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Attention-deficit/hyperactivity disorder (ADHD) symptoms are associated with myriad adverse outcomes, including interpersonal difficulties, but factors that moderate the developmental course and functional impact of ADHD over time are not well understood. The present study evaluated developmental contributions of the triarchic neurobehavioral traits (boldness, meanness, and disinhibition) to ADHD symptomatology and its subdimensions from adolescence to young adulthood. Participants were twins and triplets assessed at ages 14, 17, and 19 (initial N = 1,185, 51.2% female). Path analyses using negative binomial regression revealed that boldness at age 14 was associated with more ADHD symptoms cross-sectionally (especially hyperactivity/impulsivity), but fewer symptoms (especially inattention) at age 19 in the prospective analysis. Notably, inclusion of interpersonal problems at ages 14 and 17 as covariates reduced the latter effect to nonsignificant. Disinhibition concurrently and prospectively predicted higher levels of ADHD symptoms, including both subdimensions, and the prospective effects were partially mediated by greater social impairment at age 17. Meanness prospectively (but not concurrently) predicted higher levels of hyperactivity/impulsivity symptoms. Sex moderated certain associations of meanness and disinhibition with ADHD symptoms. These findings highlight how fundamental neurobehavioral traits shape both psychopathology and adaptive outcomes in the developmental course of ADHD.
The characterization of poorly crystalline minerals formed by weathering is difficult using conventional techniques. The objective of this study was to use cutting-edge spectroscopic techniques to characterize secondary Fe mineralogy in young soils formed in basaltic cinders in a cool, arid environment. The mineralogy of a chronosequence of soils formed on 2, 6, and 15 thousand year old basaltic cinders at Craters of the Moon National Monument (COM) was examined using synchrotron-based X-ray absorption fine structure (XAFS) spectroscopy in combination with selective extractions. Fe K-edge XAFS is useful for determining speciation in poorly crystalline materials such as young weathering products. Over 86% of Fe in the soil clay fractions was contained in poorly crystalline materials, mostly in the form of ferrihydrite, with the remainder in a poorly crystalline Fe-bearing smectite. The XAFS spectra suggest that ferrihydrite in the 15 ka soil clay is more resistant to ammonium oxalate (AOD) extraction than is ferrihydrite in the younger materials. Fe in the poorly crystalline smectite is subject to dissolution during citrate-bicarbonate- dithionite (CBD) extraction. The results indicate that relatively few mineralogical changes occur in these soils within the millennial time frame and under the environmental conditions associated with this study. Although the secondary mineral suite remains similar in the soils of different ages, ferrihydrite crystallinity appears to increase with increasing soil age.
Allophane and imogolite are common alteration products of volcanic materials. Natural and synthetic allophanes and imogolites were characterized in the present study in order to clarify the short-range order of these materials and to gain an understanding of their spectral properties. Spectral analyses included visible/near-infrared (VNIR), and infrared (IR) reflectance of particulate samples and thermal-infrared (TIR) emissivity spectra of particulate and pressed pellets. Spectral features were similar but not identical for allophane and imogolite. In the near-infrared (NIR) region, allophane spectra exhibited a doublet near 7265 and 7120 cm−1 (1.38 and 1.40 μm) due to OH2v, a broad band near 5220 cm−1 (1.92 μm) due to H2Ov+δ, and a band near 4560 cm−1 (2.19 μm) due to OHv+δ. Reflectance spectra of imogolite in this region included a doublet near 7295 and 7190 cm−1 (1.37 and 1.39 μm) due to OH2v, a broad band near 5200 cm−1 (1.92 μm) due to H2Ov+δ, and a band near 4565 cm−1 (2.19 μm) due to OHv+δ. A strong broad band was also observed near 3200–3700 cm−1 (~2.8–3.1 μm) which is a composite of OHv, H2Ov, and H2O2δ vibrations. Visible/near-infrared spectra were also collected under two relative humidity (RH) conditions. High-RH conditions resulted in increasing band strength for the H2O combination modes near 6900–6930 cm−1 (1.45 μm) and 5170–5180 cm−1 (1.93 μm) in the allophane and imogolite spectra due to increased abundances of adsorbed H2O molecules. Variation in adsorbed H2O content caused an apparent shift in the bands near 1.4 and 1.9 μm. A doublet H2Oδ vibration was observed at 1600–1670 cm−1 (~6.0–6.2 μm) and a band due to OH bending for O3SiOH was observed at ~1350–1485 cm−1 (~6.7–7.4 μm). The Si-O-Al stretching vibrations occurred near 1030 and 940 cm−1 (~9.7 and 10.6 μm) for allophane and near 1010 and 930 cm−1 (~9.9 and 10.7 μm) for imogolite. OH out-of-plane bending modes occurred near 610 cm−1 (16.4 μm) for allophane and at 595 cm−1 (16.8 μm) for imogolite. Features due to Si-O-Al bending vibrations were observed at 545, 420, and 335 cm−1 (~18, 24, and 30 μm) for allophane and at 495, 415, and 335 cm−1 (~20, 24, and 30 μm) for imogolite. The emissivity spectra were obtained from pressed pellets of the samples, which greatly enhanced the spectral contrast of the TIR absorptions. Predicted NIR bands were calculated from the mid-IR fundamental stretching and bending vibrations and compared with the measured NIR values. Controlled-RH X-ray diffraction (XRD) experiments were also performed in order to investigate changes in the mineral structure with changing RH conditions. Both allophane and imogolite exhibited decreasing low-angle XRD intensity with increasing RH, which was probably a result of interactions between H2O molecules and the curved allophane and imogolite structures.
