1,891 research outputs found
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
Mitochondrial genome copy number measured by DNA sequencing in human blood is strongly associated with metabolic traits via cell-type composition differences
BACKGROUND: Mitochondrial genome copy number (MT-CN) varies among humans and across tissues and is highly heritable, but its causes and consequences are not well understood. When measured by bulk DNA sequencing in blood, MT-CN may reflect a combination of the number of mitochondria per cell and cell-type composition. Here, we studied MT-CN variation in blood-derived DNA from 19184 Finnish individuals using a combination of genome (N = 4163) and exome sequencing (N = 19034) data as well as imputed genotypes (N = 17718).
RESULTS: We identified two loci significantly associated with MT-CN variation: a common variant at the MYB-HBS1L locus (P = 1.6 Ă— 10
CONCLUSION: These results suggest that measurements of MT-CN in blood-derived DNA partially reflect differences in cell-type composition and that these differences are causally linked to insulin and related traits
Modification by N-acetyltransferase 1 genotype on the association between dietary heterocyclic amines and colon cancer in a multiethnic study
Colorectal cancer incidence is greater among African Americans, compared to whites in the U.S., and may be due in part to differences in diet, genetic variation at metabolic loci, and/or the joint effect of diet and genetic susceptibility. We examined whether our previously reported associations between meat-derived heterocyclic amine (HCA) intake and colon cancer were modified by N-acetyltransferase 1 (NAT1) or 2 (NAT2) genotypes and whether there were differences by race
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Parameterization Effects in the analysis of AMI Sunyaev-Zel'dovich Observations
Most Sunyaev--Zel'dovich (SZ) and X-ray analyses of galaxy clusters try to
constrain the cluster total mass and/or gas mass using parameterised models and
assumptions of spherical symmetry and hydrostatic equilibrium. By numerically
exploring the probability distributions of the cluster parameters given the
simulated interferometric SZ data in the context of Bayesian methods, and
assuming a beta-model for the electron number density we investigate the
capability of this model and analysis to return the simulated cluster input
quantities via three rameterisations. In parameterisation I we assume that the
T is an input parameter. We find that parameterisation I can hardly constrain
the cluster parameters. We then investigate parameterisations II and III in
which fg(r200) replaces temperature as a main variable. In parameterisation II
we relate M_T(r200) and T assuming hydrostatic equilibrium. We find that
parameterisation II can constrain the cluster physical parameters but the
temperature estimate is biased low. In parameterisation III, the virial theorem
replaces the hydrostatic equilibrium assumption. We find that parameterisation
III results in unbiased estimates of the cluster properties. We generate a
second simulated cluster using a generalised NFW (GNFW) pressure profile and
analyse it with an entropy based model to take into account the temperature
gradient in our analysis and improve the cluster gas density distribution. This
model also constrains the cluster physical parameters and the results show a
radial decline in the gas temperature as expected. The mean cluster total mass
estimates are also within 1 sigma from the simulated cluster true values.
However, we find that for at least interferometric SZ analysis in practice at
the present time, there is no differences in the AMI visibilities between the
two models. This may of course change as the instruments improve.Comment: 19 pages, 13 tables, 24 figure
Mitochondrial genome copy number measured by DNA sequencing in human blood is strongly associated with metabolic traits via cell-type composition differences
Background Mitochondrial genome copy number (MT-CN) varies among humans and across tissues and is highly heritable, but its causes and consequences are not well understood. When measured by bulk DNA sequencing in blood, MT-CN may reflect a combination of the number of mitochondria per cell and cell-type composition. Here, we studied MT-CN variation in blood-derived DNA from 19184 Finnish individuals using a combination of genome (N = 4163) and exome sequencing (N = 19034) data as well as imputed genotypes (N = 17718). Results We identified two loci significantly associated with MT-CN variation: a common variant at the MYB-HBS1L locus (P = 1.6 x 10(-8)), which has previously been associated with numerous hematological parameters; and a burden of rare variants in the TMBIM1 gene (P = 3.0 x 10(-8)), which has been reported to protect against non-alcoholic fatty liver disease. We also found that MT-CN is strongly associated with insulin levels (P = 2.0 x 10(-21)) and other metabolic syndrome (metS)-related traits. Using a Mendelian randomization framework, we show evidence that MT-CN measured in blood is causally related to insulin levels. We then applied an MT-CN polygenic risk score (PRS) derived from Finnish data to the UK Biobank, where the association between the PRS and metS traits was replicated. Adjusting for cell counts largely eliminated these signals, suggesting that MT-CN affects metS via cell-type composition. Conclusion These results suggest that measurements of MT-CN in blood-derived DNA partially reflect differences in cell-type composition and that these differences are causally linked to insulin and related traits.Peer reviewe
Detailed SZ study of 19 LoCuSS galaxy clusters: masses and temperatures out to the virial radius
We present 16-GHz AMI SZ observations of 19 clusters with L_X >7x10^37 W
(h50=1) selected from the LoCuS survey (0.142<z<0.295) and of A1758b, in the
FoV of A1758a. We detect 17 clusters with 5-23sigma peak surface brightnesses.
Cluster parameters are obtained using a Bayesian cluster analysis. We fit
isothermal beta-models to our data and assume the clusters are virialized (with
all the kinetic energy in gas internal energy). Our gas temperature, T_AMI, is
derived from AMI SZ data, not from X-ray spectroscopy. Cluster parameters
internal to r500 are derived assuming HSE. We find: (i) Different gNFW
parameterizations yield significantly different parameter degeneracies. (ii)
For h70 = 1, we find the virial radius r200 to be typically 1.6+/-0.1 Mpc and
the total mass M_T(r200) typically to be 2.0-2.5xM_T(r500).(iii) Where we have
found M_T X-ray (X) and weak-lensing (WL) values in the literature, there is
good agreement between WL and AMI estimates (with M_{T,AMI}/M_{T,WL}
=1.2^{+0.2}_{-0.3} and =1.0+/-0.1 for r500 and r200, respectively). In
comparison, most Suzaku/Chandra estimates are higher than for AMI (with
M_{T,X}/M_{T,AMI}=1.7+/-0.2 within r500), particularly for the stronger
mergers.(iv) Comparison of T_AMI to T_X sheds light on high X-ray masses: even
at large r, T_X can substantially exceed T_AMI in mergers. The use of these
higher T_X values will give higher X-ray masses. We stress that large-r T_SZ
and T_X data are scarce and must be increased. (v) Despite the paucity of data,
there is an indication of a relation between merger activity and SZ
ellipticity. (vi) At small radius (but away from any cooling flow) the SZ
signal (and T_AMI) is less sensitive to ICM disturbance than the X-ray signal
(and T_X) and, even at high r, mergers affect n^2-weighted X-ray data more than
n-weighted SZ, implying significant shocking or clumping or both occur even in
the outer parts of mergers.Comment: 45 pages, 33 figures, 13 tables Accepted for publication in MNRA
A measurement of the tau mass and the first CPT test with tau leptons
We measure the mass of the tau lepton to be 1775.1+-1.6(stat)+-1.0(syst.) MeV
using tau pairs from Z0 decays. To test CPT invariance we compare the masses of
the positively and negatively charged tau leptons. The relative mass difference
is found to be smaller than 3.0 10^-3 at the 90% confidence level.Comment: 10 pages, 4 figures, Submitted to Phys. Letts.
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