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In response to the COVID-19 pandemic, we rapidly implemented a plasma coordination center, within two months, to support transfusion for two outpatient randomized controlled trials. The center design was based on an investigational drug services model and a Food and Drug Administration-compliant database to manage blood product inventory and trial safety.
Methods:
A core investigational team adapted a cloud-based platform to randomize patient assignments and track inventory distribution of control plasma and high-titer COVID-19 convalescent plasma of different blood groups from 29 donor collection centers directly to blood banks serving 26 transfusion sites.
Results:
We performed 1,351 transfusions in 16 months. The transparency of the digital inventory at each site was critical to facilitate qualification, randomization, and overnight shipments of blood group-compatible plasma for transfusions into trial participants. While inventory challenges were heightened with COVID-19 convalescent plasma, the cloud-based system, and the flexible approach of the plasma coordination center staff across the blood bank network enabled decentralized procurement and distribution of investigational products to maintain inventory thresholds and overcome local supply chain restraints at the sites.
Conclusion:
The rapid creation of a plasma coordination center for outpatient transfusions is infrequent in the academic setting. Distributing more than 3,100 plasma units to blood banks charged with managing investigational inventory across the U.S. in a decentralized manner posed operational and regulatory challenges while providing opportunities for the plasma coordination center to contribute to research of global importance. This program can serve as a template in subsequent public health emergencies.
Background: Hospital acquired infections (HAI) are of interest given their resultant morbidity, mortality, and hospital utilization. Among HAIs, central line associated bloodstream infections result in the highest rates of mortality and additional costs. While all central venous catheters (CVC) carry risk for BSI, long-term catheter use is at increased risk. One population that utilize CVCs for extended durations are those undergoing hemodialysis. While data are available characterizing BSI impacts on outpatient hemodialysis patients, little data exist describing inpatients. The purpose of this study was to characterize the demographics, outcomes, and economics associated with the development of hospital acquired BSI (HA-BSI) in patients undergoing hemodialysis through a CVC (HD-CVC). Methods: All admissions of adult patients in the Premier Healthcare Database with hospital stays including HD-CVC with discharge dates during 2020-2022 were retrospectively evaluated. BSIs were identified by ICD-10 codes and blood culture collection dates. A BSI was deemed hospital acquired if the blood culture date was ≥3 calendar days after admission. Descriptive analyses were undertaken for HA-BSI patients including: baseline demographics, clinical characteristics, and outcomes. Length of stay (LOS), ICU utilization, and estimated costs were evaluated for HAI-BSI and non-BSI populations. Results: 166,394 admissions from 91,448 patients were identified. Of these, 5,722 patients (6.3%) had 5,842 admissions with a HA-BSI. These patients were 58.9% white, 28.3% black, 56.8% male, and 62.9% were aged ≥60years. Patients had considerable comorbidities at baseline with 88.9% having ≥2 Charlson comorbid conditions and 46.9% with ≥6. During the study period, all-cause mortality was 27.8% for HA-BSI patients with 85.5% of deaths occurring while inpatient. Median LOS for patients with HA-BSI was 25 days compared with 6 days for HD-CVC without BSI; patients with HA-BSI were also more likely to require the ICU (65.6% vs. 27.6%). The median ICU LOS was 12 days for HA-BSI versus 34 days for HD-CVC without BSI. Greater intensity of healthcare utilization was reflected in median costs of $402K for HA-BSI, compared with $43K for HD-CVC without BSI. Discussion: We described the characteristics of HD-CVC patients that developed HA-BSI. These patients had many comorbidities and relatively high rates of all-cause in-hospital mortality. Patients were likely to have long LOS, both in-hospital and within the ICU. Collectively, care of these patients was associated with considerable healthcare costs, particularly as compared with HD-CVC patients not developing a HA-BSI. Future studies should characterize risk factors and evaluate potential prevention strategies for this high-risk population.
The aim of this study was to compare past New Zealand immunization strategies with the New Zealand coronavirus disease 2019 (COVID-19) immunization roll-out.
Methods:
Using the READ document analysis method, 2 New Zealand immunization strategies (for influenza and measles) were analyzed for how the disease, context, vaccine supply and demand, ethical principles (equity, individual autonomy, and maximizing benefits), and the Treaty of Waitangi impacted the immunization programs. The findings were compared with the ongoing COVID-19 mass immunization program in New Zealand, as of October 15, 2021.
