Effectiveness of behavioural interventions to reduce urinary tract infections and Escherichia coli bacteraemia for older adults across all care settings: A systematic review

© 2018 Background: Escherichia coli bacteraemia rates in the UK have risen; rates are highest among older adults. Previous urinary tract infections (UTIs) and catheterization are risk factors. Aim: To examine effectiveness of behavioural interventions to reduce E. coli bacteraemia and/or symptomatic UTIs for older adults. Methods: Sixteen databases, grey literature, and reference lists were searched. Titles and/or abstracts were scanned and selected papers were read fully to confirm suitability. Quality was assessed using Critical Appraisal Skills Programme guidelines and Scottish Intercollegiate Guidelines Network grading. Findings: Twenty-one studies were reviewed, and all lacked methodological quality. Six multi-faceted hospital interventions including education, with audit and feedback or reminders reduced UTIs but only three supplied statements of significance. One study reported decreasing catheter-associated UTI (CAUTI) by 88% (F (1,20) = 7.25). Another study reported reductions in CAUTI from 11.17 to 10.53 during Phase I and by 0.39 during Phase II (χ2 = 254). A third study reported fewer UTIs per patient week (risk ratio = 0.39). Two hospital studies of online training and catheter insertion and care simulations decreased CAUTIs from 33 to 14 and from 10.40 to 0. Increasing nursing staff, community continence nurses, and catheter removal reminder stickers reduced infection. There were no studies examining prevention of E. coli bacteraemias. Conclusion: The heterogeneity of studies means that one effective intervention cannot be recommended. We suggest that feedback should be considered because it facilitated reductions in UTI when used alone or in multi-faceted interventions including education, audit or catheter removal protocols. Multi-faceted education is likely to be effective. Catheter removal protocols, increased staffing, and patient education require further evaluation

The incidence of first stroke in pregnant and non-pregnant women of childbearing age: a population-based cohort study from England

Background: Pregnant women may have an increased risk of stroke compared to non-pregnant women of similar age, but the magnitude and the timing of such risk are unclear. We examined the risk of first stroke event in women of childbearing age and compared the risk during pregnancy and in the early postpartum period to background risk outside these periods. Methods and Results: We conducted an open cohort study of 2,046,048 women aged 15-49 years between 1st April 1997 and 31th March 2014 using linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care records in England. Risk of first stroke was assessed by calculating the incidence rate of stroke in antepartum, peripartum (2 days before until 1 day after delivery), early (first six weeks) and late (second six weeks) postpartum periods, compared with non-pregnant time using a Poisson regression model with adjustment for maternal age, socioeconomic group and calendar time. A total of 2,511 women had a first stroke. The incidence rate of stroke was 25.0 per 100,000 person-years (95% confidence interval 24.0-26.0) in non-pregnant time. The rate was lower antepartum (10.7/100,000 person-years, 7.6-15.1), but 9-fold higher peripartum (161.1/100,000 person-years, 80.6-322.1) and 3-fold higher early postpartum (47.1/100,000 person-years, 31.3-70.9). Rates of ischaemic and haemorrhagic stroke both increased peripartum and early postpartum. Conclusions: Although the absolute risk of first stroke is low in women of childbearing age, health care professionals should be aware of a considerable increase in relative risk during the peripartum and early postpartum periods

The influence of nova nucleosynthesis on the chemical evolution of the Galaxy

We adopt up-to-date yields of 7Li, 13C, 15N from classical novae and use a well tested model for the chemical evolution of the Milky Way in order to predict the temporal evolution of these elemental species in the solar neighborhood. In spite of major uncertainties due to our lack of knowledge of metallicity effects on the final products of explosive nucleosynthesis in nova outbursts, we find a satisfactory agreement between theoretical predictions and observations for 7Li and 13C. On the contrary, 15N turns out to be overproduced by about an order of magnitude.Comment: 8 pages, latex, 3 figures. To appear in "The Chemical Evolution of the Milky Way: Stars versus Clusters", eds. F. Giovannelli and F. Matteucci (Kluwer: Dordrecht

The origin of variability of the intermediate-mass black-hole ULX system HLX-1 in ESO 243-49

