Drawing on socioanalytic theory, the present study examines a moderated mediation model of personality, self-monitoring, and organizational citizenship behavior. Results from a field study ...demonstrated that the relationship between self-ratings and observer ratings of personality was moderated by participants' self-monitoring. Specifically, the relationship between self-rated and observer-rated Agreeableness was higher for low self-monitors, but the relationship between self-rated and observer-rated Conscientiousness was higher for high self-monitors. Last, we found that self-monitoring moderated the indirect effects of self-rated personality on organizational citizenship behavior through observer ratings of personality.
Summary In this study, we compared the fat‐saturated (FS) and non‐FS turbo spin echo (TSE) magnetic resonance imaging knee sequences reconstructed conventionally (conventional‐TSE) against a deep ...learning‐based reconstruction of accelerated TSE (DL‐TSE) scans. A total of 232 conventional‐TSE and DL‐TSE image pairs were acquired for comparison. For each consenting patient, one of the clinically acquired conventional‐TSE proton density‐weighted sequences in the sagittal or coronal planes (FS and non‐FS), or in the axial plane (non‐FS), was repeated using a research DL‐TSE sequence. The DL‐TSE reconstruction resulted in an image resolution that increased by at least 45% and scan times that were up to 52% faster compared to the conventional TSE. All images were acquired on a MAGNETOM Vida 3T scanner (Siemens Healthineers AG, Erlangen, Germany). The reporting radiologists, blinded to the acquisition time, were requested to qualitatively compare the DL‐TSE against the conventional‐TSE reconstructions. Despite having a faster acquisition time, the DL‐TSE was rated to depict smaller structures better for 139/232 (60%) cases, equivalent for 72/232 (31%) cases and worse for 21/232 (9%) cases compared to the conventional‐TSE. Overall, the radiologists preferred the DL‐TSE reconstruction in 124/232 (53%) cases and stated no preference, implying equivalence, for 65/232 (28%) cases. DL‐TSE reconstructions enabled faster acquisition times while enhancing spatial resolution and preserving the image contrast. From these results, the DL‐TSE provided added or comparable clinical value and utility in less time. DL‐TSE offers the opportunity to further reduce the overall examination time and improve patient comfort with no loss in diagnostic accuracy.
Approximately 25% to 40% of patients with chronic obstructive pulmonary disease (COPD) have the eosinophilic endotype. It is important to identify this group accurately because they are more ...symptomatic and are at increased risk for exacerbations and accelerated decline in forced expiratory volume in the 1st second. Importantly, this endotype is a marker of treatment responsiveness to inhaled corticosteroid (ICS), resulting in decreased mortality risk. In this review, we highlight differences in the biology of eosinophils in COPD compared to asthma and the different definitions of the COPD eosinophilic endotype based on sputum and blood eosinophil count (BEC) with the corresponding limitations. Although BEC is useful as a biomarker for eosinophilic COPD endotype, optimal BEC cut- offs can be combined with clinical characteristics to improve its sensitivity and specificity. A targeted approach comprising airway eosinophilia and appropriate clinical and physiological features may improve identification of subgroups of patients who would benefit from biologic therapy or early use of ICS for disease modification.
Guidelines for chronic obstructive pulmonary disease (COPD) advocate regular influenza vaccination, which has been shown to reduce exacerbations. However, influenza vaccination rates remain low. This ...quality improvement project was initiated to help improve influenza vaccination rates in a tertiary hospital.
All patients with COPD in the airway program (TAP) in the National University Hospital at the end of 2013 were recruited. The interventions were implemented in 2014; thus, population was stratified into the pre-intervention group and post-intervention group. Those who died in 2014 were excluded. They were (1) patient education posters in the clinics on the need for regular influenza vaccination, (2) direct interventions by physicians, and (3) intervention by the nurses when vaccinations were neglected. Physicians were made aware of previous vaccination rates, vaccination card reminders were placed in the clinics, and a new electronic healthcare record system (EHR) was implemented. The patients were followed up till the end of 2015 or until death. When an influenza vaccination was administered, the patients were asked which of the interventions led to the vaccination. A questionnaire was delivered to the physicians to determine the interventions that led to any change in vaccination prescription practices.
