Trends in Illness Severity, Hospitalization, and Mortality for Community-Onset Pneumonia at 118 US Veterans Affairs Medical Centers.

BACKGROUND: Deaths from pneumonia were decreasing globally prior to the COVID-19 pandemic, but it is unclear whether this was due to changes in patient populations, illness severity, diagnosis, hospitalization thresholds, or treatment. Using clinical data from the electronic health record among a national cohort of patients initially diagnosed with pneumonia, we examined temporal trends in severity of illness, hospitalization, and short- and long-term deaths. DESIGN: Retrospective cohort PARTICIPANTS: All patients >18 years presenting to emergency departments (EDs) at 118 VA Medical Centers between 1/1/2006 and 12/31/2016 with an initial clinical diagnosis of pneumonia and confirmed by chest imaging report. EXPOSURES: Year of encounter. MAIN MEASURES: Hospitalization and 30-day and 90-day mortality. Illness severity was defined as the probability of each outcome predicted by machine learning predictive models using age, sex, comorbidities, vital signs, and laboratory data from encounters during years 2006-2007, and similar models trained on encounters from years 2015 to 2016. We estimated the changes in hospitalizations and 30-day and 90-day mortality between the first and the last 2 years of the study period accounted for by illness severity using time covariate decompositions with model estimates. RESULTS: Among 196,899 encounters across the study period, hospitalization decreased from 71 to 63%, 30-day mortality 10 to 7%, 90-day mortality 16 to 12%, and 1-year mortality 29 to 24%. Comorbidity risk increased, but illness severity decreased. Decreases in illness severity accounted for 21-31% of the decrease in hospitalizations, and 45-47%, 32-24%, and 17-19% of the decrease in 30-day, 90-day, and 1-year mortality. Findings were similar among underrepresented patients and those with only hospital discharge diagnosis codes. CONCLUSIONS: Outcomes for community-onset pneumonia have improved across the VA healthcare system after accounting for illness severity, despite an increase in cases and comorbidity burden.

Evaluating institutional fit for the conservation of threatened species.

Recovery and conservation of threatened species require adequate institutional responses. We tested an approach to systematically identify and measure how an institutional framework acknowledges threats and required responses for the recovery of endangered species. We measured institutional functional fit with a drivers-pressure-state-impacts-response (DPSIR) model integrated with a quantitative text mining method and qualitative analysis of statutory instruments to examine regulatory responses that support the recovery of 2 endangered species native to Australia, the bridled nailtail wallaby (Onychogalea fraenata) and the Eastern Bristlebird (Dasyornis brachypterus). The key components of the DPSIR model were present in the institutional framework at statutory and operational levels, but some institutional gaps remained in the protection and recovery of the Eastern Bristlebird, including feral predator control, weed control, and grazing management in some locations. However, regulatory frameworks varied in their geographic scope and the application and implementation of many instruments remained optional. Quantitative text mining can be used to quickly navigate a large volume of regulatory documents, but challenges remain in selection of terms, queries of co-occurrence, and interpretation of word frequency counts. To inform policy, we recommend that quantitative assessments of institutional fit be complemented with qualitative analysis and interpreted in light of the sociopolitical and institutional context.