The formation conditions of the ferric smectite nontronite are not fully understood. The present study couples experimental and analytical data with field observations in an attempt to constrain the rate and temperature of formation of naturally occurring nontronites from Columbia River Basalt flows. Synthetic Fe-Al-Si gels were incubated at temperatures ranging from 4 to 150°C for 4 weeks. Samples were analyzed using Fe K-edge X-ray fluorescence spectroscopy (XAFS). Spectra of the synthesized nontronites were compared with spectra of natural samples collected from weathered Columbia River Basalt flows. Cation ordering in the synthetic samples increased with incubation temperature, but the synthetic clays did not approach the degree of crystal ordering of the natural nontronite samples. These observations suggest that highly ordered natural nontronites require longer crystallization times than are typically used in laboratory experiments. The natural samples were found filling open cracks near flow surfaces, indicating that the clays formed at temperatures below the boiling point of water. A comparison of experimental and field timescales with other estimates of nontronite growth rates suggests that natural nontronite crystallization in the region must have occurred at ambient, near-surface temperatures over timescales of up to millions of years.
The nano-aluminosilicate mineral allophane is common in soils formed from parent materials containing volcanic ash and often contains Fe. Due to its lack of long-range order, the structure of allophane is still not completely understood. In the present study, Fe K-edge X-ray absorption fine structure (XAFS) was used to examine Fe-containing natural and synthetic allophane and imogolite samples. Results indicated that Fe substitutes for octahedrally coordinated Al in allophane, and that Fe exhibits a clustered distribution within the octahedral sheet. Iron adsorbed on allophane surfaces is characterized by spectral features distinct from those of isomorphically substituted Fe and of ferrihydrite. Fe adsorbed on the allophane surfaces probably exists as small polynuclear complexes exhibiting Fe-Fe edge sharing, similar to poorly crystalline Fe oxyhydroxides. The XAFS spectra of natural allophane and imogolite indicate that the Fe in the minerals is a combination of isomorphically substituted and surface-adsorbed Fe. In the synthetic Fe-substituted allophanes, the Fe XAFS spectra did not vary with the Al:Si ratio. Theoretical fits of the extended XAFS (EXAFS) spectra suggest that local atomic structure around octahedral Fe in allophanes is more similar to Fe in a smectite-like structure than to a published theoretical nanoball structure.
Various water-based heater-cooler devices (HCDs) have been implicated in nontuberculous mycobacteria outbreaks. Ongoing rigorous surveillance for healthcare-associated M. abscessus (HA-Mab) put in place following a prior institutional outbreak of M. abscessus alerted investigators to a cluster of 3 extrapulmonary M. abscessus infections among patients who had undergone cardiothoracic surgery.
Methods:
Investigators convened a multidisciplinary team and launched a comprehensive investigation to identify potential sources of M. abscessus in the healthcare setting. Adherence to tap water avoidance protocols during patient care and HCD cleaning, disinfection, and maintenance practices were reviewed. Relevant environmental samples were obtained. Patient and environmental M. abscessus isolates were compared using multilocus-sequence typing and pulsed-field gel electrophoresis. Smoke testing was performed to evaluate the potential for aerosol generation and dispersion during HCD use. The entire HCD fleet was replaced to mitigate continued transmission.
