Occurrence of yeast bloodstream infections between 1987 and 1995 in five Dutch university hospitals

The aim of this study was to identify retrospectively trends in fungal bloodstream infections in The Netherlands in the period from 1987 to 1995. Results of over 395,000 blood cultures from five Dutch university hospitals were evaluated. Overall, there were more than 12 million patient days of care during the nine-year study period. The rate of candidemia doubled in the study period, reaching an incidence of 0.71 episodes per 10,000 patient days in 1995. The general increase in candidemia was paralleled by an increase in non-Candida albicans bloodstream infections, mainly due toCandida glabrata. However, more than 60% of the infections were caused byCandida albicans. Fluconazoleresistant species such asCandida krusei did not emerge during the study period. The increasing rate of candidemia found in Dutch university hospitals is similar to the trend observed in the USA, but the rate is lower and the increase is less pronounced

Surgical versus dilational tracheostomy in patients with severe stroke: a SETPOINT2 post hoc analysis

Background Tracheostomy in mechanically ventilated patients with severe stroke can be performed surgically or dilationally. Prospective data comparing both methods in patients with stroke are scarce. The randomized Stroke-Related Early Tracheostomy vs Prolonged Orotracheal Intubation in Neurocritical Care Trial2 (SETPOINT2) assigned 382 mechanically ventilated patients with stroke to early tracheostomy versus extubation or standard tracheostomy. Surgical tracheostomy (ST) was performed in 41 of 307 SETPOINT2 patients, and the majority received dilational tracheostomy (DT). We aimed to compare ST and DT in these patients with patients. Methods All SETPOINT2 patients with ST were compared with a control group of patients with stroke undergoing DT (1:2), selected by propensity score matching that included the factors stroke type, SETPOINT2 randomization group, Stroke Early Tracheostomy score, patient age, and premorbid functional status. Successful decannulation was the primary outcome, and secondary outcome parameters included functional outcome at 6 months and adverse events attributable to tracheostomy. Potential predictors of decannulation were evaluated by regression analysis. Results Baseline characteristics were comparable in the two groups of patients with stroke undergoing ST (n = 41) and matched patients with stroke undergoing DT (n = 82). Tracheostomy was performed significantly later in the ST group than in the DT group (median 9 [interquartile range {IQR} 5–12] vs. 9 [IQR 4–11] days after intubation, p = 0.025). Patients with ST were mechanically ventilated longer (median 19 [IQR 17–24] vs.14 [IQR 11–19] days, p = 0.008) and stayed in the intensive care unit longer (median 23 [IQR 16–27] vs. 17 [IQR 13–24] days, p = 0.047), compared with patients with DT. The intrahospital infection rate was significantly higher in the ST group compared to the DT group (14.6% vs. 1.2%, p = 0.002). At 6 months, decannulation rates (56% vs. 61%), functional outcomes, and mortality were not different. However, decannulation was performed later in the ST group compared to the DT group (median 81 [IQR 66–149] vs. 58 [IQR 32–77] days, p = 0.004). Higher baseline Stroke Early Tracheostomy score negatively predicted decannulation. Conclusions In ventilated patients with severe stroke in need of tracheostomy, surgical and dilational methods are associated with comparable decannulation rate and functional outcome at 6 months. However, ST was associated with longer time to decannulation and higher rates of early infections, supporting the dilational approach to tracheostomy in ventilated patients with stroke

How to protect the proximal bronchial tree during stereotactic radiotherapy of ultracentral lung tumors: Lessons from MR-guided treatment

PURPOSE To use imaging data from stereotactic MR-guided online adaptive radiotherapy (SMART) of ultracentral lung tumors (ULT) for development of a safe non-adaptive approach towards stereotactic body radiotherapy (SBRT) of ULT. PATIENTS AND METHODS Analysis is based on 19 patients with ULT who received SMART (10 × 5.0-5.5 Gy) on a 0.35 T MR-Linac (MRIdian®) in the prospective MAGELLAN trial. 4D-planning CT data of six patients served to quantify proximal bronchial tree (PBT) breathing motion. Daily fraction MRIs are used to calculate interfractional translations (mediolateral (ML), anterior-posterior (AP), superior-inferior (SI)) and their dosimetric consequences for the PBT. A planning risk volume (PRV) is calculated for an assumed non-adaptive SBRT in deep-inspiration breath hold (DIBH) with surface-guidance (AlignRT®). Finally, non-adaptive volumetric modulated arc (VMAT) SBRT is simulated with and without a PRV for N = 10 patients (10 × 5.5 Gy). RESULTS The PBT shows relevant breathing motion, especially in superior-inferior direction (median ML: 2.5 mm, AP: 1.9 mm and SI: 9.2 mm). Furthermore, moderate interfractional translations are observed (mean absolute translation ML: 1.3 mm, AP: 1.3 mm, SI: 1.1 mm), with an estimated 2 mm PRV margin for interfractional changes alone. Simulated non-adaptive SBRT leads to PBT overdoses in 60 % of patients (median overdosed fractions VMAT: 2.5, predicted MR-linac plans 4). Both MR-guided online plan adaptation (SMART) and PRV-based non-adaptive VMAT prevent PBT overdoses, but SMART yields significantly higher planning target volume (PTV) coverage (SMART: median 96 % [IQR 95-96], VMAT: median 89 % [IQR 77-94], p = 0.014). CONCLUSIONS Both intrafractional breathing motion and interfractional translations may impact doses to the PBT during SBRT of ULT. SMART protects the PBT from overdoses while maintaining high PTV coverage. Non-adaptive SBRT appears safe with advanced breathing motion management and PRV, but yields inferior PTV coverage