La recuperación y la conservación de las especies amenazadas requieren de respuestas institucionales adecuadas. Evaluamos una estrategia para identificar y medir sistemáticamente cómo un marco de trabajo reconoce las amenazas y las respuestas requeridas para la recuperación de las especies en peligro. Medimos la aptitud funcional institucional mediante un modelo de fuerzas motrices-presión-estado-impacto-respuesta (DPSIR) integrado con un método cuantitativo de extracción de textos y un análisis cualitativo de los instrumentos legales para examinar las respuestas regulatorias que apoyan a la recuperación de dos especies en peligro nativas de Australia: Onychogalea fraenata y Dasyornis brachypterus. Los componentes clave del modelo DPSIR estuvieron presentes en el marco de trabajo institucional a niveles legales y operativos, pero algunos vacíos institucionales permanecieron en la protección y recuperación de D. brachypterus, incluyendo el control de depredadores ferales, el control de malezas y el manejo del pastoreo en algunas localidades. Sin embargo, los marcos de trabajo regulatorios variaron en cuanto a su enfoque geográfico y la aplicación e implementación de muchos de los instrumentos siguieron siendo opcionales. La extracción cuantitativa de textos puede usarse para navegar rápidamente un gran volumen de documentación regulatoria, pero todavía existen obstáculos en la selección de términos, consultas sobre la coocurrencia e interpretación de los conteos de frecuencia de palabras. Para orientar a las políticas recomendamos que las evaluaciones cuantitativas de la aptitud institucional estén complementadas con análisis cuantitativos e interpretadas a la luz del contexto institucional y sociopolítico.

Intra- and inter-observer reproducibility of CINtec® PLUS in ThinPrep® cytology preparations.

BACKGROUND: This study evaluated the intra- and inter-observer reproducibility of the dual-stain biomarker, CINtec® PLUS cytology in ThinPrep® specimens, for improved specificity in the detection of cervical disease in women testing human papillomavirus (HPV) positive. METHODS: A total of 972 cases of HPV-positive women from a triage and primary HPV screening population were selected from an ongoing study evaluating the clinical performance of CINtec® PLUS cytology. For reproducibility analyses, three cytotechnologists rescreened sets of slides which they had previously reported themselves and which were previously reported by each of the other cytotechnologists. The original results of slides previously screened by each of the three cytotechnologists were also compared with the results of an expert reference evaluator. RESULTS: Intra- and inter-observer agreement for paired evaluations between reviewers ranged from 82.8% to 94.9% (kappa 0.65-0.91) and 89.2% to 93% (kappa 0.83-0.88), respectively. Reproducibility analyses between the cytotechnologists and the reference evaluator revealed agreements ranging from 95.5% to 98% (kappa 0.89-0.96). CONCLUSION: Evaluation of the dual-stain biomarker showed a high level of agreement across all evaluators suggesting that CINtec® PLUS cytology will perform well in the hands of cytotechnologists and pathologist reviewers and could be introduced into cellular pathology laboratories that employ ThinPrep® LBC with a minimum effort.

Paediatric Consultation Liaison Psychiatry Services (PCLPS) -what are they actually doing?

Introduction Paediatric Consultation Liaison Psychiatry Services (PCLPS) are specialised services treating mental health difficulties co-morbid with medical problems. Methods Standardised clinical data was retrieved from all case notes (N=108) during the study timeframe (Jan-June 2016). Results The majority of children were female 59 (55%) with a mean age of 13. Presentation was typically via the Emergency Department (ED) (85, 79%), and of those, the majority (53, 62%) were 'out of hours' and for Deliberate Self-harm (44, 52%) Almost half of all cases seen (50, 46%) were previously known, and discharged back (84, 78%), to CAMHS. Discussion The majority of work conducted by the PCLPS involved children with acute or deteriorating psychiatry disorders, previously known to CAMHS, with a much smaller focus on typical liaison presentations. Adequate resourcing of hospital based PCLPS and 'out of hours' CAMHS are necessary to allow PCLPS provide a specialist service to children with combined medical and MH problems. Given the development of the National Children's Hospital, addressing these resourcing deficits is of vital importance.

A randomised trial of the cool pad pillow topper versus standard care for sleep disturbance and hot flushes in women on endocrine therapy for breast cancer.

