Clostridioides difficile infection (CDI) is common among patients undergoing hematopoietic stem cell transplantation (HSCT). Oral vancomycin prophylaxis may effectively prevent CDI in certain populations. We investigated the effectiveness of oral vancomycin primary prophylaxis in preventing CDI in HSCT patients.

We searched six databases from inception to March 21, 2025, for studies comparing the incidence of CDI in HSCT patients who received oral vancomycin primary prophylaxis versus those who did not. We built a Bayesian random-effects model for meta-analysis. The primary outcome was the incidence of CDI. Secondary outcomes included incidence of positive vancomycin-resistant Enterococcus cultures, blood stream infections, graft-vs-host disease, and length of hospital stay. We also assessed for heterogeneity and publication bias using Robust Bayesian Meta-Analyses.

Six studies met inclusion criteria with a total of 1,236 patients. Four of the studies were of fair to good quality. Oral vancomycin primary prophylaxis reduced the incidence of CDI during hospitalization (OR 0.31; 95%CrI 0.16–0.59). Studies were weakly heterogeneous but had strong publication bias. Oral vancomycin primary prophylaxis reduced the odds of CDI by 12% after accounting for publication bias (OR 0.88; 95%CrI 0.32–1.16), although this reduction was not statistically significant. Secondary outcomes were similar in both groups.

Oral vancomycin primary prophylaxis prevented CDI in HSCT patients without significantly affecting secondary outcomes. However, after controlling for publication bias, these findings were no longer significant. Further studies are needed to provide stronger evidence for or against this intervention, assess long-term safety, and assess potential effects on antimicrobial resistance.

Depression and anxiety are the leading contributors to the global burden of disease among young people, accounting for over a third (34.8%) of years lived with disability. Yet there is limited evidence for interventions that prevent adolescent depression and anxiety in low- and middle-income countries (LMICs), where 90% of adolescents live. This article introduces the ‘Improving Adolescent mentaL health by reducing the Impact of poVErty (ALIVE)’ study, its conceptual framework, objectives, methods and expected outcomes. The aim of the ALIVE study is to develop and pilot-test an intervention that combines poverty reduction with strengthening self-regulation to prevent depression and anxiety among adolescents living in urban poverty in Colombia, Nepal and South Africa.

This aim will be achieved by addressing four objectives: (1) develop a conceptual framework that identifies the causal mechanisms linking poverty, self-regulation and depression and anxiety; (2) develop a multi-component selective prevention intervention targeting self-regulation and poverty among adolescents at high risk of developing depression or anxiety; (3) adapt and validate instruments to measure incidence of depression and anxiety, mediators and implementation parameters of the prevention intervention; and (4) undertake a four-arm pilot cluster randomised controlled trial to assess the feasibility, acceptability and cost of the selective prevention intervention in the three study sites.

The contributions of this study include the active engagement and participation of adolescents in the research process; a focus on the causal mechanisms of the intervention; building an evidence base for prevention interventions in LMICs; and the use of an interdisciplinary approach.

By developing and evaluating an intervention that addresses multidimensional poverty and self-regulation, ALIVE can make contributions to evidence on the integration of mental health into broader development policy and practice.

This project aimed to quantify and compare Massachusetts and Georgia public school districts’ 2017–2018 winter-storm-related Twitter unplanned school closure announcements (USCA).

Public school district Twitter handles and National Center for Education Statistics data were obtained for Georgia and Massachusetts. Tweets were retrieved using Twitter application programming interface. Descriptive statistics and regression analyses were conducted to compare the rates of winter-storm-related USCA.

Massachusetts had more winter storms than Georgia during the 2017–2018 winter season, but Massachusetts school districts posted winter-storm-related USCA at a 60% lower rate per affected day (adjusted rate ratio, aRR = 0.40, 95% confidence intervals, CI: 0.30, 0.52) than Georgia school districts after controlling for the student enrollments and Twitter followers count per Twitter account. A 10-fold increase in followers count was correlated with a 118% increase in USCA rate per affected day (aRR = 2.18; 95% CI: 1.74, 2.75). Georgia school districts had a higher average USCA tweet rate per winter-storm-affected day than Massachusetts school districts. A higher number of Twitter followers was associated with a higher number of USCA tweets per winter-storm-affected day.

Twitter accounts of school districts in Massachusetts had a lower tweet rate for USCA per winter-storm-affected days than those in Georgia.

To describe characteristics of Clostridium difficile infection (CDI) and markers of severe CDI among patients with hematologic malignancies.

Case-control study.

Tertiary care teaching hospital.

Inpatients with hematologic malignancies and CDI were age and time matched with 2 control inpatients without hematologic malignancies. Chart reviews were performed, and C. difficile isolates were strain typed.

Case patients (n = 41) and control patients (n = 82) patients were different in respect to receipt of immunosuppressive agents within 2 months (92.7% vs 25.6%; P < .0001); neutropenia within 2 months (75.6% vs 3.7%; P < .0001) and mean (± standard deviation) white blood cell (WBC) count at diagnosis (4.9 ± 14.1 vs 11.8 ± 6.8 × 103 cells/mL; P = .0002); baseline mean creatinine level (0.89 ± 0.1 vs 1.6 ± 2.4 mg/dL; P = .003), mean creatinine level at diagnosis (0.83 ± 0.4 vs 1.85 ± 1.9 mg/dL; P = .004), and creatinine increases of 1.5 times over baseline (2.4% vs 15.1%; P = .02). Immunosuppressive agents and creatinine level remained significant in multivariable analysis (P = .03 for both variables). Severity correlated with mortality when measured by alternate severity criteria but not when measured by the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America criteria, which are based solely on WBC count and creatinine elevation. The prevalence of the epidemic BI/NAP1/027 strain was similar in both groups.

Patients with hematologic malignancies had lower creatinine levels at the time of CDI diagnosis compared with control patients. WBC counts also tended to be lower in case patients. CDI severity criteria based on WBC count and creatinine level may not be applicable to patients with hematologic malignancies.