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The most common congenital viral infection is CMV, which leads to numerous neurologic disabilities. Using a mouse model of congenital CMV, we previously determined that Ag-specific CD8+ T cells traffic to the brain in a CCR9-dependent manner. The mechanism by which these CD8+ T cells acquire a CCR9-dependent "brain-tropic" phenotype remains unclear. In this study, we identify the key factor that imprints brain homing specificity on CD8+ T cells, the source of production, and the location where CCR9 expression is induced. Specifically, we discovered that CCR9 is induced on CD8+ T cells by retinoic acid-producing CD8α+ dendritic cells in the cervical lymph node postinfection. We found that retinoic acid is important for CD8+ T cells to establish tissue residency in the brain. Collectively, our data expand the role of retinoic acid during infection and mechanistically demonstrate how CD8+ T cells are primed to protect the brain during congenital viral infection.
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BACKGROUND: Clostridioides difficile was listed as an urgent antimicrobial resistance (AMR) threat in a report by the CDC in 2019. AMR drives the evolution of C. difficile and facilitates its emergence and spread. The C. difficile Antimicrobial Resistance Surveillance (CDARS) study is nationwide longitudinal surveillance of C. difficile infection (CDI) in Australia. OBJECTIVES: To determine the antimicrobial susceptibility of C. difficile isolated in Australia between 2015 and 2018. METHODS: A total of 1091 strains of C. difficile were collected over a 3 year period by a network of 10 diagnostic microbiology laboratories in five Australian states. These strains were tested for their susceptibility to nine antimicrobials using the CLSI agar incorporation method. RESULTS: All strains were susceptible to metronidazole, fidaxomicin, rifaximin and amoxicillin/clavulanate and low numbers of resistant strains were observed for meropenem (0.1%; 1/1091), moxifloxacin (3.5%; 38/1091) and vancomycin (5.7%; 62/1091). Resistance to clindamycin was common (85.2%; 929/1091), followed by resistance to ceftriaxone (18.8%; 205/1091). The in vitro activity of fidaxomicin [geometric mean MIC (GM)â=â0.101 mg/L] was superior to that of vancomycin (1.700 mg/L) and metronidazole (0.229 mg/L). The prevalence of MDR C. difficile, as defined by resistance to ≥3 antimicrobial classes, was low (1.7%; 19/1091). CONCLUSIONS: The majority of C. difficile isolated in Australia did not show reduced susceptibility to antimicrobials recommended for treatment of CDI (vancomycin, metronidazole and fidaxomicin). Resistance to carbapenems and fluoroquinolones was low and MDR was uncommon; however, clindamycin resistance was frequent. One fluoroquinolone-resistant ribotype 027 strain was detected.
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Antiinfecciosos , Clostridioides difficile , Infecciones por Clostridium , Antibacterianos/farmacología , Antiinfecciosos/farmacología , Australia/epidemiología , Clostridioides , Infecciones por Clostridium/epidemiología , Farmacorresistencia Bacteriana , Humanos , Pruebas de Sensibilidad Microbiana , RibotipificaciónRESUMEN
In the early 2000s, a binary toxin (CDT)-producing strain of Clostridium difficile, ribotype 027 (RT027), caused extensive outbreaks of diarrheal disease in North America and Europe. This strain has not become established in Australia, and there is a markedly different repertoire of circulating strains there compared to other regions of the world. The C. difficile Antimicrobial Resistance Surveillance (CDARS) study is a nationwide longitudinal surveillance study of C. difficile infection (CDI) in Australia. Here, we describe the molecular epidemiology of CDI in Australian health care and community settings over the first 5 years of the study, 2013 to 2018. Between 2013 and 2018, 10 diagnostic microbiology laboratories from five states in Australia participated in the CDARS study. From each of five states, one private (representing community) and one public (representing hospitals) laboratory submitted isolates of C. difficile or PCR-positive stool samples during two collection periods per year, February-March (summer/autumn) and August-September (winter/spring). C. difficile was characterized by toxin gene profiling and ribotyping. A total of 1,523 isolates of C. difficile were studied. PCR ribotyping yielded 203 different RTs, the most prevalent being RT014/020 (n = 449; 29.5%). The epidemic CDT+ RT027 (n = 2) and RT078 (n = 6), and the recently described RT251 (n = 10) and RT244 (n = 6) were not common, while RT126 (n = 17) was the most prevalent CDT+ type. A heterogeneous C. difficile population was identified. C. difficile RT014/020 was the most prevalent type found in humans with CDI. Continued surveillance of CDI in Australia remains critical for the detection of emerging strain lineages.
