The sample of students completing the National College Health Assessment (NCHA) Survey at the University of Utah differs from the national reference group for the NCHA 2003 in age, employment, ...residence, and marital status. The purpose of this study is to determine if the defining characteristics of a commuter school increase the risk for suicidal thoughts. During the fall semester of 2004, the University of Utah implemented a randomized electronic survey assessing the student body's health status in several areas. The authors compared 88 respondents who endorsed seriously considered suicide in the previous 12 months were with the remaining 954 respondents to identify discriminating variables. Those students who seriously considered suicide more likely lived off campus, indicated they were emotionally abused, were in only fair health, experienced being assaulted, experienced unwanted sexual touching, or were not heterosexual. Students who were employed were significantly less likely to consider suicide.
The clinical use of genomic analysis has expanded rapidly resulting in an increased availability and utility of genomic information in clinical care. We have developed an infrastructure utilizing ...informatics tools and clinical processes to facilitate the use of whole genome sequencing data for population health management across the healthcare system. Our resulting framework scaled well to multiple clinical domains in both pediatric and adult care, although there were domain specific challenges that arose. Our infrastructure was complementary to existing clinical processes and well-received by care providers and patients. Informatics solutions were critical to the successful deployment and scaling of this program. Implementation of genomics at the scale of population health utilizes complicated technologies and processes that for many health systems are not supported by current information systems or in existing clinical workflows. To scale such a system requires a substantial clinical framework backed by informatics tools to facilitate the flow and management of data. Our work represents an early model that has been successful in scaling to 29 different genes with associated genetic conditions in four clinical domains. Work is ongoing to optimize informatics tools; and to identify best practices for translation to smaller healthcare systems.
: media-1vid110.1542/5839981580001PEDS-VA_2018-0290
OBJECTIVES: To determine the association of antibiotic use with weight outcomes in a large cohort of children.
Health care data were available from ...2009 to 2016 for 35 institutions participating in the National Patient-Centered Clinical Research Network. Participant inclusion required same-day height and weight measurements at 0 to <12, 12 to <30, and 48 to <72 months of age. We assessed the association between any antibiotic use at <24 months of age with BMI
score and overweight or obesity prevalence at 48 to <72 months (5 years) of age, with secondary assessments of antibiotic spectrum and age-period exposures. We included children with and without complex chronic conditions.
Among 1 792 849 children with a same-day height and weight measurement at <12 months of age, 362 550 were eligible for the cohort. One-half of children (52%) were boys, 27% were African American, 18% were Hispanic, and 58% received ≥1 antibiotic prescription at <24 months of age. At 5 years, the mean BMI
score was 0.40 (SD 1.19), and 28% of children had overweight or obesity. In adjusted models for children without a complex chronic condition at 5 years, we estimated a higher mean BMI
score by 0.04 (95% confidence interval CI 0.03 to 0.05) and higher odds of overweight or obesity (odds ratio 1.05; 95% CI 1.03 to 1.07) associated with obtaining any (versus no) antibiotics at <24 months.
Antibiotic use at <24 months of age was associated with a slightly higher body weight at 5 years of age.
The benefits of antibiotic treatment during pregnancy are immediate, but there may be long-term risks to the developing child. Prior studies show an association between early life antibiotics and ...obesity, but few have examined this risk during pregnancy.
To evaluate the association of maternal antibiotic exposure during pregnancy on childhood BMI-z at 5 years, we conducted a retrospective cohort analysis. Using electronic health record data from seven health systems in PCORnet, a national distributed clinical research network, we included children with same-day height and weight measures who could be linked to mothers with vital measurements during pregnancy. The primary independent variable was maternal outpatient antibiotic prescriptions during pregnancy (any versus none). We examined dose response (number of antibiotic episodes), spectrum and class of antibiotics, and antibiotic episodes by trimester. The primary outcome was child age- and sex-specific BMI-z at age 5 years.