Results:
Clinical presentations of case patients and epidemiologic data supported intraoperative acquisition. M. abscessus was isolated from HCDs used on patients and molecular comparison with patient isolates demonstrated clonality. Smoke testing simulated aerosolization of M. abscessus from HCDs during device operation. Because the HCD fleet was replaced, no additional extrapulmonary HA-Mab infections due to the unique clone identified in this cluster have been detected.
Conclusions:
Despite adhering to HCD cleaning and disinfection strategies beyond manufacturer instructions for use, HCDs became colonized with and ultimately transmitted M. abscessus to 3 patients. Design modifications to better contain aerosols or filter exhaust during device operation are needed to prevent NTM transmission events from water-based HCDs.
Patient safety organizations and researchers describe hospital-acquired pneumonia (HAP) as a largely preventable hospital-acquired infection that affects patient safety and quality of care. We provide evidence regarding the consequences of HAP among 2019 Medicare beneficiaries.
Design:
Retrospective case–control study.
Patients:
Calendar year 2019 Medicare beneficiaries with HAP during an initial hospitalization, defined by International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding on inpatient claims (n = 2,457). Beneficiaries with HAP were matched using diagnosis-related group (DRG) codes with beneficiaries who did not experience HAP (n = 2,457).
Methods:
The 2019 calendar year Medicare 5% Standard Analytic Files (SAF), for inpatient, outpatient, physician, and all postacute hospital settings. The case group (HAP) and control group (non-HAP) were matched on disease severity, age, sex, and race and were compared for hospital length of stay, costs, and mortality during the initial hospitalization and across settings for 30, 60, and 90 days after discharge. The 2019 fiscal year MedPAR Claims data were used to determine Medicare costs.
Results:
Medicare beneficiaries with HAP were 2.8 times more likely to die within 90 days compared with matched beneficiaries who did not develop HAP. Among those who survived, beneficiaries with HAP spent 6.6 more days in the hospital (69%) and cost the Medicare program an average of $14,487 (24%) more per episode of care across initial inpatient and postdischarge services.
Conclusions:
The findings of higher mortality and cost among Medicare beneficiaries who develop HAP suggest that HAP prevention should be prioritized as a patient safety and quality initiative for the Medicare program.
The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery (WCPCCS) will be held in Washington DC, USA, from Saturday, 26 August, 2023 to Friday, 1 September, 2023, inclusive. The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery will be the largest and most comprehensive scientific meeting dedicated to paediatric and congenital cardiac care ever held. At the time of the writing of this manuscript, The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery has 5,037 registered attendees (and rising) from 117 countries, a truly diverse and international faculty of over 925 individuals from 89 countries, over 2,000 individual abstracts and poster presenters from 101 countries, and a Best Abstract Competition featuring 153 oral abstracts from 34 countries. For information about the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery, please visit the following website: [www.WCPCCS2023.org]. The purpose of this manuscript is to review the activities related to global health and advocacy that will occur at the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery.
Acknowledging the need for urgent change, we wanted to take the opportunity to bring a common voice to the global community and issue the Washington DC WCPCCS Call to Action on Addressing the Global Burden of Pediatric and Congenital Heart Diseases. A copy of this Washington DC WCPCCS Call to Action is provided in the Appendix of this manuscript. This Washington DC WCPCCS Call to Action is an initiative aimed at increasing awareness of the global burden, promoting the development of sustainable care systems, and improving access to high quality and equitable healthcare for children with heart disease as well as adults with congenital heart disease worldwide.
The population of long-term survivors with CHDs is increasing due to better diagnostics and treatment. This has revealed many co-morbidities including different neurocognitive difficulties. However, the prevalence of psychiatric disorders among children and adolescents and the specific types of disorders they may experience are unclear. We systematically reviewed the existing literature, where psychiatric diagnoses or psychiatric symptoms were investigated in children and adolescents (age: 2–18 aged) with CHDs and compared them with a heart-healthy control group or normative data. The searches were done in the three databases PubMed, psychINFO, and Embase. We included 20 articles reporting on 8035 unique patients with CHDs. Fourteen articles repoted on psychological symptoms, four reported on psychiatric diagnoses, and two reported on both symptoms and diagnoses. We found that children and adolescents with a CHD had a higher prevalence of attention deficit hyperactivity disorder (ranging between 1.4 and 9 times higher) and autism (ranging between 1.8 and 5 times higher) than controls, but inconsistent results regarding depression and anxiety.