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Clostridioides difficile , Infecciones por Clostridium , Australia/epidemiología , Clostridioides difficile/genética , Infecciones por Clostridium/epidemiología , Atención a la Salud , Europa (Continente) , Humanos , Laboratorios , América del Norte , RibotipificaciónRESUMEN
BACKGROUND: Anchored transosseous equivalent suture-bridge technique (TOE) is widely used for arthroscopic rotator cuff repair. It is unknown how patient outcomes scores, ROM, and integrity of the rotator cuff after repair using this anchored technique compare with those after repair using an anchorless transosseous technique (TO). QUESTIONS/PURPOSES: (1) What are the differences in patient-reported outcomes (American Shoulder and Elbow Surgeons [ASES] score) and shoulder ROM between TO and TOE rotator cuff repair techniques at 1 and 2 years after surgery? (2) What is the difference in repair integrity as measured by the re-tear rate, assessed ultrasonographically at 1 year, between these two techniques? (3) What is the difference in procedure duration between the two techniques when performed by a surgeon familiar with each? METHODS: We reviewed 331 arthroscopic rotator cuff repairs performed by one surgeon from December 2011 to July 2016 in this retrospective, matched-pair study. Of these patients, 63% (208 of 331) underwent repair with standard anchored technique (anchors placed in a double-row, TOE manner) and 37% (123 of 331) underwent anchorless TO repair, with the same indications for surgery between groups. Forty-four percent (91 of 208) of patients in the TOE group and 61% (75 of 123) of patients in the TO group met the inclusion criteria. Eighty percent (73 of 91) of patients in the TOE group and 88% (66 of 75) in the TO group had minimum 2-year follow-up. We matched each group to a cohort of 50 patients by sex, age, smoking status, and tear size (by Cofield classification: small, < 1 cm; medium, 1-3 cm; large, > 3-5 cm; or massive, > 5 cm). The resulting cohorts did not differ in mean age (TO, 62 years [range 53-65 years]; TOE, 58 years [range 53-65 years]; p = 0.79), mean BMI value (TO, 30 [range 27-33]; TOE, 29 [range 27-35]; p = 0.97), or dominant arm involvement (TO, 80%; TOE, 78%; p = 0.81). The cohorts were followed for at least 2 years (median, 3.2 years [interquartile range (IQR) 2.2-4.3] for TO and 2.9 years [IQR 2.0-3.5 years] for TOE). ASES scores and ROM were evaluated before surgery and at follow-up visits and were recorded in a longitudinally maintained institutional database. Repair integrity was assessed using ultrasonography at 1 year, as is standard in our practice. For each tear-size group, we calculated the proportion of intact tendon repairs versus the proportion of re-tears. Duration of surgery was recorded for each patient. RESULTS: At 1 year, we observed no difference in median ASES scores (90 [IQR 92-98] for TO and 88 [IQR 72-98] for TOE; p = 0.44); external rotation (50° [IQR 45°-60°) for TO and 50° [IQR: 40°-60°] for TOE; p = 0.58); forward flexion (165° [IQR 160°-170°] for both groups; p = 0.91); or abduction (100° [IQR 90°-100°] for TO and 90° [IQR 90°-100°] for TOE; p = 0.06). Fourteen percent of shoulders (seven of 50) in each treatment group had evidence of re-tear at 1 year (p > 0.99): 0 of 2 small tears in each group, 0 of 7 medium tears in each group, five of 32 large tears in each group, and two of 9 massive tears in each group (all, p > 0.99). At 2 years, we found no differences in median ASES scores (92 [IQR 74-98)] for TO and 90 [IQR 80-100] for TOE; p = 0.84); external rotation (60° [IQR 50°-60°] for both groups; p = 0.74); forward flexion (170° [IQR 160°-170°] for both groups; p = 0.69); or abduction (100° [IQR 90°-100°] for both groups; p = 0.95). We found no differences between groups in mean ± SD procedure time, which was 103 ± 20 minutes for TO repair and 99 ± 20 minutes for TOE repair (p = 0.45). CONCLUSIONS: TO and TOE techniques for arthroscopic rotator cuff repair results in no differences in ROM, ASES scores, re-tear rates, and surgical time. Randomized control trials are needed to confirm these similarities or determine a superior method of repair. Future cost analyses may also help to determine the relative value of each technique. LEVEL OF EVIDENCE: Level III, therapeutic study.
