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The incubation period for Clostridioides difficile infection (CDI) is generally considered to be less than 1 week, but some recent studies suggest that prolonged carriage prior to disease onset may be common.
Objective:
To estimate the incubation period for patients developing CDI after initial negative cultures.
Methods:
In 3 tertiary care medical centers, we conducted a cohort study to identify hospitalized patients and long-term care facility residents with negative initial cultures for C. difficile followed by a diagnosis of CDI with or without prior detection of carriage. Cases were classified as healthcare facility-onset, community-onset, healthcare facility-associated, or community-associated and were further classified as probable, possible, or unlikely CDI. A parametric accelerated failure time model was used to estimate the distribution of the incubation period.
Results:
Of 4,179 patients with negative enrollment cultures and no prior CDI diagnosis within 56 days, 107 (2.6%) were diagnosed as having CDI, including 19 (17.8%) with and 88 (82.2%) without prior detection of carriage. When the data were censored to only include participants with negative cultures collected within 14 days, the estimated median incubation period was 6 days with 25% and 75% of estimated incubation periods occurring within 3 and 12 days, respectively. The observed estimated incubation period did not differ significantly for patients classified as probable, possible, or unlikely CDI.
Conclusion:
Our findings are consistent with the previous studies that suggested the incubation period for CDI is typically less than 1 week and is less than 2 weeks in most cases.
Severe weather events exacerbate existing health disparities due to poorly managed non-communicable diseases (NCDs). Our objective is to understand the experiences of staff, providers, and administrators (employees) of Federally Qualified Health Centers (FQHCs) in Puerto Rico and the US Virgin Islands (USVI) in providing care to patients living with NCDs in the setting of recent climate-related extreme events.
Methods
We used a convergent mixed-methods study design. A quantitative survey was distributed to employees at 2 FQHCs in Puerto Rico and the USVI, assessing experience with disasters, knowledge of disaster preparedness, the relevance of NCDs, and perceived gaps. Qualitative in-depth interviews explored their experience providing care for NCDs during recent disasters. Quantitative and qualitative data were merged using a narrative approach.
Results
Through the integration of quantitative and qualitative data, we recognize: (1) significant gaps in confidence and preparedness of employees with a need for more training; (2) challenges faced by persons with multiple NCDs, especially cardiovascular and mental health disorders; and (3) most clinicians do not discuss disaster preparedness with patients but recognize their important role in community resilience.
Conclusion
With these results, we recommend strengthening the capacity of FQHCs to address the needs of their patients with NCDs in disasters.
Previous studies have shown that caregivers’ sensitive, responsive interactions with young children can boost language development. We explored the association between caregivers’ sensitivity and the vocabulary development of their 8-to-36-month-olds during COVID-19 when family routines were unexpectedly disrupted. Measuring caregivers’ sensitivity from home interaction videos at three timepoints, we found that children who experienced more-sensitive concurrent interactions had higher receptive and expressive vocabularies (N=100). Children whose caregivers showed more-sensitive interactions at the beginning of the pandemic showed greater expressive vocabulary growth six (but not 12) months later (n=58). Significant associations with receptive vocabulary growth were not observed. Our findings highlight the importance of sensitivity at a time when other positive influences on language development were compromised.
Peer support interventions for dietary change may offer cost-effective alternatives to interventions led by health professionals. This process evaluation of a trial to encourage the adoption and maintenance of a Mediterranean diet in a Northern European population at high CVD risk (TEAM-MED) aimed to investigate the feasibility of implementing a group-based peer support intervention for dietary change, positive elements of the intervention and aspects that could be improved. Data on training and support for the peer supporters; intervention fidelity and acceptability; acceptability of data collection processes for the trial and reasons for withdrawal from the trial were considered. Data were collected from observations, questionnaires and interviews, with both peer supporters and trial participants. Peer supporters were recruited and trained to result in successful implementation of the intervention; all intended sessions were run, with the majority of elements included. Peer supporters were complimentary of the training, and positive comments from participants centred around the peer supporters, the intervention materials and the supportive nature of the group sessions. Attendance at the group sessions, however, waned over the intervention, with suggested effects on intervention engagement, enthusiasm and group cohesion. Reduced attendance was reportedly a result of meeting (in)frequency and organisational concerns, but increased social activities and group-based activities may also increase engagement, group cohesion and attendance. The peer support intervention was successfully implemented and tested, but improvements can be suggested and may enhance the successful nature of these types of interventions. Some consideration of personal preferences may also improve outcomes.