Many Aboriginal Australian communities are undergoing language shift from traditional Indigenous languages to contact varieties such as Kriol, an English-lexified Creole. Kriol is reportedly characterised by lexical items with highly variable phonological specifications, and variable implementation of voicing and manner contrasts in obstruents (Sandefur, 1986). A language, such as Kriol, characterised by this unusual degree of variability presents Kriol-acquiring children with a potentially difficult language-learning task, and one which challenges the prevalent theories of acquisition. To examine stop consonant acquisition in this unusual language environment, we present a study of Kriol stop and affricate production, followed by a mispronunciation detection study, with Kriol-speaking children (ages 4-7) from a Northern Territory community where Kriol is the lingua franca. In contrast to previous claims, the results suggest that Kriol-speaking children acquire a stable phonology and lexemes with canonical phonemic specifications, and that English experience would not appear to induce this stability.
Psilocybin Therapy (PT) is being increasingly studied as a psychiatric intervention. Personality relates to mental health and can be used to probe the nature of PT's therapeutic action.
Methods
In a phase 2, double-blind, randomized, active comparator controlled trial involving patients with moderate-to-severe major depressive disorder, we compared psilocybin with escitalopram, over a core 6-week trial period. Five-Factor model personality domains, Big Five Aspect Scale Openness aspects, Absorption, and Impulsivity were measured at Baseline, Week 6, and Month 6 follow-up.
Results
PT was associated with decreases in neuroticism (B = −0.63), introversion (B = −0.38), disagreeableness (B = −0.47), impulsivity (B = −0.40), and increases in absorption (B = 0.32), conscientiousness (B = 0.30), and openness (B = 0.23) at week 6, with neuroticism (B = −0.47) and disagreeableness (B = −0.41) remaining decreased at month 6. Escitalopram Treatment (ET) was associated with decreases in neuroticism (B = −0.38), disagreeableness (B = −0.26), impulsivity (B = −0.35), and increases in openness (B = 0.28) at week 6, with neuroticism (B = −0.46) remaining decreased at month 6. No significant between-condition differences were observed.
Conclusions
Personality changes across both conditions were in a direction consistent with improved mental health. With the possible exception of trait absorption, there were no compelling between-condition differences warranting conclusions regarding a selective action of PT (v. ET) on personality; however, post-ET changes in personality were significantly moderated by pre-trial positive expectancy for escitalopram, whereas expectancy did not moderate response to PT.
The White River Badlands (WRB) of South Dakota record eolian activity spanning the late Pleistocene through the latest Holocene (21 ka to modern), reflecting the effects of the last glacial period and Holocene climate fluctuations (Holocene Thermal Maximum, Medieval Climate Anomaly, and Little Ice Age). The WRB dune fields are important paleoclimate indicators in an area of the Great Plains with few climate proxies. The goal of this study is to use 1 m/pixel-resolution digital elevation models from drone imagery to distinguish Early to Middle Holocene parabolic dunes from Late Holocene parabolic dunes. Results indicate that relative ages of dunes are distinguished by slope and roughness (terrain ruggedness index). Morphological differences are attributed to postdepositional wind erosion, soil formation, and mass wasting. Early to Middle Holocene and Late Holocene paleowind directions, 324°± 13.1° (N = 7) and 323° ± 3.0° (N = 19), respectively, are similar to the modern wind regime. Results suggest significant landscape resilience to wind erosion, which resulted in preservation of a mosaic of Early and Late Holocene parabolic dunes. Quantification of dune characteristics will help refine the chronology of eolian activity in the WRB, provide insight into drought-driven landscape evolution, and integrate WRB eolian activity in a regional paleoenvironmental context.