Results:
Several themes common to the case-studies and the COVID-19 pandemic were identified including the importance of equity, obligations under the Treaty of Waitangi, ethical mandates, and preparedness.
Conclusions:
Future emergency planning should integrate learnings from other infectious disease responses and immunization programs to avoid repeating mistakes and to create better health outcomes. This study has provided a basis for ongoing research into how an appropriate immunization plan can be developed that incorporates ethical values, the Treaty of Waitangi (in the NZ context), and evidence-based research to increase trust, equity, health, and preparedness for future outbreaks.
Rapid neurodevelopment occurs during adolescence, which may increase the developing brain’s susceptibility to environmental risk and resilience factors. Adverse childhood experiences (ACEs) may confer additional risk to the developing brain, where ACEs have been linked with alterations in BOLD signaling in brain regions underlying inhibitory control. Potential resiliency factors, like a positive family environment, may attenuate the risk associated with ACEs, but limited research has examined potential buffers to adversity’s impact on the developing brain. The current study aimed to examine how ACEs relate to BOLD response during successful inhibition on the Stop Signal Task (SST) in regions underlying inhibitory control from late childhood to early adolescence and will assess whether aspects of the family environment moderate this relationship.
Participants and Methods:
Participants (N= 9,080; Mage= 10.7, range= 9-13.8 years old; 48.5% female, 70.1% non-Hispanic White) were drawn from the larger Adolescent Brain Cognitive Development (ABCD) Study cohort. ACE risk scores were created (by EAS) using parent and child reports of youth’s exposure to adverse experiences collected at baseline to 2-year follow-up. For family environment, levels of family conflict were assessed based on youth reports on the Family Environment Scale at baseline and 2-year follow-up. The SST, a task-based fMRI paradigm, was used to measure inhibitory control (contrast: correct stop > correct go); the task was administered at baseline and 2-year follow-up. Participants were excluded if flagged for poor task performance. ROIs included left and right dorsolateral prefrontal cortex, anterior cingulate cortex, anterior insula, inferior frontal gyrus (IFG), and pre-supplementary motor area (pre-SMA). Separate linear mixed-effects models were conducted to assess the relationship between ACEs and BOLD signaling in ROIs while controlling for demographics (age, sex assigned at birth, race, ethnicity, household income, parental education), internalizing scores, and random effects of subject and MRI model.
Results:
Greater ACEs was associated with reduced BOLD response in the opercular region of the right IFG (b= -0.002, p= .02) and left (b= -0.002, p= .01) and right pre-SMA (b= -0.002, p= .01). Family conflict was related to altered activation patterns in the left pre-SMA, where youth with lower family conflict demonstrated a more robust negative relationship (b=.001, p= .04). ACEs were not a significant predictor in other ROIs, and the relationship between ACEs and BOLD response did not significantly differ across time. Follow-up brain-behavior correlations showed that in youth with lower ACEs, there was a negative correlation between increased activation in the pre-SMA and less impulsive behaviors.
Conclusions:
Preadolescents with ACE history show blunted activation in regions underlying inhibitory control, which may increase the risk for future poorer inhibitory control with downstream implications for behavioral/health outcomes. Further, results demonstrate preliminary evidence for the family environment’s contributions to brain health. Future work is needed to examine other resiliency factors that may modulate the impact of ACE exposure during childhood and adolescence. Further, clinical scientists should continue to examine the relationship between ACEs and neural and behavioral correlates of inhibitory control across adolescent development, as risk-taking behaviors progress.
Parental history (PH) of problematic substance use has been identified as a risk factor for adolescent substance use, which can lead to increased use in adulthood. Researchers hypothesize that individuals with PH exhibit premorbid differences in their reward processing, increasing their likelihood of engaging in reward-driven behavior. Studies have shown that preadolescents with PH have greater activation in their putamen and nucleus accumbens (NA); however, most research has only investigated PH of alcohol use (PHA), not PH of drug use (PHD). Additionally, limited research has assessed whether reward processing develops differently among youth with (PH+) to youth without (PH-). The present study utilizes the national, prospective Adolescent Brain Cognitive Development SM (ABCD) Study to examine whether reward anticipation in the nucleus accumbens (NA) differs in preadolescents with and without parental substance use history and whether patterns of reward anticipation change over time during a two-year follow-up period. Further, it will also examine whether PHA and PHD predict similar activation patterns.