The final sample was 53,320 mother-child pairs. During pregnancy, 29.9% of mothers received antibiotics. In adjusted models, maternal outpatient antibiotic prescriptions during pregnancy were not associated with child BMI-z at age 5 years (β = 0.00, 95% CI -0.03, 0.02). When evaluating timing during pregnancy, dose-response, spectrum and class of antibiotics, there were no associations of maternal antibiotics with child BMI-z at age 5 years.
In this large observational cohort, provision of antibiotics during pregnancy was not associated with childhood BMI-z at 5 years.
Background Impaired signaling in the IFN-γ/IL-12 pathway causes susceptibility to severe disseminated infections with mycobacteria and dimorphic yeasts. Dominant gain-of-function mutations in signal ...transducer and activator of transcription 1 ( STAT1 ) have been associated with chronic mucocutaneous candidiasis. Objective We sought to identify the molecular defect in patients with disseminated dimorphic yeast infections. Methods PBMCs, EBV-transformed B cells, and transfected U3A cell lines were studied for IFN-γ/IL-12 pathway function. STAT1 was sequenced in probands and available relatives. Interferon-induced STAT1 phosphorylation, transcriptional responses, protein-protein interactions, target gene activation, and function were investigated. Results We identified 5 patients with disseminated Coccidioides immitis or Histoplasma capsulatum with heterozygous missense mutations in the STAT1 coiled-coil or DNA-binding domains. These are dominant gain-of-function mutations causing enhanced STAT1 phosphorylation, delayed dephosphorylation, enhanced DNA binding and transactivation, and enhanced interaction with protein inhibitor of activated STAT1. The mutations caused enhanced IFN-γ–induced gene expression, but we found impaired responses to IFN-γ restimulation. Conclusion Gain-of-function mutations in STAT1 predispose to invasive, severe, disseminated dimorphic yeast infections, likely through aberrant regulation of IFN-γ–mediated inflammation.
Rater training improves the reliability of observational assessment tools but has not been well studied for technical skills. This study assessed whether rater training could improve the reliability ...of technical skill assessment.
Academic and community surgeons in Royal College of Physicians and Surgeons of Canada surgical subspecialties were randomly allocated to either rater training (7-minute video incorporating frame-of-reference training elements) or no training. Participants then assessed trainees performing a suturing and knot-tying task using 3 assessment tools: a visual analogue scale, a task-specific checklist and a modified version of the Objective Structured Assessment of Technical Skill global rating scale (GRS). We measured interrater reliability (IRR) using intraclass correlation type 2.
There were 24 surgeons in the training group and 23 in the no-training group. Mean assessment tool scores were not significantly different between the 2 groups. The training group had higher IRR than the no-training group on the visual analogue scale (0.71 v. 0.46), task-specific checklist (0.46 v. 0.33) and GRS (0.71 v. 0.61). However, confidence intervals were wide and overlapping for all 3 tools.
For education purposes, the reliability of the visual analogue scale and GRS would be considered "good" for the training group but "moderate" for the no-training group. However, a significant difference in IRR was not shown, and reliability remained below the desired level of 0.8 for high-stakes testing. Training did not significantly improve assessment tool reliability. Although rater training may represent a way to improve reliability, further study is needed to determine effective training methods.
Competency-based frameworks are common in surgical training. However, the optimal use of standardized technical assessments is not well defined. We investigated the effect of rater training (RT) on ...the reliability and validity of four assessment tools.
Forty-Seven surgeons were randomized to RT (N = 24) and no training (N = 23) groups. A task-specific checklist, pass-fail, visual analog, and OSATS global rating scale (GRS) were used to assess trainee knot-tying and suturing tasks. Delayed assessment was performed two weeks later. Internal consistency, intra/inter-rater reliability, and construct validity were measured.
The GRS had superior reliability and validity compared to the other tools regardless of training. No significant differences between training groups was found. However, the RT group trended to improved reliability for all tools at both assessments.