The increasing number of diversified small-scale farms (DSSF) that raise outdoor-based livestock in the USA reflects growing consumer demand for sustainably produced food. Diversified farms are small scale and raise a combination of multiple livestock species and numerous produce varieties. This 2015–2016 cross-sectional study aimed to describe the unique characteristics of DSSF in California, estimate the prevalence of Shiga toxin-producing Escherichia coli (STEC) in livestock and evaluate the association between risk factors and the presence of STEC in livestock, using generalised linear mixed models. STEC prevalence was 13.62% (76/558). Significant variables in the mixed-effect logistic regression model included daily maximum temperature (OR 0.95; CI95% 0.91–0.98), livestock sample source (cattle (OR 4.61; CI95% 1.64–12.96) and sheep (OR 5.29; CI95% 1.80–15.51)), multiple species sharing the same barn (OR 6.23; CI95% 1.84–21.15) and livestock having contact with wild areas (OR 3.63; CI95% 1.37–9.62). Identification of STEC serogroups of public health concern (e.g. O157:H7, O26, O103) in this study indicated the need for mitigation strategies to ensure food safety by evaluating risk factors and management practices that contribute to the spread and prevalence of foodborne pathogens in a pre-harvest environment on DSSF.
Healthcare workers have faced an unprecedented workload in overstretched health facilities during the COVID-19 pandemic, and we describe various initiatives to support them. Psychological, financial and peer support, accommodation and meal services, proper personal protective equipment, applause and gratitude in the community, spiritual and religious life, child care and volunteering were identified. The potential effects of the COVID-19 pandemic – permanent stress, burnout and other mental health problems among healthcare professionals – can be expected to grow. Continued monitoring is essential to bolster resilience among healthcare workers and prevent the possible consequences for their mental health.
Adoption of healthy dietary and snacking habits could support optimum physical and mental development in children as they define health in adulthood. This study assessed parameters associated with children’s snacking such as food home availability, parenting practices, and parents’ health beliefs. In this cross-sectional study 12 039 children, 49·4% boys 5–12 years, participating in the European Feel4Diabetes-Study were included. Children’s weekly consumption of sweets and salty snacks, home availability of snacks, food parenting practices, and health beliefs were assessed via questionnaires. Logistic regression was applied to explore associations of a) home availability of snacks, b) food parenting practices (permissiveness and rewarding with snacks) and c) parent’s opinions on deterministic health beliefs with children’s consumption of sweets and salty snacks. Results showed that home availability (sweets: ORadj: 4·76, 95 % CI: 4·32, 5·23; salty snacks: ORadj: 6·56, 95 % CI: 5·64, 7·61), allowing to consume (sweets: ORadj: 3·29, 95 % CI: 2·95, 3·67; salty snacks: ORadj: 3·41, 95 % CI: 2·98, 3·90) and rewarding with sweets/salty snacks (sweets: ORadj: 2·69, 95 % CI: 2·23, 3·24; salty snacks: ORadj: 4·34, 95 % CI: 3·57, 5·28) ‘sometimes/or less frequently’ compared to ‘always/or often’ were associated with lower weekly consumption of sweets and snacks. Parents’ disagreement compared to agreement with deterministic health beliefs and inattentive eating were associated with lower consumption of salty snacks and sweets in children. Overall, the findings of this study indicate that attempts to promote healthy snacking habits in children should aim to improve parental dietary habits, food parenting practices, health beliefs, and reducing home availability of unhealthy foods and snacks.
Psychosocial stressors deriving from socioeconomic disadvantages in adolescents can result in higher metabolic syndrome (MetS) risk. We aimed to examine whether socioeconomic disadvantages were associated with MetS independent of lifestyle and whether there was a dose response relationship between the number of cumulated socioeconomic disadvantages and the risk of MetS.
Materials and Methods:
The present study included 1,037 European adolescents (aged 12.5–17.5) of the 3,528 total HELENA participants. Sociodemographic variables and lifestyle were assessed through self-reported questionnaires. Disadvantaged groups included adolescents with low educated parents, low family affluence, migrant origin, unemployed parents, and from non-traditional families. MetS score was calculated as the sum of sex- and age-specific z-scores of waist circumference, HOMA-IR index, mean of z-scores of diastolic and systolic blood pressure and mean of z-score of HDL-C multiplied by -1 and z-score of TG. A higher score indicates poor metabolic health. Linear mixed-effects models were used to study the association between social disadvantages and MetS risk score. Models were adjusted for sex, age, pubertal status (Tanner stage) and lifestyle (diet quality, physical activity, alcohol consumption and smoking status).