PURPOSE: Quality of life in women receiving adjuvant endocrine therapy for breast cancer (BC) may be impaired by hot flushes and night sweats. The cool pad pillow topper (CPPT) is a commercial product, promoted to improve quality of sleep disrupted by hot flushes. This study aimed to identify if the CPPT reduces severity of sleep disturbance by minimising effects of hot flushes. METHODS: This randomised phase II trial, recruited women with BC, on adjuvant endocrine therapy, experiencing hot flushes and insomnia. Participants were randomised (stratified by baseline sleep efficiency score (SES) and menopausal status) to the intervention arm (CPPT + standard care) or control arm (standard care). Participants completed Hospital Anxiety and Depression Scale and Functional Assessment of Cancer Therapy-Breast (FACT-B) questionnaires and fortnightly sleep/hot flush diaries (where responses were averaged over 2-week periods). The primary endpoint was change in average SES from -2 to 0 weeks to 2 to 4 weeks. RESULTS: Seventy-four pre- (68.9 %) and post-menopausal (31.1 %) women were recruited. Median age was 49.5 years. Endocrine therapies included tamoxifen (93.2 %). Median SES at weeks 2 to 4 improved in both arms but the increase on the intervention arm was almost twice that on the control arm (p = 0.024). There were significantly greater reductions in hot flushes and HADS depression in the intervention arm (p = 0.09 and p = 0.036, respectively). There were no significant differences in FACT-B or HADS anxiety. CONCLUSION: This study supports the use of the CPPT as an aid to reduce sleep disturbance and the frequency/severity of hot flushes.

Oxygen cost of walking, physical activity, and sedentary behaviours in rheumatoid arthritis.

OBJECTIVES: To evaluate the oxygen cost of gait and measure physical activity profiles, including time spent sedentary, in people with rheumatoid arthritis (RA) and matched controls. METHOD: We recruited 19 people with RA and 19 controls matched for age, sex, and body mass index (BMI). Demographic details and clinical characteristics of the RA population were recorded. Oxygen uptake per metre walked (oxygen cost) was measured in the laboratory using a portable gas analyser. Activity profiles including the number of steps per day, time spent sedentary (sitting or lying down), and intensity of walking were recorded over 5 days using an activity monitor, from which physical activity was classified by intensity categories. Levels of pain, fatigue, anxiety, and depression were recorded. RESULTS: People with RA walked with a slower self-selected gait speed (p < 0.001) than controls but there was no difference in the oxygen cost of walking (p = 0.992) between the groups. People with RA took fewer steps (p < 0.001), had increased sedentary time (p = 0.029) and lower time walking at cadences commensurate with moderate to vigorous physical activity (MVPA) compared to controls (p < 0.001). Pain, fatigue, and depression were higher in the RA group (all p < 0.001). CONCLUSIONS: The oxygen cost of walking in this cohort of people with RA was similar to that of matched controls but there was an increase in time spent sedentary and a reduction in time spent at cadences commensurate with MVPA. Clinical symptoms such as depression, pain, and fatigue may explain the changes in activity/sedentary behaviours in people with RA and require further investigation.

Association of increased postoperative opioid administration with non-small-cell lung cancer recurrence: a retrospective analysis.

BACKGROUND: Evidence suggests that opioid-sparing anaesthetic techniques might be associated with increased cancer-free postoperative survival. This could be related to suppression of natural killer cells by opioid analgesics in the perioperative period. This retrospective analysis tested the hypothesis that greater opioid use in the postoperative period is associated with a higher incidence of recurrences after surgery for lung cancer. METHODS: The medical records of 99 consecutive patients who underwent video-assisted thoracoscopic surgery with lobectomy for Stage I or IIa biopsy-proven non-small-cell lung cancer (NSCLC) were reviewed. Perioperative information including patient characteristics, laboratory data, and surgical, anaesthetic, nursing, and pharmacy reports were collected. Doses of opioids administered intra-operatively and for the first 96 h after operation were converted into equianalgesic doses of oral morphine using a standard conversion table. Data were then compared with the National Cancer Registry's incidence of disease-free survival for 5 yr. RESULTS: A total of 99 patients with similar characteristics were included in the final analysis, 73 of whom were NSCLC recurrence-free at 5 yr and 26 had NSCLC recurrence within 5 yr. Total opioid dose during the 96 h postoperative period was 124 (101) mg of morphine equivalents in the cancer-free group and 232 mg (355) mg in the recurrence group (P=0.02). CONCLUSIONS: This retrospective analysis suggests an association between increased doses of opioids during the initial 96 h postoperative period with a higher recurrence rate of NSCLC within 5 yr.

