Loneliness and sleep: A systematic review and meta-analysis

Despite the mounting evidence linking loneliness with health, the mechanisms underlying this relationship remain obscure. This systematic review and meta-analysis on the association between loneliness and one potential mechanism—sleep—identified 27 relevant articles. Loneliness correlated with self-reported sleep disturbance (r = .28, 95% confidence interval (.24, .33)) but not duration, across a diverse set of samples and measures. There was no evidence supporting age or gender as moderators or suggesting publication bias. The longitudinal relationship between loneliness and sleep remains unclear. Loneliness is related to sleep disturbance, but research is necessary to determine directionality, examine the influence of other factors, and speak to causality

The Impact of Linked Administrative Data on Community Development of Integrated Mental Health Hubs: a Case Study

Introduction Increasingly, communities are designing and implementing contextualized approaches to integrated service delivery. Having communities in the lead is critical to successful design and implementation. However, how do researchers work with communities to ensure accurate contextual interpretations of linked administrative data? Objectives and Approach PolicyWise for Children & Families has been working with communities to create a framework and assist in the implementation of integrated Community-based Mental Health Service Hubs for youth ages 11-24. The approach used to support these communities included multiple sources of data to highlight the need for youth specific mental health care, integrated service delivery and the opportunity for system transformation. This included, but wasn’t limited to, a qualitative environmental scan and individual-level linked administrative data from PolicyWise’s Child and Youth Data Lab. Results The goal of presenting the qualitative and quantitative data summaries was to inform community-led design and implementation of the Mental Health Service Hubs. This presentation describes the constructive interplay of community context, qualitative literature and linked administrative data. Community context and the qualitative environmental scan assisted community members in interpreting the administrative data. Conclusion/Implications This applied project provides an example of how community members contextualize information from linked administrative data and environmental scan findings to influence program development. The implications of this is that data can reinforce or reshape what communities know about service use and impact how they proceed with planning

Association of Infectious Disease Physician Approval of Peripherally Inserted Central Catheter With Appropriateness and Complications

Importance: Peripherally inserted central catheters (PICCs) are frequently used to deliver intravenous antimicrobial therapy. However, inappropriate PICC use may lead to patient harm. Objective: To evaluate whether infectious disease physician approval prior to PICC placement for intravenous antimicrobials is associated with more appropriate device use and fewer complications. Design, Setting, and Participants: This cohort study of 21 653 PICCs placed for a primary indication of intravenous antimicrobial therapy between January 1, 2015, and July 26, 2019, was conducted in 42 hospitals participating in a quality collaborative across Michigan among hospitalized medical patients. Main Outcomes and Measures: Appropriateness of PICCs was defined according to the Michigan Appropriateness Guide for Intravenous Catheters as a composite measure of (1) single-lumen catheter use, (2) avoiding use of PICCs for 5 days or less, and (3) avoiding use of PICCs for patients with chronic kidney disease (defined as an estimated glomerular filtration rate/min/1.73 m2). Complications related to PICCs included catheter occlusion, deep vein thrombosis, and central line-associated bloodstream infection. The association between infectious disease physician approval, device appropriateness, and catheter complications was assessed using multivariable models, adjusted for patient comorbidities and hospital clustering. Results were expressed as odds ratios with 95% CIs. Results: A total of 21 653 PICCs were placed for intravenous antimicrobials (11 960 PICCs were placed in men [55.2%]; median age, 64.5 years [interquartile range, 53.4-75.4 years]); 10 238 PICCs (47.3%) were approved by an infectious disease physician prior to placement. Compared with PICCs with no documented approval, PICCs with approval by an infectious disease physician were more likely to be appropriately used (72.7% [7446 of 10 238] appropriate with approval vs 45.4% [5180 of 11 415] appropriate without approval; odds ratio, 3.53; 95% CI, 3.29-3.79; P \u3c .001). Furthermore, approval was associated with lower odds of a PICC-related complication (6.5% [665 of 10 238] with approval vs 11.3% [1292 of 11 415] without approval; odds ratio, 0.55; 95% CI, 0.50-0.61). Conclusions and Relevance: This cohort study suggests that, when PICCs were placed for intravenous antimicrobial therapy, infectious disease physician approval of PICC insertion was associated with more appropriate device use and fewer complications. Policies aimed at ensuring infectious disease physician approval prior to PICC placement for antimicrobials may improve patient safety

Linkage Quality Assessment for Anonymously linked Administrative Data.