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Artroscopía , Medición de Resultados Informados por el Paciente , Lesiones del Manguito de los Rotadores/cirugía , Manguito de los Rotadores/cirugía , Articulación del Hombro/cirugía , Anciano , Fenómenos Biomecánicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Complicaciones Posoperatorias/etiología , Rango del Movimiento Articular , Recuperación de la Función , Recurrencia , Estudios Retrospectivos , Manguito de los Rotadores/diagnóstico por imagen , Manguito de los Rotadores/fisiopatología , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Lesiones del Manguito de los Rotadores/fisiopatología , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/fisiopatología , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Hip fractures are associated with 1-year mortality rates as high as 19% to 33%. Nonwhite patients have higher mortality and lower mobility rates at 6 months postoperatively than white patients. Studies have extensively documented racial disparities in hip fracture outcomes, but few have directly assessed racial disparities in the timing of hip fracture care. QUESTIONS/PURPOSES: Our purpose was to assess racial disparities in the care provided to patients with hip fractures. We asked, (1) do racial disparities exist in radiographic timing, surgical timing, length of hospital stay, and 30-day hospital readmission rates? (2) Does the hospital type modify the association between race and the outcomes of interest? METHODS: We retrospectively reviewed the records of 1535 patients aged 60 years or older who were admitted to the emergency department and treated surgically for a hip fracture at one of five hospitals (three community hospitals and two tertiary hospitals) in our health system from 2015 to 2017. Multivariable generalized linear models were used to assess associations between race and the outcomes of interest. RESULTS: After adjusting for patient characteristics, we found that black patients had a longer mean time to radiographic evaluation (4.2 hours; 95% confidence interval, -0.6 to 9.0 versus 1.2 hours; 95% CI, 0.1-2.3; p = 0.01) and surgical fixation (41 hours; 95% CI, 34-48 versus 34 hours 95% CI, 32-35; p < 0.05) than white patients did. Hospital type only modified the association between race and surgical timing. In community hospitals, black patients experienced a 51% (95% CI, 17%-95%; p < 0.01) longer time to surgery than white patients did; however, there were no differences in surgical timing between black and white patients in tertiary hospitals. No race-based differences were observed in the length of hospital stay and 30-day hospital readmission rates. CONCLUSIONS: After adjusting for patient characteristics, we found that black patients experienced longer wait times to radiographic evaluation and surgical fixation than white patients. Hospitals should consider evaluating racial disparities in the timing of hip fracture care in their health systems. Raising awareness of these disparities and implementing unconscious bias training for healthcare providers may help mitigate these disparities and improve the timing of care for patients who are at a greater risk of delay. LEVEL OF EVIDENCE: Level III, therapeutic study.
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Disparidades en Atención de Salud , Fracturas de Cadera/etnología , Grupos Raciales/estadística & datos numéricos , Radiografía/estadística & datos numéricos , Tiempo de Tratamiento/estadística & datos numéricos , Negro o Afroamericano/estadística & datos numéricos , Anciano , Femenino , Disparidades en el Estado de Salud , Fracturas de Cadera/diagnóstico por imagen , Fracturas de Cadera/cirugía , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Tempo Operativo , Readmisión del Paciente/estadística & datos numéricos , Estudios Retrospectivos , Factores de Tiempo , Estados Unidos , Población Blanca/estadística & datos numéricosRESUMEN
BACKGROUND: The American Shoulder and Elbow Surgeons (ASES) shoulder score and the Single Assessment Numeric Evaluation (SANE) measure shoulder function. Relative to the ASES questionnaire, the SANE questionnaire is shorter and easier to score. We sought to determine (1) the correlation between ASES and SANE scores preoperatively and at 2 years postoperatively in patients undergoing rotator cuff repair (RCR) or shoulder arthroplasty and (2) the correlation between the change in ASES scores and change in SANE scores. METHODS: We reviewed the records of 107 patients who underwent RCR (n = 74) or shoulder arthroplasty (n = 33), which included patients undergoing total shoulder arthroplasty (n = 18) and reverse total shoulder arthroplasty (n = 15), at our institution from 2014 to 2015 and who completed the ASES and SANE questionnaires preoperatively and at least 2 years postoperatively. Pearson correlation coefficients were calculated to determine the relationship between SANE and ASES scores in RCR patients and arthroplasty patients (both total shoulder arthroplasty and reverse total shoulder arthroplasty) at each time point. RESULTS: In the RCR group, correlations between SANE and ASES scores were moderately positive preoperatively (r = 0.30) and strongly positive postoperatively (r = 0.86). In the arthroplasty group, correlations between SANE and ASES scores were moderately positive preoperatively (r = 0.46) and strongly positive postoperatively (r = 0.78). CONCLUSION: SANE scores correlate positively with ASES scores postoperatively in patients undergoing RCR. Therefore, SANE scores, together with clinician-based and combination scores, can be used to assess postoperative shoulder function in these patients.
