Background
As programs for screening, brief intervention, and referral to treatment (SBIRT) for unhealthy alcohol use disseminate, evidence‐based approaches for identifying patients with unhealthy ...alcohol use and alcohol dependence (AD) are needed. While the National Institute on Alcohol Abuse and Alcoholism Clinician Guide suggests use of a single alcohol screening question (SASQ) for screening and Diagnostic and Statistical Manual checklists for assessment, many SBIRT programs use alcohol use disorders identification test (AUDIT) “zones” for screening and assessment. Validation data for these zones are limited. This study used primary care data from a bi‐ethnic southern U.S. population to examine the ability of the AUDIT zones and other AUDIT‐based approaches to identify unhealthy alcohol use and dependence.
Methods
Existing data were analyzed from interviews with 625 female and male adult drinkers presenting to 5 southeastern primary care practices. Timeline follow‐back was used to identify at‐risk drinking, and diagnostic interview schedule was used to identify alcohol abuse and dependence. Validity measures compared performance of AUDIT, AUDIT‐C, and AUDIT dependence domains scores, with and without a 30‐day binge drinking measure, for detecting unhealthy alcohol use and dependence.
Results
Optimal AUDIT scores for detecting unhealthy alcohol use were lower than current commonly used cutoffs (5 for men, 3 for women). Improved performance was obtained by combining AUDIT cutoffs of 6 for men and 4 for women with a 30‐day binge drinking measure. AUDIT scores of 15 for men and 13 for women detected AD with 100% specificity but low sensitivity (20 and 18%, respectively). AUDIT dependence subscale scores of 2 or more showed similar specificity (99%) and slightly higher sensitivity (31% for men, 24% for women).
Conclusions
Combining lower AUDIT cutoff scores and binge drinking measures may increase the detection of unhealthy alcohol use in primary care. Use of lower cutoff scores and dependence subscale scores may increase diagnosis of AD; however, better measures for detecting dependence are needed.
Background
Antibiotic‐resistant bacteria contribute to both early‐ and late‐onset sepsis and outbreaks in neonatal intensive care units (NICUs). The extent to which vertical transmission of these ...resistant bacteria contributes to colonisation or infection of vulnerable infants in NICUs is unclear. Risk factors for vertical transmission of antibiotic‐resistant bacteria are not well described.
Objectives
To identify studies describing vertical transmission of antibiotic‐resistant bacteria, risk factors for transmission and the impact of colonisation on neonatal outcomes.
Search strategy
EMBASE, CINAHL, Cochrane, PubMed, and MEDLINE databases were searched using selected terminology. Titles and s were screened by two reviewers. Selected papers were reviewed in full by two individuals to ascertain whether they fulfilled the inclusion criteria.
Selection criteria
Any original article investigating perinatal vertical transmission of antibiotic‐resistant bacteria between a mother and neonate was included.
Data collection and analysis
Data were extracted on study design, organism, antibiotic resistance, and means of ascertaining vertical transmission.
Main results
Five papers out of 4839 titles fulfilled the inclusion criteria. Four studies were predominantly observational and one was a case report. Each demonstrated perinatal transmission. No study reported risk factors for the transmission of resistant bacteria or the impact of colonisation on neonatal outcomes.
Author's conclusions
There is an absence of research into the perinatal transmission of resistant organisms despite the potential implications of such a situation. We outline objectives that need to be addressed in future research and describe a study design to ascertain the prevalence and risk factors for vertical transmission.
Additive manufacture (AM) is receiving significant attention globally, reflected in the volume of research being carried out to support the commercialisation of the technology for industrial ...applications and the interest shown by government and policy makers in the technology. The lack of distinction between 3D printing and AM, as well as the portrayal of some highly publicised applications, may imply that the technology is now firmly established. However, this is not the case. The aim of this study is to identify the current barriers to the progression of AM for end-use products from an industrial perspective and to understand the nature of those barriers. Case study research has been conducted with organisations in the UK aerospace, automotive, defence, heavy machinery and medical device industries. Eighteen barriers are identified: education, cost, design, software, materials, traceability, machine constraints, in-process monitoring, mechanical properties, repeatability, scalability, validation, standards, quality, inspection, tolerances, finishing and sterilisation. Explanation building and logic models are used to generalise the findings. The results are discussed in the context of current academic research on AM. The outcomes of this study help to inform the frontiers of research in AM and how AM research agendas can be aligned with the requirements for industrial applications.
•A paradigm shift in education is required to increase graduates understanding of AM.•Design for AM requires increased creativity reinforced by knowledge and experience.•Software is severely fragmented, it requires streamlining and tailoring for AM.•Industry requires parameter dependent operational windows for materials.•Developing inspection and finishing methods are a focus in research and industry.
Deanship in the Global South: Bridging Troubled Waters is about the lived reality of deans, their leadership role in the performance of the Faculty and its alignment to the institutional objectives. ...It proffers a strategic approach to successful leadership development.
