Clostridium difficile infection (CDI) is a common hospital-acquired infection with increasing incidence, severity, recurrence, and associated morbidity and mortality. There are emerging data on the ...occurrence of CDI in nonhospitalized patients. However, there is a relative lack of community-based CDI studies, as most of the existing studies are hospital based, potentially influencing the results by referral or hospitalization bias by missing cases of community-acquired CDI.
To better understand the epidemiology of community-acquired C. difficile infection, a population-based study was conducted in Olmsted County, Minnesota, using the resources of the Rochester Epidemiology Project. Data regarding severity, treatment response, and outcomes were compared in community-acquired vs. hospital-acquired cohorts, and changes in these parameters, as well as in incidence, were assessed over the study period.
Community-acquired CDI cases accounted for 41% of 385 definite CDI cases. The incidence of both community-acquired and hospital-acquired CDI increased significantly over the study period. Compared with those with hospital-acquired infection, patients with community-acquired infection were younger (median age 50 years compared with 72 years), more likely to be female (76% vs. 60%), had lower comorbidity scores, and were less likely to have severe infection (20% vs. 31%) or have been exposed to antibiotics (78% vs. 94%). There were no differences in the rates of complicated or recurrent infection in patients with community-acquired compared with hospital-acquired infection.
In this population-based cohort, a significant proportion of cases of CDI occurred in the community. These patients were younger and had less severe infection than those with hospital-acquired infection. Thus, reports of CDI in hospitalized patients likely underestimate the burden of disease and overestimate severity.
Abstract Objective To evaluate the association of gastric acid suppression medications, including proton pump inhibitors and histamine type 2 blockers, with outcomes in patients with Clostridium ...difficile infection (CDI) in a population-based cohort. Patients and Methods To understand the association between acid suppression and outcomes in patients with CDI, we conducted a population-based study in Olmsted County, Minnesota, from January 1, 1991, through December 31, 2005. We compared demographic data and outcomes, including severe, severe-complicated, and recurrent CDI and treatment failure, in a cohort of patients with CDI who were treated with acid suppression medications with these outcomes in a cohort with CDI that was not exposed to acid-suppressing agents. Results Of 385 patients with CDI, 36.4% were undergoing acid suppression (23.4% with proton pump inhibitors, 13.5% with histamine type 2 blockers, and 0.5% with both). On univariate analysis, patients taking acid suppression medications were significantly older (69 vs 56 years; P <.001) and more likely to have severe (34.2% vs 23.6%; P =.03) or severe-complicated (4.4% vs 2.6% CDI; P =.006) infection than patients not undergoing acid suppression. On multivariable analyses, after adjustment for age and comorbid conditions, acid suppression medication use was not associated with severe or severe-complicated CDI. In addition, no association between acid suppression and treatment failure or CDI recurrence was found. Conclusion In this population-based study, after adjustment for age and comorbid conditions, patients with CDI who underwent acid suppression were not more likely to experience severe or severe-complicated CDI, treatment failure, or recurrent infection.
To evaluate resident knowledge of colorectal cancer (CRC) screening guidelines and to define areas requiring attention.
A survey was created using three published guidelines for CRC screening. ...Program directors for internal medicine residency programs were contacted within the metro New York City area to have their residents participate.
Five programs participated, and 115 responses were recorded. For the appropriate testing and interval to screen for CRC, 61/115 residents identified flexible sigmoidoscopy every 5 years, 108/115 identified colonoscopy every 10 years, 16/115 identified double contrast barium enema (DCBE) every 5 years and only 12/115 thought CT-colography every 5 years was appropriate. Only 40/115 respondents appropriately identified fecal occult blood testing (FOBT) administered in the patient's home annually, while fecal immunohistochemical testing (FIT) annually at home was identified by 8/115 residents.
While most residents seem knowledgeable regarding CRC screening with colonoscopy, many deficiencies remain. FOBT for screening purposes remains undervalued, and confusion about administering the test persists. The distinction between screening and prevention needs further reinforcement.
Summary
Background
Community‐acquired Clostridium difficile infection (CA‐CDI) is an increasingly appreciated condition. It is being described in populations lacking traditional predisposing factors ...that have been previously considered at low‐risk for this infection. As most studies of CDI are hospital‐based, outcomes in these patients are not well known.
Aim
To examine outcomes and their predictors in patients with CA‐CDI.
Methods
A sub‐group analysis of a population‐based epidemiological study of CDI in Olmsted county, Minnesota from 1991–2005 was performed. Data regarding outcomes, including severity, treatment response, need for hospitalisation and recurrence were analysed.