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Artroplastía de Reemplazo de Hombro , Lesiones del Manguito de los Rotadores/fisiopatología , Lesiones del Manguito de los Rotadores/cirugía , Articulación del Hombro/fisiopatología , Encuestas y Cuestionarios/estadística & datos numéricos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación del Resultado de la Atención al Paciente , Periodo Posoperatorio , Estudios Retrospectivos , Articulación del Hombro/cirugía , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Positive reports of nursing-related outcomes such as quality nursing care, nursing engagement with work and good practice environment are crucial in attaining and maintaining Magnet® designation. The majority of Magnet®-designated organisations (N = 482) are in the USA, with their aggregate nursing outcomes widely published as benchmark data. Australian Magnet® outcomes have not been aggregated or published to date. METHODS: The aims are to benchmark educational preparation, occupational burnout, job satisfaction, intention to leave and working environment of nurses in Australian Magnet®-designated facilities and to determine the reliability of the Practice Environment Scale-Australia.The design is a cross-sectional multisite survey set in all three Australian Magnet®-designated organisations.The demographics included age, gender, level of education, years in practice, level of seniority and position title. Two items measured job satisfaction and intent to stay in current employment. The Maslach Burnout Inventory explored the three domains of nursing engagement: depersonalisation, personal achievement and emotional exhaustion. The Australian version of the Practice Environment Scale interrogated participants' perceptions of their work environments. RESULTS: 2004 nurses participated (response rate 45.9%). Respondents' mean age was 39.2 years (range 20-72). They were predominantly female and had worked in their current facility for more than 5 years. Eighty five percent had a minimum of a Bachelor's degree. Eighty-six percent of respondents were satisfied or very satisfied with their current position. Eighty eight percent had no intention of leaving their current employer within the next 12 months. Participants rated their hospitals highly in all domains of the practice environment. Respondents reported less burnout in the personal accomplishment and depersonalisation domains than in the emotional exhaustion domain, in which they reported average levels of burnout. The internal consistency of the Practice Environment Scale-Australia was confirmed in this sample (Cronbach α's 0.87-0.9 for subscales and 0.89 for composite score). CONCLUSION: In this paper, we present nursing outcome data from all Australian Magnet® hospitals for the first time. This provides a benchmark that facilitates comparison with nursing outcomes published by Australian non-Magnet® hospitals and with international Magnet® organisations.
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Halicephalobus gingivalis (previously Micronema deletrix) is a free-living nematode known to cause opportunistic infections, mainly in horses. Human infections are very rare, but all cases described to date involved fatal meningoencephalitis. Here we report the first case of H. gingivalis infection in an Australian human patient, confirmed by nematode morphology and sequencing of ribosomal DNA. The implications of this case are discussed, particularly, the need to evaluate real-time PCR as a diagnostic tool.