Of the wildlife casualties admitted to rehabilitation centres in England, less than half are subsequently released back into the wild. If the factors associated with survival within rehabilitation centres can be determined, they may be used to focus efforts on individuals with high chances of successful recovery, and thus improve welfare by devoting resources to those animals that are more likely to benefit. We analysed the medical record cards of eight species admitted to four wildlife rehabilitation centres run by the Royal Society for the Prevention of Cruelty to Animals between 2000-2004 to determine those factors that affected the chance of survival in care until release, and whether trends in predictive factors occurred across taxonomic groups. We found that the most important predictive factor, across all species, was the severity of the symptoms of injury or illness. Factors commonly used as important indicators of rehabilitation success in published practice guidelines, such as mass and age, were not found to affect survival significantly. Our results highlight the importance of triage based on clinical diagnosis as soon as a wildlife casualty is admitted, and indicate that although the ethos of many rehabilitation centres is to attempt the treatment of all wildlife casualties, the attempted treatment of those with severe injuries may be adversely affecting welfare by prolonging suffering.
In the event of a notifiable disease outbreak, poultry may need to be culled in situ. This should be performed swiftly and humanely to prevent further spread of the pathogen while preserving the welfare of the animals prior to death. Here, we examined the aversion of broiler chicks (Gallus domesticus) to three lethal gas mixtures at various concentrations to determine the least aversive mix that could be used in whole-house gassing. For 1 h, individual chicks (n = 36) were allowed to place their heads inside three feeding and drinking stations (FDS) in order to access food and water. Each FDS was filled with a different gas mixture, and birds could access each FDS as much as they liked. Twelve chicks each were tested at low (50% carbon dioxide [CO2] in air, 70% argon [Ar] in CO2, 70% nitrogen [N2] in CO2), medium (55% CO2 in air, 80% Ar in CO2, 80% N2 in CO2) or high (60% CO2 in air, 90% Ar in CO2, 90% N2 in CO2) concentrations of gas mixtures. Aversion was assessed based on the time birds spent with head in each FDS (with more time indicating less aversive), and the frequency of head shakes relative to time spent with head in the FDS (with a lower proportion indicating less aversive). Data were analysed by ANOVA. On average, birds spent < 3 min with their head in any FDS. Mixtures containing 90% Ar or N2 in CO2 and 80% argon in CO2 were least aversive and mixtures containing 70% N2 in CO2 and 60% CO2 in air were most aversive, based on time spent with head in. Head shakes s−1 were more frequent with low concentration gas mixtures compared to high concentrations, and with all CO2 in air mixtures, which suggests that the intensity of head shaking is related to the concentrations of CO2. From these results, one concentration of each of the three gas mixtures (90% N2 in CO2, 80% Ar in CO2, and 50% CO2 in air) were chosen for assessment on a further 12 birds and the results showed that both inert gas mixtures were less aversive than 50% CO2 in air based on time spent with head in. Frequency of head shakes s−1 did not differ between the three mixtures. Birds found all gases aversive, however it is concluded that inert gas in CO2 mixtures were least aversive compared to CO2 in air and these gases also caused less signs of respiratory discomfort.
Little has been published on the demographic composition of the clinical and translational science research workforce within the Clinical and Translational Science Awards (CTSA) Program despite the well-documented need for greater diversity in the biomedical research workforce. Analyses of workforce demographic reveal that women and members of underrepresented groups remain persistently underrepresented in the CTSA hub and training components principal investigators. In contrast, in the CTSA Program career development and training programs, females have greater representation as participants, and non-Whites were better represented in training programs.
Shallow firn cores, in addition to a near-basal ice core, were recovered in 2018 from the Quelccaya ice cap (5470 m a.s.l) in the Cordillera Vilcanota, Peru, and in 2017 from the Nevado Illimani glacier (6350 m a.s.l) in the Cordillera Real, Bolivia. The two sites are ~450 km apart. Despite meltwater percolation resulting from warming, particle-based trace element records (e.g. Fe, Mg, K) in the Quelccaya and Illimani shallow cores retain well-preserved signals. The firn core chronologies, established independently by annual layer counting, show a convincing overlap indicating the two records contain comparable signals and therefore capture similar regional scale climatology. Trace element records at a ~1–4 cm resolution provide past records of anthropogenic emissions, dust sources, volcanic emissions, evaporite salts and marine-sourced air masses. Using novel ultra-high-resolution (120 μm) laser technology, we identify annual layer thicknesses ranging from 0.3 to 0.8 cm in a section of 2000-year-old radiocarbon-dated near-basal ice which compared to the previous annual layer estimates suggests that Quelccaya ice cores drilled to bedrock may be older than previously suggested by depth-age models. With the information collected from this study in combination with past studies, we emphasize the importance of collecting new surface-to-bedrock ice cores from at least the Quelccaya ice cap, in particular, due to its projected disappearance as soon as the 2050s.
