A systematic approach to contact investigations has long been a cornerstone of interrupting the transmission of tuberculosis in community settings. This paper describes the implementation of a ...systematic 10-step contact investigation within an acute care setting during a multistate outbreak of healthcare-associated tuberculosis. A systematic approach to contact investigations might have applicability to the prevention of other communicable infections within healthcare settings.
•We demonstrate long-term safety and tolerability of DMR in patients with T2D.•HbA1c was significantly reduced at 24 months post-DMR.•Over 50% of patients reduced or kept their glucose lowering ...medications constant.•Insulin resistance, a known pathological driver of T2D, improved after single DMR.•We observed additional positive effects on metabolic disturbances in T2D post-DMR.
Duodenal mucosal resurfacing (DMR) is an endoscopic procedure developed to improve metabolic parameters and restore insulin sensitivity in patients with diabetes. Here we report long-term DMR safety and efficacy from the REVITA-1 study.
REVITA-1 was a prospective, single-arm, open-label, multicenter study of DMR feasibility, safety, and efficacy in patients with type 2 diabetes (hemoglobin A1c HbA1c of 7.5–10.0% (58–86 mmol/mol)) on oral medication. Safety and glycemic (HbA1c), hepatic (alanine aminotransferase ALT), and cardiovascular (HDL, triglyceride TG/HDL ratio) efficacy parameters were assessed (P values presented for LS mean change).
Mean ± SD HbA1c levels reduced from 8.5 ± 0.7% (69.1 ± 7.1 mmol/mol) at baseline (N = 34) to 7.5 ± 0.8% (58.9 ± 8.8 mmol/mol) at 6 months (P < 0.001); and this reduction was sustained through 24 months post-DMR (7.5 ± 1.1% 59.0 ± 12.3 mmol/mol, P < 0.001) while in greater than 50% of patients, glucose-lowering therapy was reduced or unchanged. ALT decreased from 38.1 ± 21.1 U/L at baseline to 32.5 ± 22.1 U/L at 24 months (P = 0.048). HDL and TG/HDL improved during 24-months of follow-up. No device- or procedure-related serious adverse events, unanticipated device effects, or hypoglycemic events were noted between 12 and 24 months post-DMR.
DMR is associated with durable improvements in insulin sensitivity and multiple downstream metabolic parameters through 24 months post-treatment in type 2 diabetes.
Clinical trial reg. no. NCT02413567, clinicaltrials.gov.
Higher beat-to-beat blood pressure (BP) variation during haemodialysis (HD) has been shown to be associated with elevated cardiac damage markers and white matter ischaemic changes in the brain ...suggesting relevance to end-organ perfusion. We aimed to characterize individual patterns of BP variation and associated haemodynamic responses to HD.
Fifty participants underwent continuous non-invasive haemodynamic monitoring during HD and BP variation were assessed using extrema point (EP) frequency analysis. Participants were divided into those with a greater proportion of low frequency (LF, n = 21) and high frequency (HF, n = 22) of BP variation. Clinical and haemodynamic data were compared between groups.
Median EP frequencies for mean arterial pressure (MAP) of mid-week HD sessions were 0.54 Hz (interquartile range 0.18) and correlated with dialysis vintage (r = 0.32, p = 0.039), NT pro-BNP levels (r = 0.32, p = 0.038), and average real variability (ARV) of systolic BP (r = 0.33, p = 0.029), ARV of diastolic BP (r = 0.46, p = 0.002), and ARV of MAP (r = 0.57, p < 0.001). In the LF group, MAP positively correlated with cardiac power index (CPI) in each hour of dialysis, but not with total peripheral resistance index (TPRI). In contrast, in the HF group, MAP correlated with TPRI in each hour of dialysis but only with CPI in the first hour.
EP frequency analysis of continuous BP monitoring during dialysis allows assessment of BP variation and categorization of individuals into low- or high-frequency groups, which were characterized by different haemodynamic responses to dialysis. This may assist in improved individualization of dialysis therapy.