Results
Of 157 CA‐CDI cases, the median age was 50 years and 75.3% were female. Among all CA‐CDI cases, 40% required hospitalisation, 20% had severe and 4.4% had severe‐complicated infection, 20% had treatment failure and 28% had recurrent CDI. Patients who required hospitalisation were significantly older (64 years vs. 44 years, P < 0.001), more likely to have severe disease (33.3% vs. 11.7%, P = 0.001), and had higher mean Charlson comorbidity index scores (2.06 vs. 0.84, P = 0.001). They had similar treatment failure and recurrence rates as patients who did not require hospitalisation.
Conclusions
Community‐acquired Clostridium difficile infection can be associated with complications and poor outcomes, including hospitalisation and severe Clostridium difficile infection. As the incidence of community‐acquired Clostridium difficile infection increases, clinicians should be aware of risk factors (increasing age, comorbid conditions and disease severity) that predict the need for hospitalisation and complications in patients with community‐acquired Clostridium difficile infection.
Quantum mechanics places noise limits and sensitivity restrictions on physical measurements. The balance between unwanted backaction and the precision of optical measurements impose a standard ...quantum limit (SQL) on interferometric systems. In order to realize a sensitivity below the SQL, it is necessary to leverage a back-action evading measurement technique, or else exploit cancellations of any excess noise contributions at the detector. %Many proof of principle experiments have been performed, but only recently has an experiment achieved sensitivity below the SQL. In this work, we extend that initial demonstration and realize sub-SQL measurement sensitivity nearly two times better than previous measurements, and with architecture applicable to interferometric gravitational wave detectors. In fact, this technique is directly applicable to Advanced LIGO, which could observe similar effects with a detuned signal recycling cavity. By exploiting quantum correlations created by an optical spring, we measure a total sensitivity below the SQL by \(\textbf{2.8}\) dB, corresponding to a reduction in the noise power by \(\textbf{72}\pm\textbf{5.1}\) \% below the quantum limit. Through the use of a detuned optical spring, this noise reduction is tunable, allowing us to choose the desired range of frequencies that fall below the SQL. This result demonstrates access to sensitivities well below the SQL at frequencies ranges applicable to LIGO, with the potential to extend the reach of gravitational wave detectors further into the universe.
Metrology experiments can be limited by the noise produced by the laser involved via small fluctuations in the laser's power or frequency. Typically, active power stabilization schemes consisting of ...an in-loop sensor and a feedback control loop are employed. Those schemes are fundamentally limited by shot noise coupling at the in-loop sensor. In this letter we propose to use the optical spring effect to passively stabilize the classical power fluctuations of a laser beam. In a proof of principle experiment, we show that the relative power noise of the laser is stabilized from approximately \(2 \times 10^{-5}\) Hz\(^{-1/2}\) to a minimum value of \(1.6 \times 10^{-7}\) Hz\(^{-1/2}\), corresponding to the power noise reduction by a factor of \(125\). The bandwidth at which stabilization occurs ranges from \(400\) Hz to \(100\) kHz. The work reported in this letter further paves the way for high power laser stability techniques which could be implemented in optomechanical experiments and in gravitational wave detectors.
Urban biodiversity is an increasingly popular topic among researchers. Worldwide, thousands of research projects are unravelling how urbanisation impacts the biodiversity of cities and towns, as well ...as its benefits for people and the environment through ecosystem services. Exciting scientific discoveries are made on a daily basis. However, researchers often lack time and opportunity to communicate these findings to the community and those in charge of managing, planning and designing for urban biodiversity. On the other hand, urban practitioners frequently ask researchers for more comprehensible information and actionable tools to guide their actions.
This book is designed to fill this cultural and communicative gap by discussing a selection of topics related to urban biodiversity, as well as its benefits for people and the urban environment. It provides an interdisciplinary overview of scientifically grounded knowledge vital for current and future practitioners in charge of urban biodiversity management, its conservation and integration into urban planning. Topics covered include pests and invasive species, rewilding habitats, the contribution of a diverse urban agriculture to food production, implications for human well-being, and how to engage the public with urban conservation strategies.
For the first time, world-leading researchers from five continents convene to offer a global interdisciplinary perspective on urban biodiversity narrated with a simple but rigorous language. This book synthesiz research at a level suitable for both students and professionals working in nature conservation and urban planning and management.
Transmitter plasticity in the developing brain Aronson, Scott L.; Dreyfus, Cheryl F.
Mental retardation and developmental disabilities research reviews,
1998, 1998-00-00, 19980101, Letnik:
4, Številka:
3
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