Effects of benzodiazepine exposure on real-world clinical outcomes in individuals at clinical high risk for psychosis

Background and Hypothesis Animal models indicate GABAergic dysfunction in the development of psychosis, and that benzodiazepine (BDZ) exposure can prevent the emergence of psychosis-relevant phenotypes. However, whether BDZ exposure influences real-world clinical outcomes in individuals at clinical high risk for psychosis (CHR-P) is unknown. Study Design This observational cohort study used electronic health record data from CHR-P individuals to investigate whether BDZ exposure (including hypnotics, eg, zopiclone) reduces the risk of developing psychosis and adverse clinical outcomes. Cox proportional-hazards models were employed in both the whole-unmatched sample, and a propensity score matched (PSM) subsample. Study Results 567 CHR-P individuals (306 male, mean[±SD] age = 22.3[±4.9] years) were included after data cleaning. The BDZ-exposed (n = 105) and BDZ-unexposed (n = 462) groups differed on several demographic and clinical characteristics, including psychotic symptom severity. In the whole-unmatched sample, BDZ exposure was associated with increased risk of transition to psychosis (HR = 1.61; 95% CI: 1.03–2.52; P = .037), psychiatric hospital admission (HR = 1.93; 95% CI: 1.13–3.29; P = .017), home visit (HR = 1.64; 95% CI: 1.18–2.28; P = .004), and Accident and Emergency department attendance (HR = 1.88; 95% CI: 1.31–2.72; P  .05). In an analysis restricted to antipsychotic-naïve individuals, BDZ exposure reduced the risk of transition to psychosis numerically, although this was not statistically significant (HR = 0.59; 95% CI: 0.32–1.08; P = .089). Conclusions BDZ exposure in CHR-P individuals was not associated with a reduction in the risk of psychosis transition or adverse clinical outcomes. Results in the whole-unmatched sample suggest BDZ prescription may be more likely in CHR-P individuals with higher symptom severity

Effects of Benzodiazepine Exposure on Real-World Clinical Outcomes in Individuals at Clinical High-Risk for Psychosis

Background and HypothesisAnimal models indicate GABAergic dysfunction in the development of psychosis, and that benzodiazepine (BDZ) exposure can prevent the emergence of psychosis-relevant phenotypes. However, whether BDZ exposure influences real-world clinical outcomes in individuals at clinical high risk for psychosis (CHR-P) is unknown.Study DesignThis observational cohort study used electronic health record data from CHR-P individuals to investigate whether BDZ exposure (including hypnotics, eg, zopiclone) reduces the risk of developing psychosis and adverse clinical outcomes. Cox proportional-hazards models were employed in both the whole-unmatched sample, and a propensity score matched (PSM) subsample.Study Results567 CHR-P individuals (306 male, mean[±SD] age = 22.3[±4.9] years) were included after data cleaning. The BDZ-exposed (n = 105) and BDZ-unexposed (n = 462) groups differed on several demographic and clinical characteristics, including psychotic symptom severity. In the whole-unmatched sample, BDZ exposure was associated with increased risk of transition to psychosis (HR = 1.61; 95% CI: 1.03–2.52; P = .037), psychiatric hospital admission (HR = 1.93; 95% CI: 1.13–3.29; P = .017), home visit (HR = 1.64; 95% CI: 1.18–2.28; P = .004), and Accident and Emergency department attendance (HR = 1.88; 95% CI: 1.31–2.72; P &lt; .001). However, after controlling for confounding-by-indication through PSM, BDZ exposure did not modulate the risk of any outcomes (all P &gt; .05). In an analysis restricted to antipsychotic-naïve individuals, BDZ exposure reduced the risk of transition to psychosis numerically, although this was not statistically significant (HR = 0.59; 95% CI: 0.32–1.08; P = .089).ConclusionsBDZ exposure in CHR-P individuals was not associated with a reduction in the risk of psychosis transition or adverse clinical outcomes. Results in the whole-unmatched sample suggest BDZ prescription may be more likely in CHR-P individuals with higher symptom severity.</div

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Carbures de molybdène catalyseurs supportés pour hydrogénation de l'acide succinique et du dioxyde de carbone