Background:
Cannulation of arteriovenous access for haemodialysis affects longevity of the access, associates with complications and affects patients’ experiences of haemodialysis. Buttonhole and ...rope ladder techniques were developed to reduce complications. However, studies that compare these two techniques report disparate results. This systematic review performs an in-depth exploration of RCTs, with a specific focus on cannulation as a complex intervention.
Methods:
A PICO question and protocol was developed as per PRISMA-P guidance and registered on PROSPERO (CRD42018094656 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=112895). The systematic review included any RCT performed on adult patients with end-stage kidney disease undergoing cannulation of arteriovenous fistulae or grafts for in-centre haemodialysis, as performed by healthcare staff. Assessment of quality of RCTs and data extraction were performed by two co-authors independently. Data were extracted on the study design, intervention and comparator and outcomes, including patency, infection and patients’ experiences.
Results:
The literature search identified 241 records. Ten records met inclusion criteria, which described five different RCTs that compared buttonhole to either rope ladder or usual practice. Results were disparate, with patency and infection results varying. Pain Visual Analogue scores were the only measure used to capture patients’ experiences and results were inconclusive. All RCTs had differences and limitations in study design that could explain the disparity in results.
Conclusion:
Current evidence does not allow definitive conclusions as to whether buttonhole or rope ladder needling technique is superior. Future RCTs should describe interventions and comparators with adequate detail, embed process evaluation, use standardised outcome measures and build on feasibility studies to produce definitive results.
Non-invasive continuous blood pressure monitoring is not yet part of routine practice in renal dialysis units but could be a valuable tool in the detection and prevention of significant variations in ...patient blood pressure during treatment. Feasibility studies have delivered an initial validation of a method which utilises pressure sensors in the extra-corporeal dialysis circuit, without any direct contact with the person receiving treatment. Our main objective is to further develop this novel methodology from its current early development status to a continuous-time brachial artery pressure estimator.
During an in vivo patient feasibility study with concurrent measurement validation by Finapres Nova experimental physiological measurement device, real-time continuous dialysis line pressures, and intermittent occluding arm cuff pressure data were collected over the entire period of (typically 4-hour) dialysis treatments. There was found to be an underlying quasi-linear relationship between arterial line and brachial pressure measurements which supported the development of a mathematical function to describe the relationship between arterial dialysis line pressure and brachial artery BP. However, unmodelled non-linearities, dynamics and time-varying parameters present challenges to the development of an accurate BP estimation system. In this paper, we start to address the problem of physiological parameter time variance by novel application of an iterative learning run-to-run modelling methodology originally developed for process control engineering applications to a parameterised BP model.
The iterative run-to-run learning methodology was applied to the real-time data measured during an observational study in 9 patients, supporting subsequent development of an adaptive real-time BP estimator. Tracking of patient BP is analysed for all the subjects in our patient study, supported only by intermittent updates from BP cuff measurements.
The methodology and associated technology is shown to be capable of tracking patient BP non-invasively via arterial line pressure measurement during complete 4-hour treatment sessions. A robust and tractable method is demonstrated, and future refinements to the approach are defined.
•Non-invasive continuous blood pressure monitoring is not yet part of routine practice in renal dialysis units.•Feasibility studies have delivered an initial validation of a method utilizing sensors in the dialysis circuit.•Main objective is to further develop this method to a continuous-time brachial artery pressure estimator.•There was found to be a quasi-linear relationship between arterial line and brachial pressure measurements.•In this paper, we start to address physiological parameter time variance.•We use a novel application of an iterative learning run-to-run modelling methodology in an adaotive model.•The methodology was applied to the real-time data measured during an observational study.•Tracking of patient BP is analysed for all the subjects, supported by updates from BP cuff measurements.•The methodology and associated technology is shown to be capable of tracking BP non-invasively via arterial line measurement.
Background: DMR is a minimally invasive, endoscopic procedure designed to treat insulin resistance-related metabolic diseases via hydrothermal rejuvenation of duodenal mucosa leading to improvement ...in insulin sensitivity. Primary (24 week) results from REVITA-2, the first randomized, sham-controlled, double-blind, prospective, multicenter study, demonstrated that a single DMR procedure safely elicits significant improvements in glycemic and hepatic parameters in sub-optimally controlled T2D. Here we report on durability of glycemic results through 48 weeks posttreatment in REVITA-2 patients at 9 European study centers.
