integration with existing agreements, standards and specifications, trade implications, monitoring and reporting, responsibility and historical contributions, binding vs. non-binding commitments, and financing and technology transfer). The findings suggest potential compromises in the treaty’s environmental provisions, influenced by domestic interests and international power disparities. As negotiations progress, the imperative for cooperation and decisive action against plastic pollution becomes increasingly pressing, challenging member states to prioritize global environmental integrity over national interests.
This editorial considers the value and nature of academic psychiatry by asking what defines the specialty and psychiatrists as academics. We frame academic psychiatry as a way of thinking that benefits clinical services and discuss how to inspire the next generation of academics.
The Ediacaran Subcommission of the International Commission on Stratigraphy is diligently working toward the goal of subdividing the Ediacaran Period into precise and useful chronostratigraphic units. As emphasized by Xiao and colleagues in 2016, one of the most effective tools in this endeavor will be the use of index fossils. Our special issue serves as a presentation of ongoing research efforts aimed at advancing this task and contains explorations into taxonomy, taphonomy, and the diversity of life during the Ediacaran Period.
An investigation into an outbreak of Salmonella Newport infections in Canada was initiated in July 2020. Cases were identified across several provinces through whole-genome sequencing (WGS). Exposure data were gathered through case interviews. Traceback investigations were conducted using receipts, invoices, import documentation, and menus. A total of 515 cases were identified in seven provinces, related by 0–6 whole-genome multi-locus sequence typing (wgMLST) allele differences. The median age of cases was 40 (range 1–100), 54% were female, 19% were hospitalized, and three deaths were reported. Forty-eight location-specific case sub-clusters were identified in restaurants, grocery stores, and congregate living facilities. Of the 414 cases with exposure information available, 71% (295) had reported eating onions the week prior to becoming ill, and 80% of those cases who reported eating onions, reported red onion specifically. The traceback investigation identified red onions from Grower A in California, USA, as the likely source of the outbreak, and the first of many food recall warnings was issued on 30 July 2020. Salmonella was not detected in any tested food or environmental samples. This paper summarizes the collaborative efforts undertaken to investigate and control the largest Salmonella outbreak in Canada in over 20 years.
The interplay between SARS-CoV-2 and contemporaneous bacterial or fungal culture growth may have crucial implications for clinical outcomes of hospitalized patients. This study aimed to quantify the effect of microbiological culture positivity on mortality among hospitalized patients with SARS-CoV-2.
Methods:
In this retrospective cohort study, we included adult hospitalized patients from OPTUM COVID-19 specific data set, who tested positive for SARS-CoV-2 within 14 days of hospitalization between 01/20/2020 and 01/20/2022. We examined outcomes of individuals with organisms growing on cultures from the bloodstream infections (BSIs), urinary tract, and respiratory tract, and a composite of the three sites. We used propensity score matching on covariates included demographics, comorbidities, and hospitalization clinical parameters. In a sensitivity analysis, we included same covariates but excluded critical care variables such as length of stay, intensive care unit stays, mechanical ventilation, and extracorporeal membrane oxygenation.
Results:
The cohort included 104,560 SARS-CoV-2 positive adult hospitalized patients across the United States. The unadjusted mortality odds increased significantly with BSIs (98.7%) and with growth on respiratory cultures (RC) (176.6%), but not with growth on urinary cultures (UC). Adjusted analyses showed that BSIs and positive RC independently contribute to mortality, even after accounting for critical care variables.
Conclusions:
In SARS-CoV-2-positive hospitalized patients, positive bacterial and fungal microbiological cultures, especially BSIs and RC, are associated with an increased risk of mortality even after accounting for critical care variables associated with disease severity. These findings underscore the importance of stringent infection control and the effective management of secondary infections to improve patient outcomes.
Advanced biopreservation technologies using subzero approaches such as supercooling, partial freezing, and vitrification with reanimating techniques including nanoparticle infusion and laser rewarming are rapidly emerging as technologies with potential to radically disrupt biomedicine, research, aquaculture, and conservation. These technologies could pause biological time and facilitate large-scale banking of biomedical products including organs, tissues, and cell therapies.
Research on advanced biopreservation — technologies that include, for example, partial freezing, supercooling, and vitrification with nanoparticle infusion and laser rewarming — is proceeding at a rapid pace, potentially affecting many areas of medicine and the life sciences, food, agriculture, and environmental conservation. Given the breadth and depth of its medical, scientific, and corresponding social impacts, advanced biopreservation is poised to emerge as a disruptive technology with real benefits, but also ethical challenges and risks. Early engagement with potentially affected groups can help navigate possible societal barriers to adoption of this new technology and help ensure that emerging capabilities align with the needs, desires, and expectations of a broad range of interested parties.