The ultra-luminous intermediate-mass black-hole system HLX-1 in the ESO 243-49 galaxy exhibits variability with a possible recurrence time of a few hundred days. Finding the origin of this variability would constrain the still largely unknown properties of this extraordinary object. Since it exhibits an intensity-hardness behavior characteristic of black-hole X-ray transients, we have analyzed the variability of HLX-1 in the framework of the disk instability model that explains outbursts of such systems. We find that the long-term variability of HLX-1 is unlikely to be explained by a model in which outbursts are triggered by thermal-viscous instabilities in an accretion disc. Possible alternatives include the instability in a radiation-pressure dominated disk but we argue that a more likely explanation is a modulated mass-transfer due to tidal stripping of a star on an eccentric orbit around the intermediate-mass black hole. We consider an evolutionary scenario leading to the creation of such a system and estimate the probability of its observation. We conclude, using a simplified dynamical model of the post-collapse cluster, that no more than 1/100 to 1/10 of Mbh < 10^4 Msun IMBHs - formed by run-away stellar mergers in the dense collapsed cores of young clusters - could have a few times 1 Msun Main-Sequence star evolve to an AGB on an orbit eccentric enough for mass transfer at periapse, while avoiding collisional destruction or being scattered into the IMBH by 2-body encounters. The finite but low probability of this configuration is consistent with the uniqueness of HLX-1. We note, however, that the actual response of a standard accretion disk to bursts of mass transfer may be too slow to explain the observations unless the orbit is close to parabolic (and hence even rarer) and/or additional heating, presumably linked to the highly time-dependent gravitational potential, are invoked.Comment: 8 pages, 2 figures. Additional figure, extended discussion. To be published in ApJ, June 10, 2011, v734 -

Infrared spectroscopy of Nova Cassiopeiae 1993 (V705 Cas). IV. A closer look at the dust

Nova Cassiopeiae 1993 (V705 Cas) was an archetypical dust-forming nova. It displayed a deep minimum in the visual light curve, and spectroscopic evidence for carbon, hydrocarbon and silicate dust. We report the results of fitting the infrared spectral energy distribution with the DUSTY code, which we use to determine the properties and geometry of the emitting dust. The emission is well described as originating in a thin shell whose dust has a carbon:silicate ratio of ~2:1 by number (1.26:1 by mass) and a relatively flat size distribution. The 9.7micron and 18micron silicate features are consistent with freshly-condensed dust and, while the lower limit to the grain size distribution is not well constrained, the largest grains have dimensions \~0.06micron; unless the grains in V705 Cas were anomalously small, the sizes of grains produced in nova eruptions may previously have been overestimated in novae with optically thick dust shells. Laboratory work by Grishko & Duley may provide clues to the apparently unique nature of nova UIR features.Comment: 11 pages, 9 fugure

Secular changes in the quiescence of WZ Sge: the development of a cavity in the inner disk

We find a dimming during optical quiescence of the cataclysmic variable WZ Sge by about half a magnitude between superoutbursts. We connect the dimming with the development of a cavity in the inner part of the accretion disk. We suggest that, when the cavity is big enough, accretion of material is governed by the magnetic field of the white dwarf and pulsations from the weakly magnetic white dwarf appear. The time scale of forming the cavity is about a decade, and it persists throughout the whole quiescent phase. Such a cavity can be accommodated well by the proposed magnetic propeller model for WZ Sge, where during quiescence mass is being expelled by the magnetic white dwarf from the inner regions of the accretion disk to larger radii.Comment: 10 pages, 4 figures, accepted for publication in Astronomy and Astrophysics; following referee report, many textual changes, figures improved, more historic data added, conclusions unchange

Synthesis and structural characterization of a mimetic membrane-anchored prion protein

During pathogenesis of transmissible spongiform encephalopathies (TSEs) an abnormal form (PrPSc) of the host encoded prion protein (PrPC) accumulates in insoluble fibrils and plaques. The two forms of PrP appear to have identical covalent structures, but differ in secondary and tertiary structure. Both PrPC and PrPSc have glycosylphospatidylinositol (GPI) anchors through which the protein is tethered to cell membranes. Membrane attachment has been suggested to play a role in the conversion of PrPC to PrPSc, but the majority of in vitro studies of the function, structure, folding and stability of PrP use recombinant protein lacking the GPI anchor. In order to study the effects of membranes on the structure of PrP, we synthesized a GPI anchor mimetic (GPIm), which we have covalently coupled to a genetically engineered cysteine residue at the C-terminus of recombinant PrP. The lipid anchor places the protein at the same distance from the membrane as does the naturally occurring GPI anchor. We demonstrate that PrP coupled to GPIm (PrP-GPIm) inserts into model lipid membranes and that structural information can be obtained from this membrane-anchored PrP. We show that the structure of PrP-GPIm reconstituted in phosphatidylcholine and raft membranes resembles that of PrP, without a GPI anchor, in solution. The results provide experimental evidence in support of previous suggestions that NMR structures of soluble, anchor-free forms of PrP represent the structure of cellular, membrane-anchored PrP. The availability of a lipid-anchored construct of PrP provides a unique model to investigate the effects of different lipid environments on the structure and conversion mechanisms of PrP