Method: Eligible patients were aged 28-75 years, taking ≥ 1 OAD, had HbA1c levels 7.5%-10.0%, and BMI of 24-40 kg/m2. The modified intent-to-treat (mITT) population included randomized patients in whom a procedure was attempted. Patients lost to follow up were excluded, and data obtained post-rescue medication were set to missing. Significance (0.05 level) was determined using a 2-sided Wilcoxon signed-rank test.
Results: Thirty-one of 39 patients randomized to DMR (mITT) were followed to 48 weeks. Median change from baseline HbA1c was -0.6% at 24 weeks (n = 38, p = 0.003) and -0.7% at 48 weeks (n = 27, p < 0.001). Sixty-eight percent of patients achieved a reduction in HbA1c from baseline at 24 weeks (median HbA1c change: -1.1%) and were defined as responders. Most responders (84%) maintained a durable response through 48 weeks (median HbA1c change: -1.0%) without an increase in antidiabetic medication. Median weight change was -2.4 kg at 24 weeks (n = 38, p < 0.001) and -2.1 kg at 48 weeks (n = 28, p = 0.003).
Conclusion: A single DMR procedure safely elicits durable, clinically significant glycemic improvements through 48 weeks posttreatment in suboptimally controlled T2D; most patients who respond at 24 weeks maintain the beneficial effects at 48 weeks without needing additional medication.
Disclosure
G. Mingrone: Consultant; Self; Fractyl Laboratories, Inc., Johnson & Johnson, Novo Nordisk A/S. D. Hopkins: Advisory Panel; Self; Fractyl Laboratories, Inc., Roche Diabetes Care. Speaker’s Bureau; Self; AstraZeneca, Novo Nordisk A/S, Sanofi, Sunovion Pharmaceuticals Inc. G. Aithal: None. G. Costamagna: Advisory Panel; Self; Cook Medical, Ethicon, Inc., Olympus. Research Support; Self; Apollo EndoSurgery, Boston Scientific. L. Crenier: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk Inc., Sanofi. J.M. Deviere: Research Support; Self; Fractyl Laboratories, Inc. R. Drummond: None. R. Haidry: None. I.R. I: None. A. Lania: Research Support; Self; Ipsen Biopharmaceuticals, Pfizer Inc. C. Magee: None. M. Nieuwdorp: Board Member; Self; Caelus Health, Kaleido Biosciences. V. Bhambhani: None. J. Huang: Employee; Self; Fractyl Laboratories, Inc. K. White: Employee; Self; Fractyl Laboratories, Inc. Stock/Shareholder; Self; Johnson & Johnson. J. Lopez-Talavera: Employee; Self; Fractyl Laboratories, Inc. H. Rajagopalan: Employee; Self; Fractyl Laboratories, Inc. J.J. Bergman: Research Support; Self; Fractyl Laboratories, Inc. Other Relationship; Self; Fractyl Laboratories, Inc.
Purpose
Weight stigma involves stereotyping individuals based on body size. Individuals with obesity face weight stigma in many areas of their lives, and consequences can include impairment of mental ...and physical health, relationships, and academic performance. Weight-stigmatizing messages are pervasive in mass media, but the degree and characteristics of its presence within new-media social environments remain comparatively unknown.
Methods
This study examined weight stigma on Twitter by coding Tweet content that included the word “fat” within a 4-h timeframe (
N
= 4596). Coding marked demographic characteristics represented in content, messages about weight, and perceived intent of the message.
Results
Of all messages, 56.57 % were negative and 32.09 % were neutral. Of those containing weight-stigmatizing messages (
n
= 529), themes relating to fatness included: gluttonous (48.58 %), unattractive (25.14 %), not sexually desirable (2.65 %), sedentary (13.80 %), lazy (5.86 %), and stupid (4.16 %).
