Creation and assessment of a clinical predictive calculator and mortality associated with Candida krusei bloodstream infections

Abstract Background Candida krusei bloodstream infection (CK BSI) is associated with high mortality, but whether this is due to underlying comorbidities in affected patients or the organism itself is unknown. Identifying patient characteristics that are associated with CK BSI is crucial for clinical decision-making and prognosis. Methods We conducted a retrospective analysis of hospitalized patients with Candida BSI at our institution between 2002 and 2015. Data were collected on demographics, comorbidities, medications, procedures, central lines, vital signs, and laboratory values. Multivariable logistic and Cox regression were used to identify risk factors associated with CK and mortality, respectively. Results We identified 1873 individual patients who developed Candida BSI within the study period, 59 of whom had CK BSI. CK BSI was predicted by hematologic malignancy, gastric malignancy, neutropenia, and the use of prophylactic azole antifungals, monoclonal antibodies, and β-lactam/β-lactamase inhibitor combinations. The C-statistic was 0.86 (95% confidence interval, 0.81–0.91). The crude mortality rates were 64.4% for CK BSI and 41.4% for non-CK BSI. Although CK was associated with higher mortality in univariable Cox regression, this relationship was no longer significant with the addition of the following confounders: lymphoma, neutropenia, glucocorticoid use, chronic liver disease, and elevated creatinine. Conclusions Six patient comorbidities predicted the development of CK BSI with high accuracy. Although patients with CK BSI have higher crude mortality rates than patients with non-CK BSI, this difference is not significant when accounting for other patient characteristics. </jats:sec

Reframing the Presentation of Environmental Law and Policy

In 1995, Congress, with the support of the Clinton administration, passed the Personal Responsibility and Work Opportunity Reconciliation Act, a sweeping welfare reform designed to appease conservative critics of 1960s War on Poverty programs. In the last decade, conservatives have intensified a comparable campaign to dismantle environmental programs and regulatory agencies established during the 1970s through the efforts of the environmental movement. Conservatives’ calls for market forces to replace governmental environmental protection programs echo the arguments of conservative opponents of welfare. Similarly, contemporary battles over environmental policy are being waged in the mass media arena. Therefore, it behooves environmental advocates to review the public discourse that surrounded the welfare debates of the 1990s. Using frame analysis, this Essay describes the evolution of media discourse in Massachusetts from 1990 through 1994 regarding the role of government and its responsibility in providing public welfare programs. The Essay then draws lessons from welfare reform that are relevant to current environmental debate

Physiological and genetic description of dissimilatory perchlorate reduction by the novel marine bacterium Arcobacter sp. strain CAB.

A novel dissimilatory perchlorate-reducing bacterium (DPRB), Arcobacter sp. strain CAB, was isolated from a marina in Berkeley, CA. Phylogenetically, this halophile was most closely related to Arcobacter defluvii strain SW30-2 and Arcobacter ellisii. With acetate as the electron donor, strain CAB completely reduced perchlorate (ClO4(-)) or chlorate (ClO3(-)) [collectively designated (per)chlorate] to innocuous chloride (Cl(-)), likely using the perchlorate reductase (Pcr) and chlorite dismutase (Cld) enzymes. When grown with perchlorate, optimum growth was observed at 25 to 30°C, pH 7, and 3% NaCl. Transmission electron microscopy (TEM) and scanning electron microscopy (SEM) preparations were dominated by free-swimming straight rods with 1 to 2 polar flagella per cell. Strain CAB utilized a variety of organic acids, fructose, and hydrogen as electron donors coupled to (per)chlorate reduction. Further, under anoxic growth conditions strain CAB utilized the biogenic oxygen produced as a result of chlorite dismutation to oxidize catechol via the meta-cleavage pathway of aerobic catechol degradation and the catechol 2,3-dioxygenase enzyme. In addition to (per)chlorate, oxygen and nitrate were alternatively used as electron acceptors. The 3.48-Mb draft genome encoded a distinct perchlorate reduction island (PRI) containing several transposases. The genome lacks the pcrC gene, which was previously thought to be essential for (per)chlorate reduction, and appears to use an unrelated Arcobacter c-type cytochrome to perform the same function. IMPORTANCE The study of dissimilatory perchlorate-reducing bacteria (DPRB) has largely focused on freshwater, mesophilic, neutral-pH environments. This study identifies a novel marine DPRB in the genus Arcobacter that represents the first description of a DPRB associated with the Campylobacteraceae. Strain CAB is currently the only epsilonproteobacterial DPRB in pure culture. The genome of strain CAB lacks the pcrC gene found in all other DPRB tested, demonstrating a new variation on the (per)chlorate reduction pathway. The ability of strain CAB to oxidize catechol via the oxygenase-dependent meta-cleavage pathway in the absence of external oxygen by using the biogenic oxygen produced from the dismutation of chlorite provides a valuable model for understanding the anaerobic degradation of a broad diversity of xenobiotics which are recalcitrant to anaerobic metabolism but labile to oxygenase-dependent mechanisms

Dirty laundry: The nature and substance of seeking relationship help from strangers online

Interpersonal relationships are vital to our well-being. In recent years, it has become increasingly common to seek relationship help through anonymous online platforms. Accordingly, we conducted a large-scale analysis of real-world relationship help-seeking to create a descriptive overview of the nature and substance of online relationship help-seeking. By analyzing the demographic characteristics and language of relationship help-seekers on Reddit (N = 184,631), we establish the first-ever big data analysis of relationship help-seeking and relationship problems in situ among the general population. Our analyses highlight real-world relationship struggles found in the general population, extending beyond past work that is typically limited to counseling/intervention settings. We find that relationship problem estimates from our sample are closer to those found in the general population, providing a more generalized insight into the distribution and prevalence of relationship problems as compared with past work. Further, we find several meaningful associations between relationship help-seeking behavior, gender, and attachment. Notably, numerous gender differences in help-seeking and romantic attachment emerged. Our findings suggest that, contrary to more traditional contexts, men are more likely to seek help with their relationships online, are more expressive of their emotions (e.g., discussing the topic of "heartache"), and show language patterns generally consistent with more secure attachment. Our analyses highlight pathways for further exploration, providing even deeper insights into the timing, lifecycle, and moderating factors that influence who, what, why, and how people seek help for their interpersonal relationships