Electroconvulsive therapy (ECT) is a psychiatric intervention that has proven effectiveness and safety in various psychiatric conditions, such as major depressive disorder, prolonged or severe manic episodes and catatonia. Despite positive scientific evidence, ECT was always seen as controversial by patients, caregivers, and even some psychiatrists, which lead to a decrease in its use over the years.
Objectives
To investigate the way young psychiatrists view the place of ECT in modern psychiatry by assessing their knowledge, attitude and access to training opportunities in ECT.
Methods
An anonymous survey was disseminated online among early career psychiatrists and psychiatric trainees. The questionnaire consisted of 36 multiple-choice and Likert scale questions.
Results
Most of our respondents consider ECT both an effective and a safe treatment option and would recommend ECT to their patients when indicated. Early career psychiatrists who had access to ECT training are more knowledgeable about the indications, precautions and side effects of this method, but more than half of the participants mentioned ECT training was unavailable during their residency programme. Almost all respondents stated that they are interested in enhancing their theoretical and practical competencies in ECT.
Conclusions
Early career psychiatrists have a positive attitude towards ECT but express the need of targeted education aimed at improving levels of knowledge about ECT.
This study identified 26 late invasive primary surgical site infection (IP-SSI) within 4–12 months of transplantation among 2073 SOT recipients at Duke University Hospital over the period 2015–2019. Thoracic organ transplants accounted for 25 late IP-SSI. Surveillance for late IP-SSI should be maintained for at least one year following transplant.
Removal and disposal of nonnative trees is expensive and time-consuming. Using these nonnative trees as a substrate to produce edible mushrooms could diversify farming operations and provide additional income to small-scale farmers. This research compared the production of shiitake mushrooms (Lentinula edodes) on nonnative tree logs to shiitake mushroom production on native oak (Quercus L.) logs, which are the traditional substrate. In a 2-yr study, we evaluated nonnative tree species as alternate substrates for growing shiitake mushrooms at farms in northern Florida and southern Georgia. A mix of native Quercus spp. and nonnative trees was targeted for removal on participating farms. Five nonnative tree species were initially tested for their ability to produce edible mushrooms, either shiitake or oyster (Pleurotus ostreatus var. florida). Of the nonnative trees we tested: Chinaberry (Melia azedarach L.), Chinese tallowtree [Triadica sebifera (L.) Small], silktree (Albizia julibrissin Durazz.), earleaf acacia (Acacia auriculiformis A. Cunn. ex Benth.), and paperbark tree [Melaleuca quinquenervia (Cav.) S.F. Blake], only T. sebifera produced shiitake mushrooms, and none produced native Florida oyster mushrooms. In on-farm trials, Quercus spp. logs produced more total mushrooms and more mushrooms per log and had a higher total mushroom yield per log. However, mushrooms produced on T. sebifera logs had higher mean weight per mushroom. Edible fungi can be used to recycle invasive, nonnative T. sebifera and transform their biomass from waste into an income-producing resource.
Medical devices increasingly include software components, which facilitate remote patient monitoring. The introduction of software into previously analog medical devices, as well as innovation in software-driven devices, may introduce new safety concerns – all the more so when such devices are used in patients’ homes, well outside of traditional health care delivery settings. We review four key mechanisms for the post-market surveillance of medical devices in the United States: (1) Post-market trials and registries; (2) manufacturing plant inspections; (3) adverse event reporting; and (4) recalls. We use comprehensive regulatory data documenting adverse events and recalls to describe trends in the post-market safety of medical devices, based on the presence or absence of software. Overall, devices with software are associated with more reported adverse events (i.e. individual injuries and deaths) and more high-severity recalls, compared to devices without software. However, in subgroup analyses of individual medical specialties, we consistently observe differences in recall probability but do not consistently detect differences in adverse events. These results suggest that adverse events are a noisy signal of post-market safety and not necessarily a reliable predictor of subsequent recalls. As patients and health care providers weigh the benefits of new remote monitoring technologies against potential safety issues, they should not assume that safety concerns will be readily identifiable through existing post-market surveillance mechanisms. Both health care providers and developers of remote patient monitoring technologies should therefore consider how they might proactively ensure that newly introduced remote patient monitoring technologies work safely and as intended.
Although behavioral mechanisms in the association among depression, anxiety, and cancer are plausible, few studies have empirically studied mediation by health behaviors. We aimed to examine the mediating role of several health behaviors in the associations among depression, anxiety, and the incidence of various cancer types (overall, breast, prostate, lung, colorectal, smoking-related, and alcohol-related cancers).
Methods
Two-stage individual participant data meta-analyses were performed based on 18 cohorts within the Psychosocial Factors and Cancer Incidence consortium that had a measure of depression or anxiety (N = 319 613, cancer incidence = 25 803). Health behaviors included smoking, physical inactivity, alcohol use, body mass index (BMI), sedentary behavior, and sleep duration and quality. In stage one, path-specific regression estimates were obtained in each cohort. In stage two, cohort-specific estimates were pooled using random-effects multivariate meta-analysis, and natural indirect effects (i.e. mediating effects) were calculated as hazard ratios (HRs).