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Meningoencefalitis/diagnóstico , Meningoencefalitis/patología , Infecciones por Rhabditida/diagnóstico , Infecciones por Rhabditida/patología , Rabdítidos/aislamiento & purificación , Anciano , Animales , Australia , Encéfalo/parasitología , Encéfalo/patología , ADN Ribosómico/química , ADN Ribosómico/genética , Femenino , Histocitoquímica , Humanos , Meningoencefalitis/parasitología , Microscopía , Datos de Secuencia Molecular , Rabdítidos/anatomía & histología , Rabdítidos/clasificación , Rabdítidos/genética , Infecciones por Rhabditida/parasitología , Análisis de Secuencia de ADNRESUMEN
OBJECTIVES: The objective of this study was to determine the activity of fidaxomicin and comparator antimicrobials against Clostridium difficile isolated from patients with C. difficile infection (CDI) in Australian hospitals and in the community. METHODS: One private and one public laboratory from five states in Australia submitted a total of 474 isolates/PCR-positive stool samples during three collection periods in August-September 2013 (nâ=â175), February-March 2014 (nâ=â134) and August-September 2014 (nâ=â165). Isolate identification was confirmed by selective culture for C. difficile and a proportion of isolates from each state were characterized by PCR for toxin genes and PCR ribotyping. MICs of fidaxomicin and eight comparator antimicrobials were determined for all isolates using agar methodology. RESULTS: Site collection yielded 440 isolates of C. difficile and PCR revealed a heterogeneous strain population comprising 37 different PCR ribotypes (RTs), 95% of which were positive for tcdA and tcdB (A+B+). The most common RTs were 014 (29.8%) and 002 (15.9%). Epidemic RT 027 was not identified; however, small numbers of virulent RTs 078 and 244 were found. Resistance to vancomycin, metronidazole and fidaxomicin was not detected and resistance to moxifloxacin was very low (3.4%). Fidaxomicin showed potent in vitro activity against all 440 isolates (MIC50/MIC90 0.03/0.12 mg/L) and was superior to metronidazole (MIC50/MIC90 0.25/0.5 mg/L) and vancomycin (MIC50/MIC90 1/2 mg/L). CONCLUSIONS: These data confirm the potent in vitro activity of fidaxomicin against C. difficile. Moreover, this study provides an important baseline for ongoing long-term surveillance of antimicrobial resistance and prospective tracking of prominent and emerging strain types.
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Antibacterianos/farmacología , Clostridioides difficile/efectos de los fármacos , Infecciones por Clostridium/microbiología , Farmacorresistencia Bacteriana , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Aminoglicósidos/farmacología , Australia/epidemiología , Niño , Preescolar , Clostridioides difficile/clasificación , Clostridioides difficile/genética , Clostridioides difficile/aislamiento & purificación , Infecciones Comunitarias Adquiridas/microbiología , Infección Hospitalaria , Monitoreo Epidemiológico , Femenino , Fidaxomicina , Humanos , Lactante , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Estudios Prospectivos , Ribotipificación , Adulto JovenRESUMEN
Clostridioides difficile infection (CDI) remains a significant public health threat globally. New interventions to treat CDI rely on an understanding of the evolution and epidemiology of circulating strains. Here we provide longitudinal genomic data on strain diversity, transmission dynamics and antimicrobial resistance (AMR) of C. difficile ribotypes (RTs) 014/020 (n=169), 002 (n=77) and 056 (n=36), the three most prominent C. difficile strains causing CDI in Australia. Genome scrutiny showed that AMR was uncommon in these lineages, with resistance-conferring alleles present in only 15/169 RT014/020 strains (8.9â%), 1/36 RT056 strains (2.78â%) and none of 77 RT002 strains. Notably, ~90â% of strains were resistant to MLSB agents in vitro, but only ~5.9â% harboured known resistance alleles, highlighting an incongruence between AMR genotype and phenotype. Core genome analyses revealed all three RTs contained genetically heterogeneous strain populations with limited evidence of clonal transmission between CDI cases. The average number of pairwise core genome SNP (cgSNP) differences within each RT group ranged from 23.3 (RT056, ST34, n=36) to 115.6 (RT002, ST8, n=77) and 315.9 (RT014/020, STs 2, 13, 14, 49, n=169). Just 19 clonal groups (encompassing 40 isolates), defined as isolates differing by ≤2 cgSNPs, were identified across all three RTs (RT014/020, n=14; RT002, n=3; RT056, n=2). Of these clonal groups, 63â% (12/19) comprised isolates from the same Australian State and 37â% (7/19) comprised isolates from different States. The low number of plausible transmission events found for these major RTs (and previously documented populations in animal and environmental sources/reservoirs) points to widespread and persistent community sources of diverse C. difficile strains as opposed to ongoing nationwide healthcare outbreaks dominated by a single clone. Together, these data provide new insights into the evolution of major lineages causing CDI in Australia and highlight the urgent need for enhanced surveillance, and for public health interventions to move beyond the healthcare setting and into a One Health paradigm to effectively combat this complex pathogen.