Results:
Adolescents with low educated mothers showed a higher MetS score (0.54 [0.09–0.98]; β [99% confidence interval]) compared to high-educated mothers. Adolescents who accumulated more than three disadvantages (0.69 [0.08–1.31]) or with missing information on disadvantages (0.72 [0.04–1.40]) had a higher MetS risk compared to non-socioeconomically disadvantaged groups. Stronger associations between socioeconomic disadvantages and MetS were found in male in comparison with female adolescents.
Discussion:
Out of the studied socioeconomic disadvantages, maternal education is the most important determinant of adolescent's MetS risk independently of sex, age, Tanner stage, smoking status, alcohol consumption, diet quality and physical activity. Social vulnerabilities (migrant background, unemployment status and belonging to a non-traditional family) were not associated with a higher MetS risk in European adolescents. However, we found a dose-response relationship between the number of factors related to social disadvantage and adolescents’ MetS risk with adolescents accumulating three or more socioeconomic disadvantages showing the highest risk. Stronger associations between socioeconomic disadvantages and MetS were found in male compared to female adolescents. Policy makers should focus on low educated families to tackle health disparities.
The giant gypsum crystals of Naica cave have fascinated scientists since their discovery in 2000. Human activity has changed the microclimate inside the cave, making scientists wonder about the potential environmental impact on the crystals. Over the last 9 years, we have studied approximately 70 samples. This paper reports on the detailed chemical–structural characterization of the impurities present at the surface of these crystals and the experimental simulations of their potential deterioration patterns. Selected samples were studied by petrography, optical and electronic microscopy, and laboratory X-ray diffraction. 2D grazing incidence X-ray diffraction, X-ray μ-fluorescence, and X-ray μ-absorption near-edge structure were used to identify the impurities and their associated phases. These impurities were deposited during the latest stage of the gypsum crystal formation and have afterward evolved with the natural high humidity. The simulations of the behavior of the crystals in microclimatic chambers produced crystal dissolution by 1–4% weight fraction under high CO2 concentration and permanent fog, and gypsum phase dehydration under air and CO2 gaseous environment. Our work suggests that most surface impurities are of natural origin; the most significant anthropogenic damage on the crystals is the extraction of water from the caves.
The day-to-day behaviors of undocumented immigrants are significantly affected when local law enforcement officials do the work of federal immigration enforcement. One such behavior, which has been widely discussed in debates over so-called sanctuary policies, is that undocumented immigrants are less likely to report crimes to the police when local law enforcement officials work with U.S. Immigration and Customs Enforcement (ICE) on federal immigration enforcement. However, the mechanism that explains this relationship of decreased trust in law enforcement has not yet been systematically tested. Do undocumented immigrants become less trusting of police officers and sheriffs when local law enforcement officials work with ICE on federal immigration enforcement? To answer this, we embedded an experiment that varied the interior immigration enforcement context in a survey (n = 512) drawn from a probability-based sample of undocumented immigrants. When local law enforcement officials work with ICE on federal immigration enforcement, respondents are statistically significantly less likely to say that they trust that police officers and sheriffs will keep them, their families, and their communities safe; will protect the confidentiality of witnesses to crimes even if they are undocumented; will protect the rights of all people equally, including undocumented immigrants; and will protect undocumented immigrants from abuse or discrimination.
Despite the well-known relevance of twin studies in the medical and social sciences and the growing number of twin registries throughout the world, Latin America has not fully incorporated into the twin research community. We describe the first steps taken toward developing a twin registry in Mexico: its aim, organization, recruiting potential and main short-term objectives.
To investigate whether adherence to the adapted Mediterranean Diet Score for Adolescents (MDS_A) and the adapted Mediterranean Diet Quality Index for Adolescents (KIDMED_A) is associated with better food/nutrient intakes and nutritional biomarkers.
Design:
The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study is a cross-sectional study aiming to obtain comparable data on a variety of nutritional and health-related parameters in European adolescents aged 12·5–17·5 years.
Setting:
Nine European countries.