The pre-intervention influenza vaccination rate was low at 47.7%. The post-intervention influenza vaccination rate improved to 80.7% with the multi-pronged approach. Physicians initiated the majority of vaccinations (87.9%), while nurses helped intervene in a further 12.1%. Physicians' vaccination prescription practices changed as a result of self-awareness of low vaccination rates, vaccination card reminders, and the new EHR. Patient education made minimal impact.
This project demonstrates that with regular audits to track progress and several easy-to-implement interventions, improving influenza vaccination rates is an achievable goal.
Resistance to insecticides remains a major problem for the successful control of the horn fly,
Haematobia irritans irritans (L.), one of the most important pests of cattle in many countries including ...the United States. The organophosphate (OP) insecticide diazinon has been used to control pyrethroid-resistant populations of the horn fly. There are only a few reported cases of horn fly resistance to diazinon in the United States and Mexico. Piperonyl butoxide (PBO) has been used successfully as a synergist of pyrethroid insecticides to control horn flies. PBO-synergized diazinon products are also available for horn fly control in the United States, although PBO is known to inhibit the bio-activation of certain OP insecticides including diazinon. A study was conducted to evaluate the effect of PBO on diazinon toxicity to horn flies using a filter paper bioassay technique. These bioassays in both the susceptible and diazinon-resistant horn fly strains revealed a biphasic effect of PBO on diazinon toxicity to horn flies. PBO inhibited diazinon toxicity when the PBO concentration used was high (5%), and no effect was observed when PBO concentration was intermediate (2%). However, at low concentrations (1% and lower), PBO significantly synergized diazinon toxicity. We demonstrated that enhanced esterase activity was associated with survivability of horn flies exposed to diazinon alone. PBO has been shown to inhibit esterase activity in other insect species. However, results of biochemical assays with esterases from this study suggest that PBO did not have significant effect on the overall esterase activity in the horn fly. The observed synergistic effect of PBO at lower concentrations on diazinon toxicity to horn flies could not be explained by reduced esterase activity due to PBO inhibition. It is likely that PBO synergized diazinon toxicity at lower concentrations by facilitating penetration of diazinon through the cuticle and/or inhibiting the oxidative detoxification of diazinon, and reduced diazinon toxicity at high PBO concentration by inhibiting the bio-activation of diazinon.
The peroxisome proliferator-activated receptor gamma (PPARgamma) is a nuclear receptor that regulates fat-cell development and glucose homeostasis and is the molecular target of a class of ...insulin-sensitizing agents used for the management of type 2 diabetes mellitus. PPARgamma is highly expressed in macrophage foam cells of atherosclerotic lesions and has been demonstrated in cultured macrophages to both positively and negatively regulate genes implicated in the development of atherosclerosis. We report here that the PPARgamma-specific agonists rosiglitazone and GW7845 strongly inhibited the development of atherosclerosis in LDL receptor-deficient male mice, despite increased expression of the CD36 scavenger receptor in the arterial wall. The antiatherogenic effect in male mice was correlated with improved insulin sensitivity and decreased tissue expression of TNF-alpha and gelatinase B, indicating both systemic and local actions of PPARgamma. These findings suggest that PPARgamma agonists may exert antiatherogenic effects in diabetic patients and provide impetus for efforts to develop PPARgamma ligands that separate proatherogenic activities from antidiabetic and antiatherogenic activities.
Surviving sepsis after burn campaign Greenhalgh, David G.; Hill, David M.; Burmeister, David M. ...