To describe the epidemiology of complex colon surgical procedures (COLO), stratified by present at time of surgery (PATOS) surgical-site infections (SSIs) and non-PATOS SSIs and their impact on the epidemiology of colon-surgery SSIs.
Design:
Retrospective cohort study.
Methods:
SSI data were prospectively collected from patients undergoing colon surgical procedures (COLOs) as defined by the National Healthcare Safety Network (NHSN) at 34 community hospitals in the southeastern United States from January 2015 to June 2019. Logistic regression models identified specific characteristics of complex COLO SSIs, complex non-PATOS COLO SSIs, and complex PATOS COLO SSIs.
Results:
Over the 4.5-year study period, we identified 720 complex COLO SSIs following 28,188 COLO surgeries (prevalence rate, 2.55 per 100 procedures). Overall, 544 complex COLO SSIs (76%) were complex non-PATOS COLO SSIs (prevalence rate [PR], 1.93 per 100 procedures) and 176 (24%) complex PATOS COLO SSIs (PR, 0.62 per 100 procedures). Age >75 years and operation duration in the >75th percentile were independently associated with non-PATOS SSIs but not PATOS SSIs. Conversely, emergency surgery and hospital volume for COLO procedures were independently associated with PATOS SSIs but not non-PATOS SSIs. The proportion of polymicrobial SSIs was significantly higher for non-PATOS SSIs compared with PATOS SSIs.
Conclusions:
Complex PATOS COLO SSIs have distinct features from complex non-PATOS COLO SSIs. Removal of PATOS COLO SSIs from public reporting allows more accurate comparisons among hospitals that perform different case mixes of colon surgeries.
The western Antarctic Peninsula harbours a diverse benthic marine community where dense canopies of macroalgae can dominate the shallow subtidal zone (0–40 m or greater). In the lower portion of this range (below 25–35 m depending on topography), invertebrates such as sponges and echinoderms can be found in greater abundance due to reduced competition for space from the algal species. Dendrilla antarctica (previously Dendrilla membranosa) is a common demosponge that thrives in both communities and is known for producing diterpene secondary metabolites as a defence against sympatric sea star and amphipod predators. Omnivorous mesograzers such as amphipods inhabit both communities; however, they are in greatest abundance within the macroalgal canopy. Due to the differences between habitats, it was hypothesized that specific amphipod species not susceptible to the defensive metabolites of D. antarctica would take refuge from predators in the chemically defended sponge. Analysis of the metabolome and amphipod communities from sponges in both habitats found correlations of metabolic profile to both abundance and habitat. These studies serve to inform our understanding of the complex ecosystem of the Antarctic benthos that stands to be dramatically altered by the rapidly changing climate in the years to come.
Sparse recent data are available on the epidemiology of surgical site infections (SSIs) in community hospitals. Our objective was to provide updated epidemiology data on complex SSIs in community hospitals and to characterize trends of SSI prevalence rates over time.
Design:
Retrospective cohort study.
Methods:
SSI data were collected from patients undergoing 26 commonly performed surgical procedures at 32 community hospitals in the southeastern United States from 2013 to 2018. SSI prevalence rates were calculated for each year and were stratified by procedure and causative pathogen.
Results:
Over the 6-year study period, 3,561 complex (deep incisional or organ-space) SSIs occurred following 669,467 total surgeries (prevalence rate, 0.53 infections per 100 procedures). The overall complex SSI prevalence rate did not change significantly during the study period: 0.58 of 100 procedures in 2013 versus 0.53 of 100 procedures in 2018 (prevalence rate ratio [PRR], 0.84; 95% CI, 0.66–1.08; P = .16). Methicillin-sensitive Staphylococcus aureus (MSSA) complex SSIs (n = 480, 13.5%) were more common than complex SSIs caused by methicillin-resistant S. aureus (MRSA; n = 363, 10.2%).
Conclusions:
The complex SSI rate did not decrease in our cohort of community hospitals from 2013 to 2018, which is a change from prior comparisons. The reason for this stagnation is unclear. Additional research is needed to determine the proportion of or remaining SSIs that are preventable and what measures would be effective to further reduce SSI rates.