Fauxcurrence: simulating multi-species occurrences for null models in species distribution modelling and biogeography

The work was funded by Newton Fund (UK)/NERC (UK)/RISTEKDIKTI (Indonesia) grants awarded to JT, BJ, ACA, ASTP, CG-R, GB and LTL (grant no.: NE/S006923/1, NE/S006893/1, 2488/IT3.L1/PN/2020 and 3982/IT3.L1/PN/2020). GB and CG-R are funded by Royal Society Univ. Research Fellowships (UF160614 and UF150571 respectively).Peer reviewedPublisher PD

Progesterone for the prevention of preterm birth in women with multiple pregnancies: the AMPHIA trial

Contains fulltext : 53264.pdf (publisher's version ) (Open Access)BACKGROUND: 15% of multiple pregnancies ends in a preterm delivery, which can lead to mortality and severe long term neonatal morbidity. At present, no generally accepted strategy for the prevention of preterm birth in multiple pregnancies exists. Prophylactic administration of 17-alpha hydroxyprogesterone caproate (17OHPC) has proven to be effective in the prevention of preterm birth in women with singleton pregnancies with a previous preterm delivery. At present, there are no data on the effectiveness of progesterone in the prevention of preterm birth in multiple pregnancies. METHODS/DESIGN: We aim to investigate the hypothesis that 17OHPC will reduce the incidence of the composite neonatal morbidity of neonates by reducing the early preterm birth rate in multiple pregnancies. Women with a multiple pregnancy at a gestational age between 15 and 20 weeks of gestation will be entered in a placebo-controlled, double blinded randomised study comparing weekly 250 mg 17OHPC intramuscular injections from 16-20 weeks up to 36 weeks of gestation versus placebo. At study entry, cervical length will be measured. The primary outcome is composite bad neonatal condition (perinatal death or severe morbidity). Secondary outcome measures are time to delivery, preterm birth rate before 32 and 37 weeks, days of admission in neonatal intensive care unit, maternal morbidity, maternal admission days for preterm labour and costs. We need to include 660 women to indicate a reduction in bad neonatal outcome from 15% to 8%. Analysis will be by intention to treat. We will also analyse whether the treatment effect is dependent on cervical length. DISCUSSION: This trial will provide evidence as to whether or not 17OHPC-treatment is an effective means of preventing bad neonatal outcome due to preterm birth in multiple pregnancies. TRIAL REGISTRATION: Current Controlled Trials ISRCTN40512715

Schlussbericht

Heterogenität und Inklusion gestalten – Zukunftsstrategie Lehrer*innenbildung (ZuS)“ an der Universität zu Köln hat sich eine wichtige und aktuelle gesellschaftliche und bildungspolitische Aufgabe zum Leitmotiv gemacht: Sie will Studierende besser auf ihre beruflichen Herausforderungen vorbereiten und zugleich die dafür entwickelten Maßnahmen für einen nachhaltigen institutionellen Wandel nutzen. Diese Strategie wurde in vier großen thematischen Handlungsfeldern umgesetzt: Studium inklusiv als thematisch strukturiertes Lehrangebot, Competence Labs als innovative praxisorientierte Lehr-Lernformate sowie Nachwuchsförderung und Qualitätssicherung als Mittel der Nachhaltigkeit. Die zweite Förderphase des Projektes soll die bewährten Innovationen strukturell verankern und nachhaltig in die Gesamtheit der Fächer und der Studierenden sowie in die zweite Ausbildungsphase transferieren. Anknüpfend an die erste Förderphase werden zusätzlich zur inklusiven Bildung zwei weitere Zieldimensionen adressiert: digitale Bildung und sprachliche Bildung. Damit werden die drei zentralen Herausforderungen im Bildungsbereich bearbeitet, nämlich das Unterrichten in heterogenen Klassen, die kritisch-konstruktive Nutzung digitaler Ressourcen sowie die Vermittlung bildungssprachlicher Kompetenzen im Kontext der Mehrsprachigkeit. Datei-Upload durch TIB„Performing heterogeneity and inclusion – Teacher Training Quality Campaign (ZuS)” at the University of Cologne has adopted a significant and topical task as its guiding theme: The campaign has set out to better prepare students for their professional challenges and at the same time is intent on profiting from the measures developed for that purpose in order to warrant a sustainable institutional change. This strategy is currently being realized in four large thematic spheres of activity: Inclusive Studies (“Studium inklusiv”) as a thematically structured programme, Competence Labs as innovate, practice-oriented teaching and learning formats as well as Promotion of Young Researchers (“Nachwuchsförderung”) and Quality Assurances as means of sustainability. In the second funding phase the successful innovations will be structurally implemented and transferred to all of the study programmes accross disciplines, to all the students as well as to the second educational phase (i.e. the teacher training phase). In connection to the first funding phase, two further objectives will be addressed: digital education and linguistic education. These objectives ensure that we are facing the following three central challenges: i. teaching heterogeneous classes, ii. the critical-constructive use of digital teaching iii. linguistic educational competences in the context of multilingualism