Burns,
11/2023, Letnik:
49, Številka:
7
Journal Article
Recenzirano
The Surviving Sepsis Campaign was developed to improve outcomes for all patients with sepsis. Despite sepsis being the primary cause of death after thermal injury, burns have always been excluded ...from the Surviving Sepsis efforts. To improve sepsis outcomes in burn patients, an international group of burn experts developed the Surviving Sepsis After Burn Campaign (SSABC) as a testable guideline to improve burn sepsis outcomes.
The International Society for Burn Injuries (ISBI) reached out to regional or national burn organizations to recommend members to participate in the program. Two members of the ISBI developed specific “patient/population, intervention, comparison and outcome” (PICO) questions that paralleled the 2021 Surviving Sepsis Campaign 1. SSABC participants were asked to search the current literature and rate its quality for each topic. At the Congress of the ISBI, in Guadalajara, Mexico, August 28, 2022, a majority of the participants met to create “statements” based on the literature. The “summary statements” were then sent to all members for comment with the hope of developing an 80% consensus. After four reviews, a consensus statement for each topic was created or “no consensus” was reported.
The committee developed sixty statements within fourteen topics that provide guidance for the early treatment of sepsis in burn patients. These statements should be used to improve the care of sepsis in burn patients. The statements should not be considered as “static” comments but should rather be used as guidelines for future testing of the best treatments for sepsis in burn patients. They should be updated on a regular basis.
Members of the burn community from the around the world have developed the Surviving Sepsis After Burn Campaign guidelines with the goal of improving the outcome of sepsis in burn patients.
•Sepsis in burns is different than for the general population.•Patient/Population, Intervention, Comparator, Outcome (PICO) questions for burn sepsis were created that paralleled the current Surviving Sepsis Campaign.•Experts from around the world reviewed and graded the current literature on sepsis in burns.•The experts created “statements” that standardize and promote the diagnosis and treatment of sepsis in burn patients.•The “statements” will be used as areas for future research.•The Surviving Sepsis After Burn Campaign should be updated on a regular basis.
Leakage from underground pipes could result in foundations being undermined and cause damage to adjacent infrastructure. Soil particles surrounding the leaking area could be mobilised, displaced, and ...even washed out of the soil matrix by the leaking fluid, generating a void or cavity. A two-dimensional simulation using a coupled discrete element method and lattice Boltzmann method （DEM-LBM） has been used to investigate the behaviour of a soil bed subject to a locally injected fluid, which represents a leak in a pipe. Various values of inter-particle surface energy were also adopted to model the mechanical effects of cohesive particles. The results suggest that the inter-particle surface energy greatly influences the bed response with respect to the leaking fluid, including the excess pressure initiating the cavity, the cavity shape and its evolution rate.
There is limited data regarding surveillance adherence after cervical cancer (CC) treatment. The National Comprehensive Cancer Network (NCCN) recommends interval exams every 3–6 months during first 2 ...years, every 6–12 months for 3–5 years, and annually beyond 5 years. We hypothesize patients are discordant with adherence beyond the first year and aim to identify factors associated with adherence. We further seek to validate NCCN surveillance guidelines with recurrence detection.
We retrospectively identified patients treated for CC between 2011–2016. Baseline demographic, pathologic, treatment, surveillance, and recurrence data were collected. We examined concordant and total retention of posttreatment surveillance visits for patients with CC. NCCN-concordant retention was defined as completed sequential visits with a range from predicted date of less than half the greatest surveillance interval, bidirectionally.
111 patients met criteria for review. Median age of treatment was 47. Most patients were white (77%), spoke English (99%), privately insured (72%), squamous histology predominated (72%), with most common stage being IB1 (37%). Average NCCN-concordant surveillance was 827 days, with a total average surveillance length of 1124 days. White race (p=0.61), mental health diagnosis (p=0.79), private insurance (p=0.12), nor lower stage (p=0.51) were associated with changes in surveillance adherence. Within our population 14% recurred with average time to recurrence of 491 days. Recurrences were detected by imaging (44%), symptoms (32%), physical exam (19%), and pap smear (<1%); and the majority (88%) were detected while patients were NCCN-concordant.