Participants:
European adolescents (n 2330) recruited to the HELENA study. Dietary intake was obtained with 24 h dietary recalls, an FFQ and a Food Choices and Preferences questionnaire. MDS_A was calculated as a categorical variable using cut-offs (MDS_A), as a continuous variable (zMDS_A) and with energy adjustments (zEnMDS_A). The KIDMED_A score was also calculated.
Results:
Multilevel linear regression analysis showed positive associations for zMDS_A and KIDMED_A with serum levels of vitamin D, vitamin C, plasma folate, holo-transcobalamin, β-carotene and n-3 fatty acids, while negative associations were observed with trans-fatty acid serum levels. For categorical indices, blood biomarkers showed few significant results. zMDS_A and KIDMED_A showed positive associations with vegetables and fruits intake, and negative associations with energy-dense and low-nutritious foods. zMDS_A and KIDMED_A were positively associated with all macronutrients, vitamins and minerals (all P < 0·0001), except with monosaccharides and PUFA for KIDMED_A and cholesterol for both indices (P < 0·05).
Conclusions:
zMDS_A and KIDMED_A have shown the strongest associations with the dietary indicators and biomarkers that have been associated with the Mediterranean diet before, and are therefore considered the most appropriate and valid Mediterranean diet scores for European adolescents.
To analyse the Nutritional Knowledge Test (NKT) using Item Response Theory (ITR) analysis and to assess the construct validity of the Nutritional Knowledge Scale (NKTS) and its associations with adolescent food group consumption and nutritional biomarkers.
Design
Cross-sectional study.
Setting
Multicentre investigation conducted in ten European cities.
Participants
Adolescents aged 12·5–17·5 years (n 3215) who completed over 75 % of the NKT.
Results
Factor analysis indicated that the NKT can be analysed with a one-dimensional model. Eleven out of twenty-three items from the NKT presented adequate parameters and were selected to be included in the NKTS. Nutrition knowledge was positively associated with consumption of fruits, cereals, dairy products, pulses, meat and eggs, and fish, as well as with blood concentrations of vitamin C, β-carotene, n-3 fatty acids, holo-transcobalamin, cobalamin and folate; nutrition knowledge was negatively associated with intake of olives and avocado, alcohol and savoury snacks.
Conclusions
The NKTS assessed nutritional knowledge adequately and it is proposed as a new tool to investigate this subject in future studies.
Modern-day Guatemalan history is marked by the thirty-six-year-long civil war that ravaged the nation. The 1954 CIA-backed military coup of President Jacobo Arbenz led to an extended period of violence and armed conflict, the longest in Central American history. The civil war began in 1960. Military strategies included kidnappings, torture, disappearances, and death lists. More than 245,000 civilians were disappeared or killed and over 400 villages destroyed. In addition, over 1 million people were displaced from their homes. The armed conflict thus damaged the people, the environment, and the very psyche of Guatemala, creating a culture of corruption, fear, and silence. The civil war ended in late 1996 with the signing of the Peace Accords. However some scholars and activists argue that while the Accords were signed, peace has yet to be established in present-day Guatemala.
Intracardiac rhabdomyomas can cause severe ventricular dysfunction and outflow tract obstruction.
Case report
A term newborn infant with antenatal diagnosis of giant left ventricle rhabdomyoma presented with cardiac failure and duct-dependent systemic circulation after birth. She was treated successfully with everolimus, showing decrease in tumour size and improvement in left ventricular ejection fraction.
Discussion
Tumour regression rate was 0.32 cm2/day and improved to 0.80 cm2/day with the use of everolimus. Herein we report a newborn with inoperable giant left ventricular cardiac rhabdomyoma and significant regression of the tumour. To our knowledge, this is the largest left ventricular rhabdomyoma reported. A review of the literature was undertaken for comparison.
Conclusion
Everolimus has proven to be efficacious in size reduction of cardiac rhabdomyomas in cases when surgical resection is not possible.