This work focuses on the synthesis of supported molybdenum carbides and evaluating their catalytic performance in succinic acid hydrogenation reactions in aqueous phase using batch reactor and carbon dioxide hydrogenation in gas phase using continuous flow reactor. The catalysts were prepared by the temperature programmed reduction carburization method, where the parameters were modified leading to different molybdenum to carbon ratios. The different catalysts tested were active in converting succinic acid to gamma butyrolctone and more remarkably butyric acid which is not reported in significant quantities in this reaction with precious metal based catalysts. The catalysts containing more carbon contents that were prepared by increasing the gas hourly space velocity showed higher activity in converting succinic acid and higher selectivity to butyric acid. The intermediates were then converted to tetrahydrofuran, butanol, 1,4-butanediol and butane gas. The deactivation observed while recycling the catalyst was mainly attributed to a decrease in the amounts of carbidic molybdenum and carbidic carbon, as demonstrated by XPS analysis. Preliminary tests for these catalysts in carbon dioxide hydrogenation showed that they functioned mainly as reverse water gas shift catalysts, and the excess of carbon hinders the catalytic activity in an opposite manner of the reaction in aqueous phase. The support seems playing a role in the reactivity of the catalysts, carbon dioxide conversion as well as methane and methanol selectivity increased in the order: molybdenum carbide supported on DT51 TiO2 > P25 TiO2 ˜ ZrO2Ce travail de thèse porte sur la synthèse de carbures de molybdène sur support afin de tester leurs performances catalytiques dans des réactions d’hydrogénation. Dans ce but, la conversion d'acide succinique en phase aqueuse dans un réacteur discontinu et du dioxyde de carbone en phase gazeuse dans un réacteur à flux continu, ont été effectuées. Les catalyseurs ont été préparés par la méthode de carburation par réduction en température programmée, pendant laquelle des paramètres ont été modifiés conduisant à différents rapports molybdène/carbone. Les différents catalyseurs testés dans cette réaction étaient actifs pour la conversion de l'acide succinique en gamma-butyrolctone et, plus remarquablement, en acide butyrique, ce dernier n'était pas obtenu en quantités significatives avec des catalyseurs à base de métaux précieux. L’augmentation de la conversion d’acide succinique avec une sélectivité plus élevée en acide butyrique a été faite avec les catalyseurs contenant plus de carbone, préparés en augmentant la vitesse spatiale horaire gazeuse. Les intermédiaires ont été ensuite convertis en tétrahydrofurane, butanol, 1,4-butanediol et butane. La désactivation observée lors de recyclage du catalyseur a été principalement attribuée à une diminution de la quantité de molybdène et de carbone carbidique, démontrée par l'analyse XPS. Des essais préliminaires de ces catalyseurs dans l'hydrogénation du dioxyde de carbone ont montré qu'ils fonctionnaient principalement en tant que catalyseurs pour la réaction du gaz à l’eau inverse, et l'excès de carbone entrave l'activité catalytique d'une manière opposée à la réaction en phase aqueuse. Le support semble jouer un rôle dans la réactivité des catalyseurs, la conversion du dioxyde de carbone ainsi que la sélectivité en méthane et méthanol, qui ont augmenté dans l'ordre suivant: carbure de molybdène sur support DT51 TiO2> P25 TiO2 ˜ ZrO

Carbures de molybdène catalyseurs supportés pour hydrogénation de l'acide succinique et du dioxyde de carbone

Ce travail de thèse porte sur la synthèse de carbures de molybdène sur support afin de tester leurs performances catalytiques dans des réactions d’hydrogénation. Dans ce but, la conversion d'acide succinique en phase aqueuse dans un réacteur discontinu et du dioxyde de carbone en phase gazeuse dans un réacteur à flux continu, ont été effectuées. Les catalyseurs ont été préparés par la méthode de carburation par réduction en température programmée, pendant laquelle des paramètres ont été modifiés conduisant à différents rapports molybdène/carbone. Les différents catalyseurs testés dans cette réaction étaient actifs pour la conversion de l'acide succinique en gamma-butyrolctone et, plus remarquablement, en acide butyrique, ce dernier n'était pas obtenu en quantités significatives avec des catalyseurs à base de métaux précieux. L’augmentation de la conversion d’acide succinique avec une sélectivité plus élevée en acide butyrique a été faite avec les catalyseurs contenant plus de carbone, préparés en augmentant la vitesse spatiale horaire gazeuse. Les intermédiaires ont été ensuite convertis en tétrahydrofurane, butanol, 1,4-butanediol et butane. La désactivation observée lors de recyclage du catalyseur a été principalement attribuée à une diminution de la quantité de molybdène et de carbone carbidique, démontrée par l'analyse XPS. Des essais préliminaires de ces catalyseurs dans l'hydrogénation du dioxyde de carbone ont montré qu'ils fonctionnaient principalement en tant que catalyseurs pour la réaction du gaz à l’eau inverse, et l'excès de carbone entrave l'activité catalytique d'une manière opposée à la réaction en phase aqueuse. Le support semble jouer un rôle dans la réactivité des catalyseurs, la conversion du dioxyde de carbone ainsi que la sélectivité en méthane et méthanol, qui ont augmenté dans l'ordre suivant: carbure de molybdène sur support DT51 TiO2> P25 TiO2 ˜ ZrO2This work focuses on the synthesis of supported molybdenum carbides and evaluating their catalytic performance in succinic acid hydrogenation reactions in aqueous phase using batch reactor and carbon dioxide hydrogenation in gas phase using continuous flow reactor. The catalysts were prepared by the temperature programmed reduction carburization method, where the parameters were modified leading to different molybdenum to carbon ratios. The different catalysts tested were active in converting succinic acid to gamma butyrolctone and more remarkably butyric acid which is not reported in significant quantities in this reaction with precious metal based catalysts. The catalysts containing more carbon contents that were prepared by increasing the gas hourly space velocity showed higher activity in converting succinic acid and higher selectivity to butyric acid. The intermediates were then converted to tetrahydrofuran, butanol, 1,4-butanediol and butane gas. The deactivation observed while recycling the catalyst was mainly attributed to a decrease in the amounts of carbidic molybdenum and carbidic carbon, as demonstrated by XPS analysis. Preliminary tests for these catalysts in carbon dioxide hydrogenation showed that they functioned mainly as reverse water gas shift catalysts, and the excess of carbon hinders the catalytic activity in an opposite manner of the reaction in aqueous phase. The support seems playing a role in the reactivity of the catalysts, carbon dioxide conversion as well as methane and methanol selectivity increased in the order: molybdenum carbide supported on DT51 TiO2 > P25 TiO2 ˜ ZrO