Introduction Alcohol and tobacco use are common among U.S. women, yet if used during pregnancy these substances present significant preventable risks to prenatal and perinatal health. Because use of ...alcohol and tobacco often continue into the first trimester and beyond, especially among women with unintended pregnancies, effective evidence-based approaches are needed to decrease these risk behaviors. This study was designed to test the efficacy of CHOICES Plus, a preconception intervention for reducing the risk of alcohol- and tobacco-exposed pregnancies (AEPs and TEPs). Study design RCT with two intervention groups: CHOICES Plus ( n =131) versus Brief Advice ( n =130). Data collected April 2011 to October 2013. Data analysis finalized February 2016. Setting/participants Settings were 12 primary care clinics in a large Texas public healthcare system. Participants were women who were non-sterile, non-pregnant, aged 18–44 years, drinking more than three drinks per day or more than seven drinks per week, sexually active, and not using effective contraception (N=261). Forty-five percent were smokers. Intervention Interventions were two CHOICES Plus sessions and a contraceptive visit or Brief Advice and referral to community resources. Main outcome measures Primary outcomes were reduced risk of AEP and TEP through 9-month follow-up. Results In intention-to-treat analyses across 9 months, the CHOICES Plus group was more likely than the Brief Advice group to reduce risk of AEP with an incidence rate ratio of 0.620 (95% CI=0.511, 0.757) and absolute risk reduction of –0.233 (95% CI= –0.239, –0.226). CHOICES Plus group members at risk for both exposures were more likely to reduce TEP risk (incidence rate ratio, 0.597; 95% CI=0.424, 0.840 and absolute risk reduction, –0.233; 95% CI= –0.019, –0.521). Conclusions CHOICES Plus significantly reduced AEP and TEP risk. Addressing these commonly co-occurring risk factors in a single preconception program proved both feasible and efficacious in a low-income primary care population. Intervening with women before they become pregnant could shift the focus in clinical practice from treatment of substance-exposed pregnancies to prevention of a costly public health concern. Trial registration This study is registered at clinicaltrials.gov NCT01032772.
Summary Probiotics are live micro-organisms administered to provide health benefits. Probiotics are being increasingly used in healthcare contexts both in research studies and routine practice, for ...example in neonatal intensive care. Currently there is a paucity of guidelines or regulations governing the mitigation of infection risks associated with the use of probiotics in clinical practice. We propose a number of recommendations to mitigate risks. These include the communication of probiotic use to appropriate stakeholders, ensuring that routine laboratories can identify and test the susceptibility of probiotic strains, assuring standards for preparation and administration, and ensuring surveillance designed to capture adverse events.
We investigated the effects of gonadal hormone replacement on the pulsatile parameters underlying basal circadian corticosterone secretion in castrated male and ovariectomized female rats using an ...automated sampling system. Blood was collected from freely moving, unanaesthetized rats every 10 min over a 24‐h period and sampling was continued during a noise stress and after lipopolysaccharide (LPS) administration. Castrated male rats had markedly higher corticosterone levels than intact controls. This was reflected by increased number and frequency of pulses in addition to an increase in the pulse height and amplitude under both basal circadian and stress conditions. Hormone replacement with either testosterone or dihydrotestosterone returned these corticosterone levels and circadian profile to those found in intact males, confirming an androgen‐mediated effect. Ovariectomized females had significantly lower basal and stress‐induced corticosterone levels with lower frequency and amplitude of corticosterone pulses than intact females. 17β‐oestradiol replacement returned basal levels, pulsatile measurements and stress‐induced corticosterone levels to those found in intact females. Three hours post‐LPS administration, castrated males demonstrated significantly higher values of parvocellular paraventricular nucleus (PVN) arginine vasopressin and corticotrophin‐releasing factor and anterior pituitary pro‐opiomelanocortin mRNA while ovariectomized females showed significantly lower levels of all three transcripts compared to intact controls. PVN glucocorticoid receptor mRNA levels 3 h post‐LPS administration were significantly decreased in castrated males and significantly increased in ovariectomized female rats. Replacement of gonadal steroids resulted in a return to the levels found in intact controls after LPS. Gonadal steroid replacement is sufficient to reverse changes in the pulsatile characteristics of corticosterone release after gonadectomy. In addition, gonadal steroid replacement reverses stress‐induced alterations in hypothalamic‐pituitary‐adrenal (HPA) activity. These data demonstrate a major contribution of gonadal steroids to the regulation of HPA axis activity and to the pulsatile characteristics of corticosterone release.
The Spitzer Space Telescope Legacy Program SAGE-SMC allows global studies of resolved stellar populations in the SMC in a different environment than our Galaxy. Using the SAGE-SMC IRAC (3.6-8.0 mu m) ...and MIPS (24 and 70 mu m) catalogs and images combined with near-infrared (JHK sub(s)) and optical (UBVI) data, we identified a population of ~1000 intermediate- to high-mass young stellar objects (YSOs) in the SMC (three times more than previously known). Our method of identifying YSO candidates builds on the method developed for the Large Magellanic Cloud by Whitney et al. with improvements based on what we learned from our subsequent studies and techniques described in the literature. We perform (1) color-magnitude cuts based on five color-magnitude diagrams (CMDs), (2) visual inspection of multi-wavelength images, and (3) spectral energy distribution (SED) fitting with YSO models. For each YSO candidate, we use its photometry to calculate a measure of our confidence that the source is not a non-YSO contaminant, but rather a true YSO, based on the source's location in the color-magnitude space with respect to non-YSOs. We use this CMD score and the SED fitting results to define two classes of sources: high-reliability YSO candidates and possible YSO candidates. We found that, due to polycyclic aromatic hydrocarbon emission, about half of our sources have 3.6-4.5 and 4.5-5.8 colors not predicted by previous YSO models. The YSO candidates are spatially correlated with gas tracers.
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