Physical activity, organized sport participation and active transportation to school among Canadian youth by gender identity and sexual attraction. / Activité physique, participation à des sports organisés et utilisation du transport actif pour se rendre à l'école chez les adolescents canadiens par identité de genre et par orientation sexuelle.

INTRODUCTION: Regular physical activity is associated with a wide range of health benefits in youth. While previous studies have identified disparities in physical activity among youth by gender identity and sexual attraction, these have seldom been explored in Canadian youth. METHODS: Data from the 2019 Canadian Health Survey on Children and Youth were used to assess prevalence of and time spent in organized sports participation, total physical activity and active transportation by gender identity (non-cisgender vs. cisgender) among youth aged 12 to 17, and by sexual attraction (nonheterosexual attraction vs. heterosexual attraction) among youth aged 15 to 17. RESULTS: There was no difference in average minutes of total physical activity per week between non-cisgender and cisgender Canadian youth. Non-cisgender youth (which represent 0.5% of the population) averaged significantly fewer minutes of organized sports per week than their cisgender counterparts. There was some evidence of increased active transportation to school among non-cisgender youth, but insufficient power to detect significant differences. Canadian youth reporting any nonheterosexual attraction (which represent 21.2% of the population, including mostly heterosexual youth) were less likely to be regularly physically active and participate in organized sports than youth reporting exclusive heterosexual attraction. Differences were larger among males than females. Males reporting nonheterosexual attraction were more likely to use active transportation to get to school than their heterosexual counterparts. CONCLUSION: Non-cisgender youth and youth reporting nonheterosexual attraction tended to participate less in organized sports than their counterparts, but may have engaged in more active transportation. Mitigating the barriers associated with sport participation could increase physical activity among these groups.

Estradiol-independent restoration of T-cell function in post-reproductive females.

Aging leads to a general decline in protective immunity. The most common age-associated effects are in seen T-cell mediated immune function. Adult mice whose immune systems show only moderate changes in T-cell subsets tend to live longer than age-matched siblings that display extensive T-cell subset aging. Importantly, at the time of reproductive decline, the increase in disease risks in women significantly outpace those of men. In female mice, there is a significant decline in central and peripheral naïve T-cell subsets at the time of reproductive failure. Available evidence indicates that this naïve T-cell decline is sensitive to ovarian function and can be reversed in post-reproductive females by transplantation of young ovaries. The restoration of naïve T-cell subsets due to ovarian transplantation was impressive compared with post-reproductive control mice, but represented only a partial recovery of what was lost from 6 months of age. Apparently, the influence of ovarian function on immune function may be an indirect effect, likely moderated by other physiological functions. Estradiol is significantly reduced in post-reproductive females, but was not increased in post-reproductive females that received new ovaries, suggesting an estradiol-independent, but ovarian-dependent influence on immune function. Further evidence for an estradiol-independent influence includes the restoration of immune function through the transplantation of young ovaries depleted of follicles and through the injection of isolated ovarian somatic cells into the senescent ovaries of old mice. While the restoration of naïve T-cell populations represents only a small part of the immune system, the ability to reverse this important functional parameter independent of estradiol may hold promise for the improvement of post-reproductive female immune health. Further studies of the non-reproductive influence of the ovary will be needed to elucidate the mechanisms of the relationship between the ovary and health.

Implementation and outcomes of a clinician-directed intervention to improve antibiotic prescribing for acute respiratory tract infections within the Veterans' Affairs Healthcare System.