Carbures de molybdène catalyseurs supportés pour hydrogénation de l'acide succinique et du dioxyde de carbone

This work focuses on the synthesis of supported molybdenum carbides and evaluating their catalytic performance in succinic acid hydrogenation reactions in aqueous phase using batch reactor and carbon dioxide hydrogenation in gas phase using continuous flow reactor. The catalysts were prepared by the temperature programmed reduction carburization method, where the parameters were modified leading to different molybdenum to carbon ratios. The different catalysts tested were active in converting succinic acid to gamma butyrolctone and more remarkably butyric acid which is not reported in significant quantities in this reaction with precious metal based catalysts. The catalysts containing more carbon contents that were prepared by increasing the gas hourly space velocity showed higher activity in converting succinic acid and higher selectivity to butyric acid. The intermediates were then converted to tetrahydrofuran, butanol, 1,4-butanediol and butane gas. The deactivation observed while recycling the catalyst was mainly attributed to a decrease in the amounts of carbidic molybdenum and carbidic carbon, as demonstrated by XPS analysis. Preliminary tests for these catalysts in carbon dioxide hydrogenation showed that they functioned mainly as reverse water gas shift catalysts, and the excess of carbon hinders the catalytic activity in an opposite manner of the reaction in aqueous phase. The support seems playing a role in the reactivity of the catalysts, carbon dioxide conversion as well as methane and methanol selectivity increased in the order: molybdenum carbide supported on DT51 TiO2 > P25 TiO2 ˜ ZrO2Ce travail de thèse porte sur la synthèse de carbures de molybdène sur support afin de tester leurs performances catalytiques dans des réactions d’hydrogénation. Dans ce but, la conversion d'acide succinique en phase aqueuse dans un réacteur discontinu et du dioxyde de carbone en phase gazeuse dans un réacteur à flux continu, ont été effectuées. Les catalyseurs ont été préparés par la méthode de carburation par réduction en température programmée, pendant laquelle des paramètres ont été modifiés conduisant à différents rapports molybdène/carbone. Les différents catalyseurs testés dans cette réaction étaient actifs pour la conversion de l'acide succinique en gamma-butyrolctone et, plus remarquablement, en acide butyrique, ce dernier n'était pas obtenu en quantités significatives avec des catalyseurs à base de métaux précieux. L’augmentation de la conversion d’acide succinique avec une sélectivité plus élevée en acide butyrique a été faite avec les catalyseurs contenant plus de carbone, préparés en augmentant la vitesse spatiale horaire gazeuse. Les intermédiaires ont été ensuite convertis en tétrahydrofurane, butanol, 1,4-butanediol et butane. La désactivation observée lors de recyclage du catalyseur a été principalement attribuée à une diminution de la quantité de molybdène et de carbone carbidique, démontrée par l'analyse XPS. Des essais préliminaires de ces catalyseurs dans l'hydrogénation du dioxyde de carbone ont montré qu'ils fonctionnaient principalement en tant que catalyseurs pour la réaction du gaz à l’eau inverse, et l'excès de carbone entrave l'activité catalytique d'une manière opposée à la réaction en phase aqueuse. Le support semble jouer un rôle dans la réactivité des catalyseurs, la conversion du dioxyde de carbone ainsi que la sélectivité en méthane et méthanol, qui ont augmenté dans l'ordre suivant: carbure de molybdène sur support DT51 TiO2> P25 TiO2 ˜ ZrO