Participants and Methods:
The current sample (N=6,600, Mage = 10.9; range = 9-13.8 years old; 46.7% female) was drawn from the national ABCD Study. To assess reward processing, the Monetary Incentive Delay Task (MID), a fMRI task-based paradigm, was administered at baseline and 2 year follow-up. The primary regions of interest (ROI) were the left and right NA and neutral vs anticipation of large rewards was the selected contrast. The Family History Assessment was used to assess problematic parental alcohol and drug use for both parents, with scores ranging from 0-2, with two indicating that both parents demonstrate problematic use. Three PH contrasts (PH- vs.PH+1, PH-vs.PH+2, & PH+1 vs. PH+2) were created for each group (PHA and PHD) (Martz et al., 2022). Separate linear mixed-effect models with predictors variables (parental contrasts, timepoint, and parental contrasts-by-time-point) and covariates (age, sex, race/ethnicity, income, parental education, parental warmth, parental monitoring, and the random effects of MRI model, family status, and subject) were run to predict reward anticipation.
Results:
Results indicated that PHA and,not PHD, was predictive of reward anticipation. PHA+1 youth showed greater activation in the l-NA (b= .02827, p= .03) and r-NA (b= .03476, p=.005), compared to PH- youth. Additionally, PHA+1 youth showed greater activation in the r-NA (b=-.07029, p=.008) compared to PHA+2 youth, but not in the l-NA. Those with PHA+2 demonstrated blunted activity in both the l-NA (b= -.07244, p=.02) and right nucleus accumbens (b= -.1091, p=001) when compared to those with PH-. No interactions with time were found.
Conclusions:
Preadolescents with a PHA+ for both parents had blunted activity in reward anticipation, conferring a unique risk not seen in youth with only one parent with problematic alcohol use, or in youth with a PH of drug use. Future research should attempt to disentangle both genetic and environmental factors that may explain these discrepancies in reward processing, as well as the protective factors that may mitigate it. The current study found no interaction between PHA+ and time, suggesting that during preadolescents, the pattern of reward functioning remains consistent, but future work should assess if this pattern holds up across adolescence
The coronavirus disease 2019 (COVID-19) pandemic has demonstrated the importance of stewardship of viral diagnostic tests to aid infection prevention efforts in healthcare facilities. We highlight diagnostic stewardship lessons learned during the COVID-19 pandemic and discuss how diagnostic stewardship principles can inform management and mitigation of future emerging pathogens in acute-care settings. Diagnostic stewardship during the COVID-19 pandemic evolved as information regarding transmission (eg, routes, timing, and efficiency of transmission) became available. Diagnostic testing approaches varied depending on the availability of tests and when supplies and resources became available. Diagnostic stewardship lessons learned from the COVID-19 pandemic include the importance of prioritizing robust infection prevention mitigation controls above universal admission testing and considering preprocedure testing, contact tracing, and surveillance in the healthcare facility in certain scenarios. In the future, optimal diagnostic stewardship approaches should be tailored to specific pathogen virulence, transmissibility, and transmission routes, as well as disease severity, availability of effective treatments and vaccines, and timing of infectiousness relative to symptoms. This document is part of a series of papers developed by the Society of Healthcare Epidemiology of America on diagnostic stewardship in infection prevention and antibiotic stewardship.1
Yarkoni's analysis clearly articulates a number of concerns limiting the generalizability and explanatory power of psychological findings, many of which are compounded in infancy research. ManyBabies addresses these concerns via a radically collaborative, large-scale and open approach to research that is grounded in theory-building, committed to diversification, and focused on understanding sources of variation.
Preoperative mechanical ventilation is associated with morbidity and mortality following CHD surgery, but prior studies lack a comprehensive analysis of how preoperative respiratory support mode and timing affects outcomes.
Methods:
We retrospectively collected data on children <18 years of age undergoing cardiac surgery at an academic tertiary care medical centre. Using multivariable regression, we examined the association between modes of preoperative respiratory support (nasal cannula, high-flow nasal cannula/noninvasive ventilation, or invasive mechanical ventilation), escalation of preoperative respiratory support, and invasive mechanical ventilation on the day of surgery for three outcomes: operative mortality, postoperative length of stay, and postoperative complications. We repeated our analysis in a subcohort of neonates.