OBJECTIVE: To determine whether a clinician-directed acute respiratory tract infection (ARI) intervention was associated with improved antibiotic prescribing and patient outcomes across a large US healthcare system. DESIGN: Multicenter retrospective quasi-experimental analysis of outpatient visits with a diagnosis of uncomplicated ARI over a 7-year period. PARTICIPANTS: Outpatients with ARI diagnoses: sinusitis, pharyngitis, bronchitis, and unspecified upper respiratory tract infection (URI-NOS). Outpatients with concurrent infection or select comorbid conditions were excluded. INTERVENTION(S): Audit and feedback with peer comparison of antibiotic prescribing rates and academic detailing of clinicians with frequent ARI visits. Antimicrobial stewards and academic detailing personnel delivered the intervention; facility and clinician participation were voluntary. MEASURE(S): We calculated the probability to receive antibiotics for an ARI before and after implementation. Secondary outcomes included probability for a return clinic visits or infection-related hospitalization, before and after implementation. Intervention effects were assessed with logistic generalized estimating equation models. Facility participation was tracked, and results were stratified by quartile of facility intervention intensity. RESULTS: We reviewed 1,003,509 and 323,023 uncomplicated ARI visits before and after the implementation of the intervention, respectively. The probability to receive antibiotics for ARI decreased after implementation (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.78-0.86). Facilities with the highest quartile of intervention intensity demonstrated larger reductions in antibiotic prescribing (OR, 0.69; 95% CI, 0.59-0.80) compared to nonparticipating facilities (OR, 0.89; 95% CI, 0.73-1.09). Return visits (OR, 1.00; 95% CI, 0.94-1.07) and infection-related hospitalizations (OR, 1.21; 95% CI, 0.92-1.59) were not different before and after implementation within facilities that performed intensive implementation. CONCLUSIONS: Implementation of a nationwide ARI management intervention (ie, audit and feedback with academic detailing) was associated with improved ARI management in an intervention intensity-dependent manner. No impact on ARI-related clinical outcomes was observed.

Electronic surveillance criteria for non-ventilator-associated hospital-acquired pneumonia: Assessment of reliability and validity.

OBJECTIVE: Surveillance of non-ventilator-associated hospital-acquired pneumonia (NV-HAP) is complicated by subjectivity and variability in diagnosing pneumonia. We compared a fully automatable surveillance definition using routine electronic health record data to manual determinations of NV-HAP according to surveillance criteria and clinical diagnoses. METHODS: We retrospectively applied an electronic surveillance definition for NV-HAP to all adults admitted to Veterans' Affairs (VA) hospitals from January 1, 2015, to November 30, 2020. We randomly selected 250 hospitalizations meeting NV-HAP surveillance criteria for independent review by 2 clinicians and calculated the percent of hospitalizations with (1) clinical deterioration, (2) CDC National Healthcare Safety Network (CDC-NHSN) criteria, (3) NV-HAP according to a reviewer, (4) NV-HAP according to a treating clinician, (5) pneumonia diagnosis in discharge summary; and (6) discharge diagnosis codes for HAP. We assessed interrater reliability by calculating simple agreement and the Cohen κ (kappa). RESULTS: Among 3.1 million hospitalizations, 14,023 met NV-HAP electronic surveillance criteria. Among reviewed cases, 98% had a confirmed clinical deterioration; 67% met CDC-NHSN criteria; 71% had NV-HAP according to a reviewer; 60% had NV-HAP according to a treating clinician; 49% had a discharge summary diagnosis of pneumonia; and 82% had NV-HAP according to any definition according to at least 1 reviewer. Only 8% had diagnosis codes for HAP. Interrater agreement was 75% (κ = 0.50) for CDC-NHSN criteria and 78% (κ = 0.55) for reviewer diagnosis of NV-HAP. CONCLUSIONS: Electronic NV-HAP surveillance criteria correlated moderately with existing manual surveillance criteria. Reviewer variability for all manual assessments was high. Electronic surveillance using clinical data may therefore allow for more consistent and efficient surveillance with similar accuracy compared to manual assessments or diagnosis codes.