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Clostridioides difficile , Infecciones por Clostridium , Filogenia , Ribotipificación , Clostridioides difficile/genética , Clostridioides difficile/clasificación , Clostridioides difficile/efectos de los fármacos , Clostridioides difficile/aislamiento & purificación , Australia/epidemiología , Humanos , Infecciones por Clostridium/microbiología , Infecciones por Clostridium/epidemiología , Infecciones por Clostridium/transmisión , Genoma Bacteriano , Farmacorresistencia Bacteriana/genética , Antibacterianos/farmacología , Polimorfismo de Nucleótido Simple , GenotipoRESUMEN
Handpumps are the main water supply for rural communities across sub-Saharan Africa. However, studies show that >25 % of handpumps are non-functional at any time. We present results from a systematic field study of handpump borehole functionality. The study was designed to investigate the contribution of physical factors to functionality outcomes, including; hydrogeology, borehole configuration, and handpump components. To achieve this, we deconstructed and examined 145 handpump boreholes in Ethiopia, Uganda and Malawi. Pumping tests showed that 19 % of boreholes were located in aquifers with transmissivity below the minimum required to sustain a handpump. Water levels, measured during the dry season, had a complex relationship with borehole configuration and transmissivity. The handpump cylinder was <10 m below the water table at 38 % of sites, which increases the risk of the handpump running dry during intensive use and/or in areas of low transmissivity. The water column was <20 m at 23 % of sites and screens were <10 m long at 29 % of sites and often sub-optimally positioned in the borehole. Borehole depth had no clear relationship with functionality. Using multinomial regression and four functionality categories (functional; unreliable; low yield; unreliable and low yield) as dependant variables, we found that transmissivity is a significant risk factor for the classification of handpump boreholes as low yield. The configuration of the borehole (e.g. cylinder position, screen/casing configuration and water column) is a statistically significant risk factor for the classification of handpump boreholes as unreliable. Handpump components were in poor overall condition but rising main pipes were a particular problem with 53 % of galvanised pipes corroded and 82 % of uPVC pipes damaged, with implications for handpump performance. Our study highlights the importance of; understanding aquifer properties, investing in borehole siting, construction (including supervision) and commissioning, and improving the quality of components and maintenance of handpumps.
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Agua Subterránea , Abastecimiento de Agua , Humanos , Malaui , AguaAsunto(s)
Difilobotriosis/diagnóstico , Difilobotriosis/parasitología , Diphyllobothrium/clasificación , Animales , Australia/epidemiología , Preescolar , ADN de Helmintos , Difilobotriosis/epidemiología , Diphyllobothrium/genética , Genes de Helminto , Humanos , Masculino , Filogenia , Reacción en Cadena de la PolimerasaRESUMEN
Appropriate waiting time for hip fracture surgery is disputed. The American Academy of Orthopaedic Surgeons recommends surgery within 48 hours of presentation, although evidence suggests that earlier surgery (within 24 hours) reduces the risks of complications and death. The authors asked: (1) Do patients who receive earlier radiographic evaluation of hip fracture undergo surgery earlier? and (2) Is "surgery delay" (time from presentation to surgery) associated with postoperative opioid use, duration of hospital stay, and 30-day and 1-year mortality rates? The authors identified 511 adults 60 years or older who were admitted to their emergency department with hip fractures from 2015 through 2017. Patients were divided into 6 cohorts according to length of surgery delay and 3 cohorts according to length of radiography delay (time from presentation to first hip radiograph). The authors found that medium radiography delay (>2 to 4 hours) was associated with an additional 11 hours of surgery delay compared with short radiography delay (≤2 hours; P=.026). Longer surgery delay (>12 hours) was associated with use of 9.6 more morphine equivalents (95% confidence interval, 0.7 to 8.6) during the first 24 hours postoperatively compared with shorter surgery delay (≤12 hours). Surgery delay of greater than 36 hours was an independent risk factor for longer hospital stay (odds ratio, 2.8; 95% confidence interval, 1.7 to 4.8). Thirty-day and 1-year mortality rates were significantly higher among patients who experienced a surgery delay of greater than 36 hours compared with those who experienced a surgery delay of 36 hours or less. [Orthopedics. 2020;43(6):e609-e615.].