Results:
A total of 701 children underwent 800 surgical procedures, and 40% received preoperative respiratory support. Among neonates, 243 patients underwent 253 surgical procedures, and 79% received preoperative respiratory support. In multivariable analysis, all modes of preoperative respiratory support, escalation in preoperative respiratory support, and invasive mechanical ventilation on the day of surgery were associated with increased odds of prolonged length of stay in children and neonates. Children (odds ratio = 3.69, 95% CI 1.2–11.4) and neonates (odds ratio = 8.97, 95% CI 1.31–61.14) on high-flow nasal cannula/noninvasive ventilation had increased odds of operative mortality compared to those on room air.
Conclusion:
Preoperative respiratory support is associated with prolonged length of stay and mortality following CHD surgery. Knowing how preoperative respiratory support affects outcomes may help guide surgical timing, inform prognostic conversations, and improve risk stratification models.
While American political development scholars tend to focus on national or state-level politics, late nineteenth-century cities provided the lion's share of services: clean water, paved and lighted streets, and sanitation. How did cities innovate and build municipal capacity to do these things? We answer this question by looking at municipal responses to the garbage problem. As cities grew and trash piled up in the 1890s, cities explored ways to effectively collect the garbage. A government requires not just resources, but also the ability to marshal those resources. Corruption could provide such abilities. Looking at four corrupt cities—Pittsburgh, Charleston, New Orleans, and St. Louis—we consider whether corruption, and what type of corruption, fostered innovation and capacity. We compare these corrupt cities with a shadow study of the reformist government of Columbus. We found the following: (1) The logic of corruption is the most important factor to explain why municipal governments chose particular garbage strategies. Corrupt regimes chose garbage collection and disposal strategies that would benefit themselves—but these varied depending on what type of corruption dominated a city. (2) Corruption sometimes promoted innovation and capacity, but at other times, corruption hindered them. For better or worse, cities ruled by corruption gained the capacity that these informal regimes held.
Typically pediatric end-of-life decision-making studies have examined the decision-making process, factors, and doctors’ and parents’ roles. Less attention has focussed on what happens after an end-of-life decision is made; that is, decision enactment and its outcome. This study explored the views and experiences of bereaved parents in end-of-life decision-making for their child. Findings reported relate to parents’ experiences of acting on their decision. It is argued that this is one significant stage of the decision-making process.
Methods
A qualitative methodology was used. Semi-structured interviews were conducted with bereaved parents, who had discussed end-of-life decisions for their child who had a life-limiting condition and who had died. Data were thematically analysed.
Results
Twenty-five bereaved parents participated. Findings indicate that, despite differences in context, including the child’s condition and age, end-of-life decision-making did not end when an end-of-life decision was made. Enacting the decision was the next stage in a process. Time intervals between stages and enactment pathways varied, but the enactment was always distinguishable as a separate stage. Decision enactment involved making further decisions - parents needed to discern the appropriate time to implement their decision to withdraw or withhold life-sustaining medical treatment. Unexpected events, including other people’s actions, impacted on parents enacting their decision in the way they had planned. Several parents had to re-implement decisions when their child recovered from serious health issues without medical intervention.
Significance of results
A novel, critical finding was that parents experienced end-of-life decision-making as a sequence of interconnected stages, the final stage being enactment. The enactment stage involved further decision-making. End-of-life decision-making is better understood as a process rather than a discrete once-off event. The enactment stage has particular emotional and practical implications for parents. Greater understanding of this stage can improve clinician’s support for parents as they care for their child.
Mental disorders of women during the postnatal period are a major public health problem. Compared with women's mental disorders, much less attention has been paid to men's mental disorders in the perinatal period. To date, there have been no reports in the literature describing secular changes of both maternal and paternal hospital admissions for mental disorders over the period covering the year before pregnancy (non-parents), during pregnancy (expectant parents) and up to the first year after birth (parents) based on linked parental data. The co-occurrences of couples' hospital admissions for mental disorders have not previously been investigated.
