8 results
A pilot study to evaluate the quality of care in oral anticoagulant and antiplatelet use in patients with permanent atrial fibrillation in Irish general practice
- Sarah McErlean, John Broughan, Geoff McCombe, Ronan Fawsitt, Walter Cullen, Joe Gallagher
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- Journal:
- Primary Health Care Research & Development / Volume 25 / 2024
- Published online by Cambridge University Press:
- 25 April 2024, e23
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Aim:
The aim of this pilot study is to determine the pattern of oral anticoagulant and antiplatelet use in patients with permanent atrial fibrillation (AF) in Irish general practice.
Background:Worldwide, AF is the most common sustained cardiac arrhythmia in adults and poses a significant burden to patients, physicians and healthcare systems. There is a five-fold increased risk of stroke with AF, and AF-related strokes are associated with higher levels of both morbidity and mortality compared to other stroke subtypes. Thankfully, appropriate use of oral anticoagulation (OAC) for AF can reduce the risk of stroke by up to 64%. However, we know that patients are commonly undertreated with OAC, prescribed inappropriate doses of OAC and have prolonged use of an antiplatelet agent in addition to OAC without indication.
Methods:A descriptive, cross-sectional observational study was undertaken. Proportionate sampling was used across 11 practices from the Ireland East practice-based research network. The general practitioners completed a report form on each patient provided by the research team by undertaking a retrospective chart review.
Findings:Eleven practices participated with a total number of 1855 patients with AF. We received data on 153 patients.
The main findings from this pilot project are that:
1. 11% of patients were undertreated with OAC
2. 20 % of patients were on an incorrect non-vitamin K antagonist oral anticoagulant dose
3. 28 patients (18%) were inappropriately prescribed combination antithrombotic therapy
Undertreatment and underdosing of OAC expose patients to higher risk of thromboembolic events, bleeding and all-cause mortality. Prolonged combination antithrombotic therapy is associated with serious increased risk of bleeding with no additional stroke protection. This pilot project highlights several gaps between guidelines and clinical practice. By identifying these areas, we hope to develop a targeted quality improvement intervention using the electronic health records in general practice to improve the care that those with AF receive.
Investigation of the first cluster of Candida auris cases among pediatric patients in the United States―Nevada, May 2022
- Sophie Jones, Kaitlin Forsberg, Christopher Preste, Joe Sexton, Paige Gable, Janet Glowicz, Heather Jones, Maroya Walters, Meghan Lyman, Chidinma Njoku, Kimisha Causey, Jeanne Ruff, Dallas Smith, Karen Wu, Elizabeth Misas, Teri Lynn, Chantal Lewis, Brian Min, Fathia Osman, Erin Archer
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S2 / June 2023
- Published online by Cambridge University Press:
- 29 September 2023, pp. s118-s119
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Background: Candida auris is a frequently drug-resistant yeast that can cause invasive disease and is easily transmitted in healthcare settings. Pediatric cases are rare in the United States, with <10 reported before 2022. In August 2021, the first C. auris case in Las Vegas was identified in an adult. By May 2022, 117 cases were identified across 16 healthcare facilities, including 3 pediatric cases at an acute-care hospital (ACH) with adult cases, representing the first pediatric cluster in the United States. The CDC and Nevada Division of Public and Behavioral Health (NVDPBH) sought to describe these cases and risk factors for C. auris acquisition. Methods: We defined a case as a patient’s first positive C. auris specimen. We reviewed medical records and infection prevention and control (IPC) practices. Environmental sampling was conducted on high-touch surfaces throughout affected adult and pediatric units. Isolate relatedness was assessed using whole-genome sequencing (WGS). Results: All 3 pediatric patients were born at the facility and had congenital heart defects. All were aged <6 months when they developed C. auris bloodstream infections; 2 developed C. auris endocarditis. One patient died. Patients overlapped in the pediatric cardiac intensive care unit; 2 did not leave between birth and C. auris infection. Mobile medical equipment was shared between adult and pediatric patients; lapses in cleaning and disinfection of shared mobile medical equipment and environmental surfaces were observed, presenting opportunities for transmission. Overall, 32 environmental samples were collected, and C. auris was isolated from 2 specimens from an adult unit without current cases. One was a composite sample from an adult patient’s bed handles, railings, tray table and call buttons, and the second was from an adult lift-assistance device. WGS of specimens from adult and pediatric cases and environmental isolates were in the same genetic cluster, with 2–10 single-nucleotide polymorphisms (SNPs) different, supporting within-hospital transmission. The pediatric cases varied by 0–3 SNPs; at least 2 were highly related. Conclusions: C. auris was likely introduced to the pediatric population from adults via inadequately cleaned and disinfected mobile medical equipment. We made recommendations to ensure adequate cleaning and disinfection and implement monitoring and audits. No pediatric cases have been identified since. This investigation demonstrates transmission can occur between unrelated units and populations and that robust infection prevention and control practices throughout the facility are critical for reducing C. auris environmental burden and limiting transmission, including to previously unaffected vulnerable populations, like children.