RT did not lead to significant improvements in skills assessments. Standardized assessments (OSATS GRS) are preferred due to their superior reliability and validity over other methods. Despite findings, we believe more effective training methods or repeated sessions may be required for sustained and significant effects.
•Rater training has been shown to improve the use of observational assessment tools.•Global rating scales had superior psychometric properties comparted to other tools.•Training did not significantly improve the reliability of surgical skill assessments.•Training led to trends in improved reliability for all assessment tools.•Further study is required to determine the optimal form of rater training.
Abstract We present observations and analysis of the starburst PACS-819 at z = 1.45 ( M * = 10 10.7 M ⊙ ), using high-resolution (0.″1; 0.8 kpc) Atacama Large Millimeter/submillimeter Array (ALMA) ...and multiwavelength JWST images from the COSMOS-Web program. Dissimilar to Hubble Space Telescope (HST) ACS images in the rest-frame UV, the redder NIRCam and MIRI images reveal a smooth central mass concentration and spiral-like features, atypical for such an intense starburst. Through dynamical modeling of the CO ( J = 5–4) emission with ALMA, PACS-819 is rotation dominated and thus consistent with having a disk-like nature. However, kinematic anomalies in CO and asymmetric features in the bluer JWST bands (e.g., F150W) support a more disturbed nature likely due to interactions. The JWST imaging further enables us to map the distribution of stellar mass and dust attenuation, thus clarifying the relationships between different structural components not discernible in the previous HST images. The CO ( J = 5–4) and far-infrared dust continuum emission are cospatial with a heavily obscured starbursting core (<1 kpc) that is partially surrounded by much less obscured star-forming structures including a prominent arc, possibly a tidally distorted dwarf galaxy, and a massive clump (detected in CO), likely a recently accreted low-mass satellite. With spatially resolved maps, we find a high molecular gas fraction in the central area reaching ∼3 ( M gas / M * ) and short depletion times ( M gas /SFR ∼ 120 Myr, where SFR is star formation rate) across the entire system. These observations provide insights into the complex nature of starbursts in the distant Universe and underscore the wealth of complementary information from high-resolution observations with both ALMA and JWST.
Abstract We report the discovery of 15 exceptionally luminous 10 ≲ z ≲ 14 candidate galaxies discovered in the first 0.28 deg 2 of JWST/NIRCam imaging from the COSMOS-Web survey. These sources span ...rest-frame UV magnitudes of −20.5 > M UV > −22, and thus constitute the most intrinsically luminous z ≳ 10 candidates identified by JWST to date. Selected via NIRCam imaging, deep ground-based observations corroborate their detection and help significantly constrain their photometric redshifts. We analyze their spectral energy distributions using multiple open-source codes and evaluate the probability of low-redshift solutions; we conclude that 12/15 (80%) are likely genuine z ≳ 10 sources and 3/15 (20%) likely low-redshift contaminants. Three of our z ∼ 12 candidates push the limits of early stellar mass assembly: they have estimated stellar masses ∼ 5 × 10 9 M ⊙ , implying an effective stellar baryon fraction of ϵ ⋆ ∼ 0.2−0.5, where ϵ ⋆ ≡ M ⋆ /( f b M halo ). The assembly of such stellar reservoirs is made possible due to rapid, burst-driven star formation on timescales < 100 Myr where the star formation rate may far outpace the growth of the underlying dark matter halos. This is supported by the similar volume densities inferred for M ⋆ ∼ 10 10 M ⊙ galaxies relative to M ⋆ ∼ 10 9 M ⊙ —both about 10 −6 Mpc −3 —implying they live in halos of comparable mass. At such high redshifts, the duty cycle for starbursts would be of order unity, which could cause the observed change in the shape of the UV luminosity function from a double power law to a Schechter function at z ≈ 8. Spectroscopic redshift confirmation and ensuing constraints of their masses will be critical to understand how, and if, such early massive galaxies push the limits of galaxy formation in the Lambda cold dark matter paradigm.
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