Aims
To describe maternal and paternal hospital admissions for mental disorders before and after birth. To compare the co-occurrences of parents' hospital admissions for mental disorder in the perinatal period.
Method
This is a cohort study using paired parents' population data from the New South Wales (NSW) Perinatal Data Collection (PDC), Registry of Births, Deaths and Marriages (RBDM) and Admitted Patients Data Collection (APDC). The study included all parents (n=196 669 couples) who gave birth to their first child in NSW between 1 January 2003 and 31 December 2009.
Results
The hospital admission rate for women with a principal mental disorder diagnosis in the period between the year before pregnancy and the first year after birth was significantly higher than that for men. Parents' mental disorders influenced each other. If a man was admitted to hospital with a principal mental disorder diagnosis, his wife or partner was more likely to be admitted to hospital with a principal mental disorder diagnosis compared with women whose partner had not had a hospital admission, and vice versa.
Conclusions
Mothers' mental disorders after birth increased more significantly than fathers. However, fathers' mental disorders significantly impacted the co-occurrence of mothers' mental disorders.
We propose a methodological strategy that addresses some of the widespread criticisms of survey research. Traditional survey research has, to a great extent, neglected the role of contested concepts in politics and respondents' subjectivity. Our mix of methods—including conceptual analysis, Q-methodology, and survey research—enables us to measure people's subjective understandings of contested concepts while allowing us to reap the benefits of survey research. In two case studies, one on patriotism and the other on participatory citizenship, we demonstrate that the mixed method more accu rately measures respondents' subjectivity and leads to greater predictive abil ity through more accurate measures.
Background: Identifying individuals at risk for mental health problems after a disaster often involves assessing potentially traumatic exposures inherent to the disaster. Survivors of disasters also may have been exposed, both before and during the event, to trauma not directly related to the disaster. A substantial literature suggests exposure to interpersonal violence may have more severe negative outcomes than exposure to non-violent events; however, it is unclear whether violent vs nonviolent exposures before and during a disaster have differential effects on postdisaster psychological functioning.
Methods: We examined the associations of violent and nonviolent exposures before and during Hurricane Katrina with postdisaster psychological functioning in a sample of male military veterans.
Results: Violent and nonviolent exposures post-Hurricane Katrina as well as pre-Katrina violent exposures were significantly associated with symptoms of posttraumatic stress disorder, panic, and generalized anxiety disorder more than 2 years after the storm. Moreover, veterans who reported violent exposures pre-Katrina were more than 4 times more likely to have reexperienced interpersonal violence during Katrina than those who did not report such exposures.
Conclusions: Results suggest assessing disaster-specific experiences in addition to predisaster interpersonal violence may be important for identifying and triaging individuals at risk for postdisaster mental health problems.
(Disaster Med Public Health Preparedness. 2011;5:S227-S234)
With Malice toward Some: How People Make Civil Liberties Judgments addresses an issue integral to democratic societies: how people faced with a complex variety of considerations decide whether or not to tolerate extremist groups. Relying on several survey-experiments, Marcus, Sullivan, Theiss-Morse, and Wood identify and compare the impact on decision making of contemporary information, long-standing predispositions, and enduring values and beliefs. Citizens react most strongly to information about a group's violations of behavioral norms and information about the implications for democracy of the group's actions. The authors conclude that democratic citizens should have a strong baseline of tolerance yet be attentive to and thoughtful about current information.
The activities of the Commission have continued to focus on controlling unwanted light and radio emissions at observatory sites, monitoring of conditions at observatory sites, and education and outreach. Commission members have been active in securing new legislation in several locations to further the protection of observatory sites as well as in the international regulation of the use of the radio spectrum and the protection of radio astronomical observations.
The measure used to assess the success of any given assisted reproductive technology (ART) treatment is dependent upon whose perspective the outcome is being determined and the quality of the data available to populate the measure. The three most commonly used denominators to measure the success of ART treatment are initiated cycles, aspirations, and embryos transferred. Clinical pregnancy is the most widely used measure of the success of ART treatment. The choice of initiated cycle as the denominator is limited to differentiate the success rates between some ART procedures such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Cryopreservation of embryos is now routine practice. The dilemma is how to present success rates of ART treatment following transfer of thawed embryos. A higher success rate is also experienced with patients undertaking their first treatment cycle or who have a history of a live birth.