Disclosures: None
The rationale of rationalization
- Walter Veit, Joe Dewhurst, Krzysztof Dołęga, Max Jones, Shaun Stanley, Keith Frankish, Daniel C. Dennett
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- Journal:
- Behavioral and Brain Sciences / Volume 43 / 2020
- Published online by Cambridge University Press:
- 15 April 2020, e53
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While we agree in broad strokes with the characterisation of rationalization as a “useful fiction,” we think that Fiery Cushman's claim remains ambiguous in two crucial respects: (1) the reality of beliefs and desires, that is, the fictional status of folk-psychological entities and (2) the degree to which they should be understood as useful. Our aim is to clarify both points and explicate the rationale of rationalization.
Tides modulate crevasse opening prior to a major calving event at Bowdoin Glacier, Northwest Greenland
- Eef van Dongen, Guillaume Jouvet, Andrea Walter, Joe Todd, Thomas Zwinger, Izumi Asaji, Shin Sugiyama, Fabian Walter, Martin Funk
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- Journal:
- Journal of Glaciology / Volume 66 / Issue 255 / February 2020
- Published online by Cambridge University Press:
- 04 December 2019, pp. 113-123
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Retreat of calving glaciers worldwide has contributed substantially to sea-level rise in recent decades. Mass loss by calving contributes significantly to the uncertainty of sea-level rise projections. At Bowdoin Glacier, Northwest Greenland, most calving occurs by a few large events resulting from kilometre-scale fractures forming parallel to the calving front. High-resolution terrestrial radar interferometry data of such an event reveal that crevasse opening is fastest at low tide and accelerates during the final 36 h before calving. Using the ice flow model Elmer/Ice, we identify the crevasse water level as a key driver of modelled opening rates. Sea water-level variations in the range of local tidal amplitude (1 m) can reproduce observed opening rate fluctuations, provided crevasse water level is at least 4 m above the low-tide sea level. The accelerated opening rates within the final 36 h before calving can be modelled by additional meltwater input into the crevasse, enhanced ice cliff undercutting by submarine melt, ice damage increase due to tidal cyclic fatigue, crevasse deepening or a combination of these processes. Our results highlight the influence of surface meltwater and tides on crevasse opening leading to major calving events at grounded tidewater glaciers such as Bowdoin.