Results
Smoking (HRs range 1.04–1.10) and physical inactivity (HRs range 1.01–1.02) significantly mediated the associations among depression, anxiety, and lung cancer. Smoking was also a mediator for smoking-related cancers (HRs range 1.03–1.06). There was mediation by health behaviors, especially smoking, physical inactivity, alcohol use, and a higher BMI, in the associations among depression, anxiety, and overall cancer or other types of cancer, but effects were small (HRs generally below 1.01).
Conclusions
Smoking constitutes a mediating pathway linking depression and anxiety to lung cancer and smoking-related cancers. Our findings underline the importance of smoking cessation interventions for persons with depression or anxiety.
White matter hyperintensity (WMH) volume is a neuroimaging marker of lesion load related to small vessel disease that has been associated with cognitive aging and Alzheimer’s disease (AD) risk.
Method:
The present study sought to examine whether regional WMH volume mediates the relationship between APOE ε4 status, a strong genetic risk factor for AD, and cognition and if this association is moderated by age group differences within a sample of 187 healthy older adults (APOE ε4 status [carrier/non-carrier] = 56/131).
Results:
After we controlled for sex, education, and vascular risk factors, ANCOVA analyses revealed significant age group by APOE ε4 status interactions for right parietal and left temporal WMH volumes. Within the young-old group (50-69 years), ε4 carriers had greater right parietal and left temporal WMH volumes than non-carriers. However, in the old-old group (70-89 years), right parietal and left temporal WMH volumes were comparable across APOE ε4 groups. Further, within ε4 non-carriers, old-old adults had greater right parietal and left temporal WMH volumes than young-old adults, but there were no significant differences across age groups in ε4 carriers. Follow-up moderated mediation analyses revealed that, in the young-old, but not the old-old group, there were significant indirect effects of ε4 status on memory and executive functions through left temporal WMH volume.
Conclusions:
These findings suggest that, among healthy young-old adults, increased left temporal WMH volume, in the context of the ε4 allele, may represent an early marker of cognitive aging with the potential to lead to greater risk for AD.
Avian schistosomes are snail-borne trematode parasites (Trichobilharzia spp.) that can cause a nasty skin rash in humans when their cercariae mistake us for their normal bird hosts. We sought to investigate drivers of the spatial distribution of Trichobilharzia cercaria abundance throughout Northern Michigan lakes. For 38 sites on 16 lakes, we assessed several dozen potential environmental predictors that we hypothesized might have direct or indirect effects on overall cercaria abundance, based on known relationships between abiotic and biotic factors in wetland ecosystems. We included variables quantifying local densities of intermediate hosts, temperature, periphyton growth rates, human land use and hydrology. We also measured daily abundance of schistosome cercariae in the water over a 5-week period, supported by community scientists who collected and preserved filtered water samples for qPCR. The strongest predictor of cercaria abundance was Lymnaea host snail density. Lymnaea density was higher in deeper lakes and at sites with more deciduous tree cover, consistent with their association with cool temperature habitats. Contrary to past studies of human schistosomes, we also found a significant negative relationship between cercaria abundance and submerged aquatic vegetation, possibly due to vegetation blocking cercaria movement from offshore snail beds. If future work shows that these effects are indeed causal, then these results suggest possible new approaches to managing swimmer's itch risk in northern MI lakes, such as modifying tree cover and shallow-water vegetation at local sites.
Prognosticating outcomes for traumatic brain injury (TBI) patients is challenging due to the required specialized skills and variability among clinicians. Recent attempts to standardize TBI prognosis have leveraged machine learning (ML) methodologies. This study evaluates the necessity and influence of ML-assisted TBI prognostication through healthcare professionals’ perspectives via focus group discussions.
Methods:
Two virtual focus groups included ten key TBI care stakeholders (one neurosurgeon, two emergency clinicians, one internist, two radiologists, one registered nurse, two researchers in ML and healthcare and one patient representative). They answered six open-ended questions about their perceptions and potential ML use in TBI prognostication. Transcribed focus group discussions were thematically analyzed using qualitative data analysis software.
Results:
The study captured diverse perceptions and interests in TBI prognostication across clinical specialties. Notably, certain clinicians who currently do not prognosticate expressed an interest in doing so independently provided they had access to ML support. Concerns included ML’s accuracy and the need for proficient ML researchers in clinical settings. The consensus suggested using ML as a secondary consultation tool and promoting collaboration with internal or external research resources. Participants believed ML prognostication could enhance disposition planning and standardize care regardless of clinician expertise or injury severity. There was no evidence of perceived bias or interference during the discussions.
Conclusion:
Our findings revealed an overall positive attitude toward ML-based prognostication. Despite raising multiple concerns, the focus group discussions were particularly valuable in underscoring the potential of ML in democratizing and standardizing TBI prognosis practices.