Introduction Linked datasets are important resources for research, but linkage errors can lead to incorrect results. For data security and privacy concerns, when linkage of personal identifiers is performed anonymously, it is difficult to assess the quality of the linked dataset. We describe the method used to perform linkage quality. Objectives and Approach We explored how to check the quality of linkages while preserving the privacy of individuals. We also adopted an approach that minimized time and burden on data providers involved in physical verification using randomly-generated appropriate sample sizes. To validate these linkages, data providers were given random samples of 50 unique records from both linked and unlinked individuals across two other Government programs. Data providers were asked to look at the records associated with those individuals in their original datasets. Three types of linkage results were validated: cross-program linkages, cross-program non-linkages, and within-program linkages. Proportions of false-matches and missed-matches were estimated. Results Twenty data providers checked their samples with two other programs which gave us a sample of 2000 individuals. The linkage process, based on anonymized personal identifiers, resulted in high true positive and high true negative rates. Agreement between human judges and the linkage software was strong. Results of this exercise and other linkage validation examinations provided confidence in the accuracy of the linkage process. With false matches occurring approximately only 3% of the time and virtually no missed-matches occurring, no adjustments were deemed necessary. Although linkage rates were reassuring, the sample sizes used for comparison were small, so it is expected that there would be significant variation associated with this 3% estimate; caution is advised in its use. Conclusion/Implications Proportions of false-matches and missed-matches determine linkage quality which is the base for research when linkages are performed anonymously. A low proportion of false-matches and an absence of missed-matches was an indication of robust linkages

Standardized observation of neighbourhood disorder: does it work in Canada?

<p>Abstract</p> <p>Background</p> <p>There is a growing body of evidence that where you live is important to your health. Despite numerous previous studies investigating the relationship between neighbourhood deprivation (and structure) and residents' health, the precise nature of this relationship remains unclear. Relatively few investigations have relied on direct observation of neighbourhoods, while those that have were developed primarily in US settings. Evaluation of the transferability of such tools to other contexts is an important first step before applying such instruments to the investigation of health and well-being. This study evaluated the performance of a systematic social observational (SSO) tool (adapted from previous studies of American and British neighbourhoods) in a Canadian urban context.</p> <p>Methods</p> <p>This was a mixed-methods study. Quantitative SSO ratings and qualitative descriptions of 176 block faces were obtained in six Toronto neighbourhoods (4 low-income, and 2 middle/high-income) by trained raters. Exploratory factor analysis was conducted with the quantitative SSO ratings. Content analysis consisted of independent coding of qualitative data by three members of the research team to yield common themes and categories.</p> <p>Results</p> <p>Factor analysis identified three factors (physical decay/disorder, social accessibility, recreational opportunities), but only 'physical decay/disorder' reflected previous findings in the literature. Qualitative results (based on raters' fieldwork experiences) revealed the tool's shortcomings in capturing important features of the neighbourhoods under study, and informed interpretation of the quantitative findings.</p> <p>Conclusions</p> <p>This study tested the performance of an SSO tool in a Canadian context, which is an important initial step before applying it to the study of health and disease. The tool demonstrated important shortcomings when applied to six diverse Toronto neighbourhoods. The study's analyses challenge previously held assumptions (e.g. social 'disorder') regarding neighbourhood social and built environments. For example, neighbourhood 'order' has traditionally been assumed to be synonymous with a certain degree of homogeneity, however the neighbourhoods under study were characterized by high degrees of heterogeneity and low levels of disorder. Heterogeneity was seen as an appealing feature of a block face. Employing qualitative techniques with SSO represents a unique contribution, enhancing both our understanding of the quantitative ratings obtained and of neighbourhood characteristics that are not currently captured by such instruments.</p

Relation between falciparum malaria and bacteraemia in Kenyan children: a population-based, case-control study and a longitudinal study.