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Fracturas de Cadera/diagnóstico por imagen , Fracturas de Cadera/cirugía , Radiografía , Anciano , Anciano de 80 o más Años , Diagnóstico Tardío , Femenino , Fijación de Fractura , Humanos , Tiempo de Internación , Masculino , Complicaciones Posoperatorias/prevención & control , Pronóstico , Factores de Riesgo , Factores de Tiempo , Tiempo de TratamientoRESUMEN
Background: Pituitary tumors are rare but are associated with significant symptoms that impact patients' quality of life (QOL). Surgery remains one of the most effective treatment options for long term disease control and symptom benefit, but symptom, and quality of life recovery in the subacute period has not been previously reported. This study aimed to better understand the impact of surgery on patients' symptom burden and QOL in the subacute post-surgical period. Methods: Twenty-three adult patients with pituitary tumors undergoing surgical resection at University of North Carolina Cancer Hospital were enrolled in this study. M.D. Anderson Symptom Inventory Brain Tumor Module, European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-BN20 questionnaires were collected pre- and 1-month post- surgical resection and differences were analyzed for individual and groups of symptoms and QOL using Wilcoxon signed-rank tests. Results: Twenty adult patients had both pre-operation and post-operation follow-up visits; 60% had functional pituitary adenomas. Seven symptoms including fatigue, memory, vision, numbness, speaking, appearance, and weakness were significantly improved at the 1-month post-operation visit while one symptom, sleep, worsened. Global Health Status/QOL measurements was improved minimally from 63 (SD 25) at pre-operation to 67 (SD 22) at 1-month post-operation without statistical significance. Conclusions: This study demonstrated a rapid improvement of many symptoms in the subacute post-operative period in pituitary tumor patients. Disturbed sleep was identified as the only symptom to worsen post-operatively, encouraging potential prospective interventions to improve sleep, and subsequently improve the QOL in pituitary tumor patients following surgical intervention.
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Fluorescence detection of various pharmaceuticals and the amino acid tryptophan (low molecular weight organic compounds) as well as the enzyme lactate dehydrogenase LDH (high molar mass compound) has been studied in aqueous solutions using alkyl ammonium formate ionic liquids as the primary solvent component. It was expected that the high viscosity of such ionic liquid-water mixtures would enhance fluorescence. Pharmaceuticals such as riboflavin and naproxen showed no such enhancement in the presence of ethylammonium formate (EAF) or isopropylammonium formate (IPAF) but the fluorescence of warfarin was substantially enhanced by a factor of 4 with 80% EAF and a factor of 7 with 70% IPAF. However, this improved fluorescence using alkylammonium formates did not seem to be general for other coumarin compounds except for bromadiolone which showed a similar fluorescence enhancement using EAF. Enhancement of tryptophan fluorescence was also seen for both EAF and IPAF. During the reversed phase elution of LDH on a polymeric HPLC column, remarkable enhancements in LDH peak intensity and activity were observed by incorporating 6% PEG 8000 in the organic mobile phase that contained either 20% acetonitrile or IPAF. Using higher concentrations of PEG 8000 is not recommended, not only because of the high viscosity, but also because the stabilizing effect of PEG 8000 is gradually reduced at higher concentrations.
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Formiatos/química , Líquidos Iónicos/química , Preparaciones Farmacéuticas/química , Animales , Cromatografía Líquida de Alta Presión , Cromatografía de Fase Inversa , Daphnia/efectos de los fármacos , Daphnia/fisiología , Líquidos Iónicos/toxicidad , L-Lactato Deshidrogenasa/química , L-Lactato Deshidrogenasa/aislamiento & purificación , Naproxeno/química , Polietilenglicoles/química , Riboflavina/química , Espectrometría de Fluorescencia , Triptófano/química , Warfarina/químicaRESUMEN
BACKGROUND AND PURPOSE: The purpose of this article is to describe student perceptions of implementation of digital badges in a drug information and literature evaluation course. EDUCATIONAL ACTIVITY AND SETTING: Two digital badges were developed as voluntary learning opportunities. Student perceptions were obtained through pre- and post-survey instruments consisting of selected questions from the Motivated Strategies for Learning Questionnaire. FINDINGS: The response rate was 69% (106/153). At baseline, 53% of respondents agreed that digital badges could help them better understand course material. More students agreed they would share earned digital badges on LinkedIn (68%) than Facebook (19%). Most students who earned digital badges agreed that badges helped increase their confidence in course material (73%), focus on specific learning objectives (55%), look deeper into course competencies (64%), and were a useful adjunct to the traditional teaching method (82%). DISCUSSION AND SUMMARY: Digital badges were perceived by students as a positive adjunct to learning and may provide a novel mechanism for development of an electronic skills-based portfolio.