Contributors
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- By Lenard A. Adler, Pinky Agarwal, Rehan Ahmed, Jagga Rao Alluri, Fawaz Al-Mufti, Samuel Alperin, Michael Amoashiy, Michael Andary, David J. Anschel, Padmaja Aradhya, Vandana Aspen, Esther Baldinger, Jee Bang, George D. Baquis, John J. Barry, Jason J. S. Barton, Julius Bazan, Amanda R. Bedford, Marlene Behrmann, Lourdes Bello-Espinosa, Ajay Berdia, Alan R. Berger, Mark Beyer, Don C. Bienfang, Kevin M. Biglan, Thomas M. Boes, Paul W. Brazis, Jonathan L. Brisman, Jeffrey A. Brown, Scott E. Brown, Ryan R. Byrne, Rina Caprarella, Casey A. Chamberlain, Wan-Tsu W. Chang, Grace M. Charles, Jasvinder Chawla, David Clark, Todd J. Cohen, Joe Colombo, Howard Crystal, Vladimir Dadashev, Sarita B. Dave, Jean Robert Desrouleaux, Richard L. Doty, Robert Duarte, Jeffrey S. Durmer, Christyn M. Edmundson, Eric R. Eggenberger, Steven Ender, Noam Epstein, Alberto J. Espay, Alan B. Ettinger, Niloofar (Nelly) Faghani, Amtul Farheen, Edward Firouztale, Rod Foroozan, Anne L. Foundas, David Elliot Friedman, Deborah I. Friedman, Steven J. Frucht, Oded Gerber, Tal Gilboa, Martin Gizzi, Teneille G. Gofton, Louis J. Goodrich, Malcolm H. Gottesman, Varda Gross-Tsur, Deepak Grover, David A. Gudis, John J. Halperin, Maxim D. Hammer, Andrew R. Harrison, L. Anne Hayman, Galen V. Henderson, Steven Herskovitz, Caitlin Hoffman, Laryssa A. Huryn, Andres M. Kanner, Gary P. Kaplan, Bashar Katirji, Kenneth R. Kaufman, Annie Killoran, Nina Kirz, Gad E. Klein, Danielle G. Koby, Christopher P. Kogut, W. Curt LaFrance, Patrick J.M. Lavin, Susan W. Law, James L. Levenson, Richard B. Lipton, Glenn Lopate, Daniel J. Luciano, Reema Maindiratta, Robert M. Mallery, Georgios Manousakis, Alan Mazurek, Luis J. Mejico, Dragana Micic, Ali Mokhtarzadeh, Walter J. Molofsky, Heather E. Moss, Mark L. Moster, Manpreet Multani, Siddhartha Nadkarni, George C. Newman, Rolla Nuoman, Paul A. Nyquist, Gaia Donata Oggioni, Odi Oguh, Denis Ostrovskiy, Kristina Y. Pao, Juwen Park, Anastas F. Pass, Victoria S. Pelak, Jeffrey Peterson, John Pile-Spellman, Misha L. Pless, Gregory M. Pontone, Aparna M. Prabhu, Michael T. Pulley, Philip Ragone, Prajwal Rajappa, Venkat Ramani, Sindhu Ramchandren, Ritesh A. Ramdhani, Ramses Ribot, Heidi D. Riney, Diana Rojas-Soto, Michael Ronthal, Daniel M. Rosenbaum, David B. Rosenfield, Durga Roy, Michael J. Ruckenstein, Max C. Rudansky, Eva Sahay, Friedhelm Sandbrink, Jade S. Schiffman, Angela Scicutella, Maroun T. Semaan, Robert C. Sergott, Aashit K. Shah, David M. Shaw, Amit M. Shelat, Claire A. Sheldon, Anant M. Shenoy, Yelizaveta Sher, Jessica A. Shields, Tanya Simuni, Rajpaul Singh, Eric E. Smouha, David Solomon, Mehri Songhorian, Steven A. Sparr, Egilius L. H. Spierings, Eve G. Spratt, Beth Stein, S.H. Subramony, Rosa Ana Tang, Cara Tannenbaum, Hakan Tekeli, Amanda J. Thompson, Michael J. Thorpy, Matthew J. Thurtell, Pedro J. Torrico, Ira M. Turner, Scott Uretsky, Ruth H. Walker, Deborah M. Weisbrot, Michael A. Williams, Jacques Winter, Randall J. Wright, Jay Elliot Yasen, Shicong Ye, G. Bryan Young, Huiying Yu, Ryan J. Zehnder
- Edited by Alan B. Ettinger, Albert Einstein College of Medicine, New York, Deborah M. Weisbrot, State University of New York, Stony Brook
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- Book:
- Neurologic Differential Diagnosis
- Published online:
- 05 June 2014
- Print publication:
- 17 April 2014, pp xi-xx