OBJECTIVES/SPECIFIC AIMS: HIV is a chronic disease that affects the immune system. HIV+ people live more thanks to effective antiretroviral treatments. The scientific data demonstrate that HIV+ is associated to the cognitive impairment presented in the 50% of the patient. The objective of this study is to determine the correlation between emotional dysfunction and perceived stigma in HIV+ women and its effects HIV-associated neurocognitive disorders (HAND). METHODS/STUDY POPULATION: HIV+ women will be recruited form the Hispanic Longitudinal Cohort and evaluated questionnaires for emotional dysfunction and stigma, neuropsychological tests, and MRI. RESULTS/ANTICIPATED RESULTS: We anticipated that women with HIV+ will experience higher levels of emotional dysfunction (ie, fear) and perceived stigma when compared with the control group. Women with HIV infection will present an association between emotional dysfunction most like fear and perceived stigma when compared with the control group. This correlation will be associated with HAND. The women with HIV infection will present circuit integrity dysfunction associated with emotional dysfunction and perceived stigma as determined by DTI and connectivity (MRI). DISCUSSION/SIGNIFICANCE OF IMPACT: HIV stigma and emotional dysfunction have a negative impact in quality of life (QOL). This effect can be improved with several treatment interventions with eventual improvement in adherence, emotional control, and QOL.
Cladding tubes of water-cooled nuclear reactors are usually made of Zircaloy and are an important retaining element for radionuclides present in the fuel both during predisposal activities such as reloading of fuel assemblies from interim storage casks to final disposal casks and during final disposal in the case of canister breaching. However, cladding integrity is affected by various processes during reactor operation and beyond, e.g. fuel cladding chemical interaction and fission product precipitation onto the inner cladding surface. Using experimental and modelling methods, the radionuclide inventory of an irradiated Zircaloy-4 plenum section is analyzed. Quantities of 235/238U, 237Np, 238/239/240/241/242Pu, 241/243Am, 243/244Cm besides 14C, 55Fe, 125Sb, 154Eu, and 134/137Cs were (radio-)chemically determined in digested Zircaloy-4 subsamples. Measured inventories of activation products in the Zr-alloy are in good agreement with calculated values. However, amounts of actinides and fission products exceed the calculated inventory by factor ∼57 (minor actinides and non-volatile fission products) and ∼114 (137Cs). Excess of minor actinides and part of enhanced Cs inventory originate from fuel residues deposited on the inner cladding surface during fuel rod fabrication, whereas vast amount of cesium is volatilized from subjacent fuel pellets and transported to the plenum.
Assuming that linguistic representation has been studied only by linguists using grammaticality judgments, Branigan & Pickering (B&P) present structural priming as a novel alternative. We show that their assumptions are incorrect for cognitive-functional linguistics, exposing converging perspectives on form/meaning pairings between generativists and cognitive-functional linguists that we hope will spark the cross-disciplinary discussion necessary to produce a cognitively plausible model of linguistic representation.
Pulmonary metastasectomy refers to the surgical excision of metastasis to the lung originating from an extrathoracic location. Pulmonary metastases can potentially develop in any malignant tumor with a prevalence of 30% in patients diagnosed with cancer. The pathophysiology of pulmonary metastases is thought to result from the dissemination of tumor cells from the primary tumor site to the blood circulation. These cells are stopped in the pulmonary capillary bed, and if they have the capacity, develop new tumor entities called metastasis. Histologic studies have demonstrated that 84% of pulmonary metastases receive their blood supply from the pulmonary arteries, while 16% receive it exclusively from bronchial arteries. The probability of a new lung lesion being a metastasis is directly related to the original primary tumor. In situations of sarcoma or melanoma primary tumors, the likelihood of a new lung nodule being metastasis is approximately 80%. If the primary tumor is urothelial or colorectal, the likelihood of a new lung nodule being metastatic is 50%. Interestingly, in situations of head and neck cancer, a new pulmonary nodule is twice as likely to be a primary tumor rather than a metastasis. The latter is mostly explained by the exposure to tobacco. For these reasons, the histologic analysis of pulmonary nodules should be performed preoperatively or intraoperatively to determine the surgical strategy of resection. Fineneedle aspiration biopsy can sometimes be a good alternative; however, this approach does not always yield enough material to differentiate primary lung cancer from lung metastasis of colorectal or breast cancer.
Rationale for curative pulmonary metastasectomy
The management of the majority of patients who develop lung metastases is generally palliative including chemotherapy due to the metastatic invasion of other organs. The resection of pulmonary metastases is sometimes indicated for palliation in situations of pain due to chest wall invasion, massive hemoptysis or retention pneumonia due to centrally located metastases. However, more important, a substantial group of patients with pulmonary metastases may benefit from resection of lung metastases with curative intent. Although there are no prospectively randomized studies comparing pulmonary metastasectomy with chemotherapy or observation, surgical resection of pulmonary metastases is widely performed in carefully selected patients.