Conclusions
Weight-stigmatizing messages are evident in the increasingly important arena of social media, and themes appear similar to those that emerge in other forms of media. Prevention and intervention body image programs should consider targeting social networks to help individuals manage societal messages.
BACKGROUND: Overuse of antibiotics is a major issue facing US hospitals, leading to increased rates of resistance, adverse effects, cost, and longer hospital stays. Procalcitonin (PCT) is a biomarker ...that is upregulated in response to a bacterial infection. Levels can be used to assist practitioners in appropriately discontinuing antibiotics. When patients are adequately treated, PCT levels fall within 24 hours of antibiotic use. The purpose of this study is to develop and implement a PCT-guided algorithm to reduce the duration of antibiotic use for hospitalized CAP patients METHODS: This is a single-center, multi-site, pre and post-intervention quality improvement project focusing on adult patients presenting to the Norman Regional Emergency Department with CAP. The project will use data obtained from the EMR to measure duration of antibiotic use in the target population before and after implementation of an algorithm for PCT-guided antibiotic treatment. INTERVENTION: When patients are admitted to the hospital, PCT levels will be drawn before antibiotics or at first lab draw, 24-hours after admission, a second 24-hour interval, then every 48 hours until the PCT drops 80% from its peak value or falls below the designated stopping threshold. Duration of antibiotic therapy and hospital length of stay, before and after implementation will be compared to evaluate the impact of implementing a PCT-guided algorithm for the treatment of CAP. RESULTS: The control group was comprised of 100 patients admitted to the hospital for CAP in January-February 2019. In the control group the average duration of antibiotics was 9.46 days and length of stay was 4.6 days. Due to a change in administration, data collection was unable to be completed and results will not be reported in this paper. Based on similar studies that have been implemented, the anticipated results will be a decrease in antibiotic duration and length of stay (Li et al, 2011). CONCLUSIONS: A PCT-guided antibiotic algorithm can safely reduce the duration of antibiotics without increasing adverse effects in the treatment of CAP.
Sexual assault and abuse have a significant impact on victims and society. Although there has been a plethora of research studies examining the criminogenic aspects of sexual offending, sparse ...literature exists on the emotional aspects of sexual offending. Prior research established that sex offenders hold deficits in their emotional functioning that could be a result of psychopathic personality traits. This research study sought to expand the literature on sex offenders and investigate if adult male sex offenders in New Jersey differ in emotional intelligence and psychopathic personality traits depending on victim typology. This study was grounded in coercion and integrated theories to explore if there are differences between the emotional intelligence and psychopathic personality traits of adult male sex offenders in New Jersey who have adult victims and child victims. The research questions asked if adult male sex offenders in New Jersey with adult victims differ in emotional intelligence and psychopathic personality traits than adult male sex offenders with child victims. Data were collected from a sample of 80 adult sex offenders located in New Jersey who were administered the Bar-On EQ-I and PPI-R. Results were analyzed using a multivariate analysis of variance. The findings of the study showed that when compared to convicted sex offenders with adult victims, convicted sex offenders with child victims had higher total and subscale scores on the EQ-I and lower scores on the three dimensions of the PPI-R. The implications for positive social change include helping to tailor treatment programs to reduce the risk of recidivism based off the identified offender emotional intelligence and psychopathic personality differences.
Chemical pollution of the marine environment from anthropogenic sources is a global concern due to the potential for long term effects on the ecosystem. Chemical monitoring schemes can detect harmful ...substances in water, sediment or biota. However, the presence of specific determinants gives no information on how individual species or the ecosystem are impacted. Biological effects techniques are therefore used in environmental monitoring schemes to provide a clearer picture of whether the chemicals present are causing deleterious effects on the species sampled, or whether organisms have been exposed to certain classes of organic contaminants that they may be able to metabolise. Using these techniques, we can provide an assessment of the health of our marine environment (Thain et al., 2008).
•Analysed three different biological effects in UK flatfish.•Positive environmental status with most sites being below the BAC for EROD and biliary PAH metabolites•More work should be done to set a BAC and EAC for the AChE method.
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