Most patients were NCCN-concordant with screening 2 years following treatment but discontinued all follow up after 3 years. We recognize our population is primarily white, English-speaking and privately insured but did not identify these factors as protective for NCCN-concordant adherence. Most recurrences were detected under NCCN-adherent surveillance, validating NCCN guidelines. 20% of recurrences were detected with physical exam suggesting a role for in-person rather than telehealth visits. Further studies will be needed to validate these findings in different patient populations and elucidate adherence factors.
Ventilator-associated pneumonia (VAP) is associated with increased mortality, prolonged hospitalisation, excessive antibiotic use and, consequently, increased antimicrobial resistance. In this phase ...4, randomised trial, we aimed to establish whether a pragmatic, individualised, short-course antibiotic treatment strategy for VAP was non-inferior to usual care.
We did an individually randomised, open-label, hierarchical non-inferiority–superiority trial in 39 intensive care units in six hospitals in Nepal, Singapore, and Thailand. We enrolled adults (age ≥18 years) who met the US Centers for Disease Control and Prevention National Healthcare Safety Network criteria for VAP, had been mechanically ventilated for 48 h or longer, and were administered culture-directed antibiotics. In culture-negative cases, empirical antibiotic choices were made depending on local hospital antibiograms reported by the respective microbiology laboratories or prevailing local guidelines. Participants were assessed until fever resolution for 48 h and haemodynamic stability, then randomly assigned (1:1) to individualised short-course treatment (≤7 days and as short as 3–5 days) or usual care (≥8 days, with precise durations determined by the primary clinicians) via permuted blocks of variable sizes (8, 10, and 12), stratified by study site. Independent assessors for recurrent pneumonia and participants were masked to treatment allocation, but clinicians were not. The primary outcome was a 60-day composite endpoint of death or pneumonia recurrence. The non-inferiority margin was prespecified at 12% and had to be met by analyses based on both intention-to-treat (all study participants who were randomised) and per-protocol populations (all randomised study participants who fulfilled the eligibility criteria, met fitness criteria for antibiotic discontinuation, and who received antibiotics for the duration specified by their allocation group). This study is registered with ClinicalTrials.gov, number NCT03382548.
Between May 25, 2018, and Dec 16, 2022, 461 patients were enrolled and randomly assigned to the short-course treatment group (n=232) or the usual care group (n=229). Median age was 64 years (IQR 51–74) and 181 (39%) participants were female. 460 were included in the intention-to-treat analysis after excluding one withdrawal (231 in the short-course group and 229 in the usual care group); 435 participants received the allocated treatment and fulfilled eligibility criteria, and were included in the per-protocol population. Median antibiotic treatment duration for the index episodes of VAP was 6 days (IQR 5–7) in the short-course group and 14 days (10–21) in the usual care group. 95 (41%) of 231 participants in the short-course group met the primary outcome, compared with 100 (44%) of 229 in the usual care group (risk difference –3% one-sided 95% CI −∞ to 5%). Results were similar in the per-protocol population. Non-inferiority of short-course antibiotic treatment was met in the analyses, although superiority compared with usual care was not established. In the per-protocol population, antibiotic side-effects occurred in 86 (38%) of 224 in the usual care group and 17 (8%) of 211 in the short-course group (risk difference –31% 95% CI –37 to –25%; p<0·0001).
In this study of adults with VAP, individualised shortened antibiotic duration guided by clinical response was non-inferior to longer treatment durations in terms of 60-day mortality and pneumonia recurrence, and associated with substantially reduced antibiotic use and side-effects. Individualised, short-course antibiotic treatment for VAP could help to reduce the burden of side-effects and the risk of antibiotic resistance in high-resource and resource-limited settings.
UK Medical Research Council; Singapore National Medical Research Council.
For the Thai and Nepali translations of the abstract see Supplementary Materials section.
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