Incidence and Outcomes of Non-Ventilator-Associated Hospital-Acquired Pneumonia in 284 US Hospitals Using Electronic Surveillance Criteria.

Importance: Non-ventilator-associated hospital-acquired pneumonia (NV-HAP) is a common and deadly hospital-acquired infection. However, inconsistent surveillance methods and unclear estimates of attributable mortality challenge prevention. Objective: To estimate the incidence, variability, outcomes, and population attributable mortality of NV-HAP. Design, Setting, and Participants: This cohort study retrospectively applied clinical surveillance criteria for NV-HAP to electronic health record data from 284 US hospitals. Adult patients admitted to the Veterans Health Administration hospital from 2015 to 2020 and HCA Healthcare hospitals from 2018 to 2020 were included. The medical records of 250 patients who met the surveillance criteria were reviewed for accuracy. Exposures: NV-HAP, defined as sustained deterioration in oxygenation for 2 or more days in a patient who was not ventilated concurrent with abnormal temperature or white blood cell count, performance of chest imaging, and 3 or more days of new antibiotics. Main Outcomes and Measures: NV-HAP incidence, length-of-stay, and crude inpatient mortality. Attributable inpatient mortality by 60 days follow-up was estimated using inverse probability weighting, accounting for both baseline and time-varying confounding. Results: Among 6 022 185 hospitalizations (median [IQR] age, 66 [54-75] years; 1 829 475 [26.1%] female), there were 32 797 NV-HAP events (0.55 per 100 admissions [95% CI, 0.54-0.55] per 100 admissions and 0.96 per 1000 patient-days [95% CI, 0.95-0.97] per 1000 patient-days). Patients with NV-HAP had multiple comorbidities (median [IQR], 6 [4-7]), including congestive heart failure (9680 [29.5%]), neurologic conditions (8255 [25.2%]), chronic lung disease (6439 [19.6%]), and cancer (5,467 [16.7%]); 24 568 cases (74.9%) occurred outside intensive care units. Crude inpatient mortality was 22.4% (7361 of 32 797) for NV-HAP vs 1.9% (115 530 of 6 022 185) for all hospitalizations; 12 449 (8.0%) were discharged to hospice. Median [IQR] length-of-stay was 16 (11-26) days vs 4 (3-6) days. On medical record review, pneumonia was confirmed by reviewers or bedside clinicians in 202 of 250 patients (81%). It was estimated that NV-HAP accounted for 7.3% (95% CI, 7.1%-7.5%) of all hospital deaths (total hospital population inpatient death risk of 1.87% with NV-HAP events included vs 1.73% with NV-HAP events excluded; risk ratio, 0.927; 95% CI, 0.925-0.929). Conclusions and Relevance: In this cohort study, NV-HAP, which was defined using electronic surveillance criteria, was present in approximately 1 in 200 hospitalizations, of whom 1 in 5 died in the hospital. NV-HAP may account for up to 7% of all hospital deaths. These findings underscore the need to systematically monitor NV-HAP, define best practices for prevention, and track their impact.

Satisfaction or connectivity?: Implications from the strong relationality model of flourishing couple relationships.

A central feature of couple relationships research is the use of self-report measures of relationship satisfaction. Despite the widespread use of such measures in couples' research, scholars have raised critical questions about satisfaction-focused assessment, including concerns about taking an ontologically individualistic focus. Moving beyond ontological individualism, drawing from the Strong Relationality Model of Relationship Flourishing and data from 615 couples in the United States and Canada (N = 1230 individuals), we explored similarities and differences between assessments of relationship satisfaction and a measure based on strong relationality (relational-connectivity). We evaluated associations with other scales assessing relationship factors including indicators of well-being, relationship processes, virtues, and responsible actions. Using confirmatory latent profile analysis, we classified individuals as Flourishing (55.4%), Languishing (31.8%), Connected, Less-Satisfied (7.8%), or Satisfied, Less-Connected (5.0%). Our results suggest that attending to richer perspectives of relationship quality may spur additional understanding of many factors associated with meaningful couple relationships.