BACKGROUND: Many investigators have suggested that malaria infection predisposes individuals to bacteraemia. We tested this hypothesis with mendelian randomisation studies of children with the malaria-protective phenotype of sickle-cell trait (HbAS). METHODS: This study was done in a defined area around Kilifi District Hospital, Kilifi, Kenya. We did a matched case-control study to identify risk factors for invasive bacterial disease, in which cases were children aged 3 months to 13 years who were admitted to hospital with bacteraemia between Sept 16, 1999, and July 31, 2002. We aimed to match two controls, by age, sex, location, and time of recruitment, for every case. We then did a longitudinal case-control study to assess the relation between HbAS and invasive bacterial disease as malaria incidence decreased. Cases were children aged 0-13 years who were admitted to hospital with bacteraemia between Jan 1, 1999, and Dec 31, 2007. Controls were born in the study area between Jan 1, 2006, and June 23, 2009. Finally, we modelled the annual incidence of bacteraemia against the community prevalence of malaria during 9 years with Poisson regression. RESULTS: In the matched case-control study, we recruited 292 cases-we recruited two controls for 236, and one for the remaining 56. Sickle-cell disease, HIV, leucocyte haemozoin pigment, and undernutrition were positively associated with bacteraemia and HbAS was strongly negatively associated with bacteraemia (odds ratio 0·36; 95% CI 0·20-0·65). In the longitudinal case-control study, we assessed data from 1454 cases and 10,749 controls. During the study period, the incidence of admission to hospital with malaria per 1000 child-years decreased from 28·5 to 3·45, with a reduction in protection afforded by HbAS against bacteraemia occurring in parallel (p=0·0008). The incidence of hospital admissions for bacteraemia per 1000 child-years also decreased from 2·59 to 1·45. The bacteraemia incidence rate ratio associated with malaria parasitaemia was 6·69 (95% CI 1·31-34·3) and, at a community parasite prevalence of 29% in 1999, 62% (8·2-91) of bacteraemia cases were attributable to malaria. INTERPRETATION: Malaria infection strongly predisposes individuals to bacteraemia and can account for more than half of all cases of bacteraemia in malaria-endemic areas. Interventions to control malaria will have a major additional benefit by reducing the burden of invasive bacterial disease. FUNDING: Wellcome Trust

Information-theoretic active contour model for microscopy image segmentation using texture

High throughput technologies have increased the need for automated image analysis in a wide variety of microscopy techniques. Geometric active contour models provide a solution to automated image segmentation by incorporating statistical information in the detection of object boundaries. A statistical active contour may be defined by taking into account the optimisation of an information-theoretic measure between object and background. We focus on a product-type measure of divergence known as Cauchy-Schwartz distance which has numerical advantages over ratio-type measures. By using accurate shape derivation techniques, we define a new geometric active contour model for image segmentation combining Cauchy-Schwartz distance and Gabor energy texture filters. We demonstrate the versatility of this approach on images from the Brodatz dataset and phase-contrast microscopy images of cells

Jupiter's Temperature Structure: A Reassessment of the Voyager Radio Occultation Measurements

The thermal structure of planetary atmospheres is an essential input for predicting and retrieving the distribution of gases and aerosols, as well as the bulk chemical abundances. In the case of Jupiter, the temperature at a reference level—generally taken at 1 bar—serves as the anchor in models used to derive the planet's interior structure and composition. Most models assume the temperature measured by the Galileo probe. However, those data correspond to a single location, an unusually clear, dry region, affected by local atmospheric dynamics. On the other hand, the Voyager radio occultation observations cover a wider range of latitudes, longitudes, and times. The Voyager retrievals were based on atmospheric composition and radio refractivity data that require updating and were never properly tabulated; the few existing tabulations are incomplete and ambiguous. Here we present a systematic electronic digitization of all available temperature profiles from Voyager, followed by their reanalysis, employing currently accepted values of the abundances and radio refractivities of atmospheric species. We find the corrected temperature at the 1 bar level to be up to 4 K greater than the previously published values, i.e., 170.3 ± 3.8 K at 12°S (Voyager 1 ingress) and 167.3 ± 3.8 K at 0°N (Voyager 1 egress). This is to be compared with the Galileo probe value of 166.1 ± 0.8 K at the edge of an unusual feature at 6fdg57N. Altogether, this suggests that Jupiter's tropospheric temperatures may vary spatially by up to 7 K between 7°N and 12°S