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β-Hydroxy-β-methylbutyrate free acid reduces markers of exercise-induced muscle damage and improves recovery in resistance-trained men
- Jacob M. Wilson, Ryan P. Lowery, Jordan M. Joy, Joe A. Walters, Shawn M. Baier, John C. Fuller, Jr, Jeffrey R. Stout, Layne E. Norton, Eric M. Sikorski, Stephanie M. C. Wilson, Nevine M. Duncan, Nelo E. Zanchi, John Rathmacher
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- Journal:
- British Journal of Nutrition / Volume 110 / Issue 3 / 14 August 2013
- Published online by Cambridge University Press:
- 03 January 2013, pp. 538-544
- Print publication:
- 14 August 2013
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The purpose of the present study was to determine the effects of short-term supplementation with the free acid form of β-hydroxy-β-methylbutyrate (HMB-FA) on indices of muscle damage, protein breakdown, recovery and hormone status following a high-volume resistance training session in trained athletes. A total of twenty resistance-trained males were recruited to participate in a high-volume resistance training session centred on full squats, bench presses and dead lifts. Subjects were randomly assigned to receive either 3 g/d of HMB-FA or a placebo. Immediately before the exercise session and 48 h post-exercise, serum creatine kinase (CK), urinary 3-methylhistadine (3-MH), testosterone, cortisol and perceived recovery status (PRS) scale measurements were taken. The results showed that CK increased to a greater extent in the placebo (329 %) than in the HMB-FA group (104 %) (P= 0·004, d= 1·6). There was also a significant change for PRS, which decreased to a greater extent in the placebo (9·1 (sem 0·4) to 4·6 (sem 0·5)) than in the HMB-FA group (9·1 (sem 0·3) to 6·3 (sem 0·3)) (P= 0·005, d= − 0·48). Muscle protein breakdown, measured by 3-MH analysis, numerically decreased with HMB-FA supplementation and approached significance (P= 0·08, d= 0·12). There were no acute changes in plasma total or free testosterone, cortisol or C-reactive protein. In conclusion, these results suggest that an HMB-FA supplement given to trained athletes before exercise can blunt increases in muscle damage and prevent declines in perceived readiness to train following a high-volume, muscle-damaging resistance-training session.
Contributors
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- By Waiel Almoustadi, Brian J. Anderson, David B. Auyong, Michael Avidan, Michael J. Avram, Roland J. Bainton, Jeffrey R. Balser, Juliana Barr, W. Scott Beattie, Manfred Blobner, T. Andrew Bowdle, Walter A. Boyle, Eugene B. Campbell, Laura F. Cavallone, Mario Cibelli, C. Michael Crowder, Ola Dale, M. Frances Davies, Mark Dershwitz, George Despotis, Clifford S. Deutschman, Brian S. Donahue, Marcel E. Durieux, Thomas J. Ebert, Talmage D. Egan, Helge Eilers, E. Wesley Ely, Charles W. Emala, Alex S. Evers, Heidrun Fink, Pierre Foëx, Stuart A. Forman, Helen F. Galley, Josephine M. Garcia-Ferrer, Robert W. Gereau, Tony Gin, David Glick, B. Joseph Guglielmo, Dhanesh K. Gupta, Howard B. Gutstein, Robert G. Hahn, Greg B. Hammer, Brian P. Head, Helen Higham, Laureen Hill, Kirk Hogan, Charles W. Hogue, Christopher G. Hughes, Eric Jacobsohn, Roger A. Johns, Dean R. Jones, Max Kelz, Evan D. Kharasch, Ellen W. King, W. Andrew Kofke, Tom C. Krejcie, Richard M. Langford, H. T. Lee, Isobel Lever, Jerrold H. Levy, J. Lance Lichtor, Larry Lindenbaum, Hung Pin Liu, Geoff Lockwood, Alex Macario, Conan MacDougall, M. B. MacIver, Aman Mahajan, Nándor Marczin, J. A. Jeevendra Martyn, George A. Mashour, Mervyn