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Distinciones y Premios , Motivación , Percepción , Estudiantes de Farmacia/psicología , Adulto , Curriculum/tendencias , Evaluación Educacional/métodos , Femenino , Objetivos , Humanos , Masculino , EnseñanzaRESUMEN
The aim of this study was to compare liposomal bupivacaine and interscalene nerve block (ISNB) for analgesia after shoulder arthroplasty. We compared 37 patients who received liposomal bupivacaine vs 21 who received ISNB after shoulder arthroplasty by length of hospital stay (LOS), opioid consumption, and postoperative pain. Pain was the same in both groups for time intervals of 1 hour and 8 to 14 hours postoperatively. Compared with ISNB patients, liposomal bupivacaine patients reported less pain at 18 to 24 hours (P = .001) and 27 to 36 hours (P = .029) and had lower opioid consumption on postoperative days 2 (P = .001) and 3 (P = .002). Mean LOS for liposomal bupivacaine patients was 46 ± 20 hours vs 57 ± 14 hours for ISNB patients (P = .012). Sixteen of 37 liposomal bupivacaine patients vs 2 of 21 ISNB patients were discharged on the first postoperative day (P = .010). Liposomal bupivacaine was associated with less pain, less opioid consumption, and shorter hospital stays after shoulder arthroplasty compared with ISNB.
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Analgesia/métodos , Anestésicos Locales/uso terapéutico , Bupivacaína/uso terapéutico , Bloqueo Nervioso/métodos , Dolor Postoperatorio/terapia , Anciano , Anestesia Local , Anestésicos Locales/administración & dosificación , Artroplastía de Reemplazo de Hombro , Bupivacaína/administración & dosificación , Femenino , Humanos , Liposomas , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/tratamiento farmacológico , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The tracking of body mass index (BMI) over a 50-y period in a longitudinal study was examined by using both correlation coefficients and the Foulkes-Davis tracking index. Over the long term, BMIs before maturity were poor predictors of middle-aged BMI status in females but were good predictors in males. The correlation between females' BMI in childhood and their BMIs at two points during middle age (40 and 50 y) was zero; in males it was r = 0.36 and 0.41, respectively. Between-age correlations were high (P less than 0.0001) for both sexes, reflecting stability in BMI over the shorter term (less than or equal to 10 y). The tracking of BMI (with the Foulkes-Davis tracking index) from childhood to middle age was better for males than for females (P less than 0.1). Linear-regression analysis was also used to assess the predictability of relative body size in middle age from earlier measures; BMI in childhood accounted for 0% of the variance in females and 17% in males. We conclude that the prediction of ponderosity in middle age from BMIs early in life is more reliable for males than for females.
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Envejecimiento , Índice de Masa Corporal , Adolescente , Adulto , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Análisis de Regresión , Caracteres SexualesRESUMEN
Recalled body weight and self-reported current weight were validated in a longitudinal study population by comparing recalls at 50 y to actual measures taken at ages 18, 30, 40, and 50 y. Recalled body weights were also compared with reported desired weights at these same ages. Self-reported weights at 50 y were equally accurate for both males and females; the mean reporting underestimate was -1.98 kg for males and -1.86 kg for females. Males' self reports at age 50 y were influenced by years of education (P less than 0.005) and current body size (P less than 0.0001) whereas females' were not. Correlations between recall of past weights and measured weights ranged from r = 0.87 at 18 y to 0.95 at 40 y. Recalls of past body weight were not significantly influenced by the passage of time, the number of years of education, or the accuracy of current weight reports. Current body size (wt/ht2) was significantly associated with life-time weight dissatisfaction in both sexes (P less than 0.0005).