Deconstructing stereotypes: Stature, match-playing time, and performance in elite Women's World Cup soccer.

Recruiting companies recommend elite female soccer players be ≥165 cm (5'5″) in stature. This study investigated if stature limits match-playing time and performance in elite World Cup soccer among players, positions, and countries. We hypothesized stature would not affect match-playing time or performance. Descriptive data were collected on 552 players from 2019 FIFA Women's World Cup. Odds ratios determined likelihood of starting for players <165 cm and ≥165 cm. ANOVAs compared playing time between stature groups, among positions, and between countries. Performance factors including assists, goals, attempts, corners, shots blocked, and defending blocks were reported. Independent t-tests compared differences between players (≥165 cm, < 165 cm). Data are reported, mean difference [95% confidence interval] [MD (95%CI)] and effect sizes (ES). On average, 32.3% of players were <165 cm. Of total players, no differences existed in total minutes (F = 0.98, p = 0.32), matches (F = 0.27 p = 0.59), or average minutes per match (F = 0.48, p = 0.49) between stature groups, regardless of position. No differences existed in playing time between players <165 cm and ≥165 cm among any positions (p > 0.05), or between countries (p > 0.05). Taller mid-fielders exhibited greater performance in goals, assists, attempts, shots blocked, and defending blocks (MD [95%CI] ES; assists, -0.44[-0.76,-0.11]0.59, p = 0.009; goals, -0.35[-0.69,-0.01]0.44, p = 0.047); attempts, 3.14[1.38, 4.90]0.80, p = 0.001; corners, 2.04[0.12, 3.95]0.48, p = 0.037; shots blocked, 0.96[0.40, 1.51]0.75, p = 0.001; defending blocks, 0.43[0.32,0.82]0.48, p = 0.035), however, actual differences were minimal. Our findings indicate stature does not inhibit playing and performing elite women's soccer, as nearly one-third of players were <165 cm.

Current practice in bowel preparation for colorectal surgery: a survey of the members of the Association of Coloproctology of GB & Ireland.

AIM: Recent meta-analyses have suggested that mechanical bowel preparation is not beneficial in patients undergoing colorectal resection. This study aimed to assess current surgical practice in the UK. METHOD: Three hundred and ninety-eight members of the Association of Coloproctology of GB & Ireland were invited to complete an online survey to ascertain their current practice for bowel preparation. RESULTS: One hundred and ninety-nine surgeons completed the survey, of whom 95 (48%) routinely performed laparoscopic resection. The proportions using full bowel preparation for open vs laparoscopic surgery were, respectively, 9.5%vs 16.8% for right hemicolectomy, 43.4%vs 40.2% for left hemicolectomy, 20.5%vs 22.5% for an abdominoperineal resection and 72.2%vs 63.6% for low anterior resection. Among the surgeons who participated, 13.6% changed their practice between doing the same procedure open and laparoscopically, 76% of surgeons routinely defunctioned a low anterior resection. Of these, 22% did not feel that full bowel preparation was necessary before formation of an ileostomy. CONCLUSION: The study demonstrates that a large proportion of patients still receive full bowel preparation despite recent advice to the contrary.

Early childhood temperament predicts intolerance of uncertainty in adolescence.

Intolerance of uncertainty (IU) is the trait propensity to react negatively to uncertainty. To date, very few studies have explored early childhood predictors of IU. The current study identifies relations between child temperament assessed at age 3 (N = 559) and IU assessed at ages 12 (N = 432) and 15 (N = 415). Temperament was assessed through both laboratory observation (Laboratory Temperament Assessment Battery) and maternal report (Children's Behavior Questionnaire). IU was assessed through both maternal rating and child self-report using the 12-item Intolerance of Uncertainty Scale for Children. Higher levels of temperamental negative emotionality/neuroticism and lower levels of temperamental positive emotionality/extraversion assessed at age 3 predicted higher levels of IU in early-mid adolescence. Unique relationships were found at the trait facet level, and differences were observed between informants. These findings suggest that certain early child temperament traits can serve as markers of risk for difficulty dealing with uncertainty later in life. Future research should explore whether this relationship translates to increased risk for psychopathology.