Maze, Thomas McDowell, Stuart McGrane, Berend Mets, Patrick Meybohm, Charles F. Minto, Jonathan Moss, Mohamed Naguib, Istvan Nagy, Nick Oliver, Paul S. Pagel, Pratik P. Pandharipande, Piyush Patel, Andrew J. Patterson, Robert A. Pearce, Ronald G. Pearl, Misha Perouansky, Kristof Racz, Chinniampalayam Rajamohan, Nilesh Randive, Imre Redai, Stephen Robinson, Richard W. Rosenquist, Carl E. Rosow, Uwe Rudolph, Francis V. Salinas, Robert D. Sanders, Sunita Sastry, Michael Schäfer, Jens Scholz, Thomas W. Schnider, Mark A. Schumacher, John W. Sear, Frédérique S. Servin, Jeffrey H. Silverstein, Tom De Smet, Martin Smith, Joe Henry Steinbach, Markus Steinfath, David F. Stowe, Gary R. Strichartz, Michel M. R. F. Struys, Isao Tsuneyoshi, Robert A. Veselis, Arthur Wallace, Robert P. Walt, David C. Warltier, Nigel R. Webster, Jeanine Wiener-Kronish, Troy Wildes, Paul Wischmeyer, Ling-Gang Wu, Stephen Yang
- Edited by Alex S. Evers, Washington University School of Medicine, St Louis, Mervyn Maze, University of California, San Francisco, Evan D. Kharasch, Washington University School of Medicine, St Louis
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- Anesthetic Pharmacology
- Published online:
- 11 April 2011
- Print publication:
- 10 March 2011, pp viii-xiv
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Mycological Research News
- Reinhard Agerer, Joe Ammirati, Paul Blanz, Régis Courtecuisse, Dennis E. Desjardin, Walter Gams, Nils Hallenberg, Roy Halling, David L. Hawksworth, Egon Horak, Richard P. Korf, Greg M. Mueller, Franz Oberwinkler, Gerhard Rambold, Richard C. Summerbell, Dagmar Triebel, Roy Watling
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- Journal:
- Mycological Research / Volume 104 / Issue 6 / June 2000
- Published online by Cambridge University Press:
- 01 June 2000, pp. 641-644
- Print publication:
- June 2000
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This month Mycological Research News features a report of an extraordinary richness of undescribed truffle-like fungi in Australia, and an explanation of why mycologists should always deposit voucher specimens and cultures to enable their work to be validated, co-authored by 18 mycologists.
Amongst the 21 papers included in this issue are three on the biocontrol of insect pests by Erynia and Metarhizium species, including methods of application and longevity of conidial preparations. Biomass estimations by ergosterol in decomposing leaves in the Everglades, and by chitin in Crinipellis infections on cacao are described. Variation in Phytophthora infestans provides evidence of heterokaryons, conidial production in Colletotrichum acutatum is favoured by monsoon conditions, and the conidia of Pestalotiopsis neglecta inhibit other fungi. Six papers on mycorrhizas address competition with saprobic fungi and other ectomycorrhizal species, the characterization of a chitin synthase, variation at the molecular level in two endomycorrhizal fungi, a culture technique, and the early response of tobacco roots to colonization. Amongst other papers are ones characterizing a protease in Schizophyllum, describing incompatability groups in Pleurotus tuberregium, and showing different Venturia species attack different pears.
The following new scientific names are introduced: Pseudohelicomyces gen. nov.; Anthostomella acuminata, A. applanata, A. caffrariae, A. colligata, A. meerensis, A. palmae, A. raphiae, A. spiralis, Pseudohelicomyces albus, Ramulispora cerealis, and Trichoderma stromaticum spp. nov.