Enzymes for carbon sequestration: neutron crystallographic studies of carbonic anhydrase.

Carbonic anhydrase (CA) is a ubiquitous metalloenzyme that catalyzes the reversible hydration of CO(2) to form HCO(3)(-) and H(+) using a Zn-hydroxide mechanism. The first part of catalysis involves CO(2) hydration, while the second part deals with removing the excess proton that is formed during the first step. Proton transfer (PT) is thought to occur through a well ordered hydrogen-bonded network of waters that stretches from the metal center of CA to an internal proton shuttle, His64. These waters are oriented and ordered through a series of hydrogen-bonding interactions to hydrophilic residues that line the active site of CA. Neutron studies were conducted on wild-type human CA isoform II (HCA II) in order to better understand the nature and the orientation of the Zn-bound solvent (ZS), the charged state and conformation of His64, the hydrogen-bonding patterns and orientations of the water molecules that mediate PT and the ionization of hydrophilic residues in the active site that interact with the water network. Several interesting and unexpected features in the active site were observed which have implications for how PT proceeds in CA.

A multicenter pilot study of a bronchial valve for the treatment of severe emphysema.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) affects millions of people and has limited treatment options. Surgical treatments for severe COPD with emphysema are effective for highly selected patients. A minimally invasive method for treating emphysema could decrease morbidity and increase acceptance by patients. OBJECTIVE: To study the safety and effectiveness of the IBV(R) Valve for the treatment of severe emphysema. METHODS: A multicenter study treated 91 patients with severe obstruction, hyperinflation and upper lobe (UL)-predominant emphysema with 609 bronchial valves placed bilaterally into ULs. RESULTS: Valves were placed in desired airways with 99.7% technical success and no migration or erosion. There were no procedure-related deaths and 30-day morbidity and mortality were 5.5 and 1.1%, respectively. Pneumothorax was the most frequent serious device-related complication and primarily occurred when all segments of a lobe, especially the left UL, were occluded. Highly significant health-related quality of life (HRQL) improvement (-8.2 +/- 16.2, mean +/- SD change at 6 months) was observed. HRQL improvement was associated with a decreased volume (mean -294 +/- 427 ml, p = 0.007) in the treated lobes without visible atelectasis. FEV(1), exercise tests, and total lung volume were not changed but there was a proportional shift, a redirection of inspired volume to the untreated lobes. Combined with perfusion scan changes, this suggests that there is improved ventilation and perfusion matching in non-UL lung parenchyma. CONCLUSION: Bronchial valve treatment of emphysema has multiple mechanisms of action and acceptable safety, and significantly improves quality of life for the majority of patients.

Preliminary joint neutron and X-ray crystallographic study of human carbonic anhydrase II.

Carbonic anhydrases catalyze the interconversion of CO(2) to HCO(3)(-), with a subsequent proton-transfer (PT) step. PT proceeds via a proposed hydrogen-bonded water network in the active-site cavity that is stabilized by several hydrophilic residues. A joint X-ray and neutron crystallographic study has been initiated to determine the specific water network and the protonation states of the hydrophilic residues that coordinate it in human carbonic anhydrase II. Time-of-flight neutron crystallographic data have been collected from a large ( approximately 1.2 mm(3)) hydrogen/deuterium-exchanged crystal to 2.4 A resolution and X-ray crystallographic data have been collected from a similar but smaller crystal to 1.5 A resolution. Obtaining good-quality neutron data will contribute to the understanding of the catalytic mechanisms that utilize water networks for PT in protein environments.