Associations between social risk factors and surgical site infections after colectomy and abdominal hysterectomy

Importance: Surgical site infection (SSI) is an important patient safety outcome. Although social risk factors have been linked to many adverse health outcomes, it is unknown whether such factors are associated with higher rates of SSI. Objectives: To determine whether social risk factors, including race/ethnicity, insurance status, and neighborhood income, are associated with higher rates of SSI after colectomy or abdominal hysterectomy, 2 surgical procedures for which SSI rates are publicly reported and included in pay-for-performance programs by Medicare and other groups. Design, Setting, and Participants: This cross-sectional study analyzed adults undergoing colectomy or abdominal hysterectomy, as captured in State Inpatient Databases for Arizona, Florida, Iowa, Massachusetts, Maryland, New York, and Vermont. Operations were performed in 2013 through 2014 at general acute care hospitals in the United States. Data analysis was conducted from October 2018 through June 2019. Exposures: Colectomy or hysterectomy. Main Outcomes and Measures: Postoperative complex SSI rates. Results: A total of 149 741 patients met the inclusion criteria, including 90 210 patients undergoing colectomies (mean [SD] age, 63.4 [15.6] years; 49 029 [54%] female; 74% white, 11% black, 9% Hispanic, and 5% other or unknown race/ethnicity) and 59 531 patients undergoing abdominal hysterectomies (mean [SD] age, 49.8 [11.8] years; 100% female; 52% white, 26% black, 14% Hispanic, and 8% other or unknown race/ethnicity). In the colectomy cohort, 34% had private insurance, 52% had Medicare, 9% had Medicaid, and 5% had other or unknown insurance or were uninsured; 24% were from the lowest quartile of median zip code income. In the hysterectomy cohort, 57% had private insurance, 16% had Medicare, 19% had Medicaid, and 3% had other or unknown insurance or were uninsured; 27% were from the lowest-income zip codes. Within 30 days of surgery, SSI rates were 2.55% for the colectomy cohort and 0.61% for the hysterectomy cohort. For colectomy, black race (adjusted odds ratio [AOR], 0.71; 95% CI, 0.61-0.82) was associated with lower odds of SSI, whereas Medicare (AOR, 1.25; 95% CI, 1.10-1.41), Medicaid (AOR, 1.23; 95% CI, 1.06-1.44), and low neighborhood income (AOR, 1.14; 95% CI, 1.01-1.29) were associated with higher odds of SSI. For hysterectomy, no social risk factors that were examined in this study had statistically significant associations with SSI after adjustment for clinical risk. Conclusions and Relevance: Inconsistent associations between social risk factors and SSIs were found. For colectomy, infection prevention programs targeting low-income groups may be important for reducing disparities in this postoperative outcome, and policy makers could consider taking social risk factors into account when evaluating hospital performance

Easy Table Runner

This is a how-to guide that provides instructions for making an easy table runner

Investigating the [C II\,{\rm \scriptsize II}]-to-H I\,{\rm \scriptsize I} conversion factor and the H I\,{\rm \scriptsize I} gas budget of galaxies at z≈6z\approx 6 with hydrodynamical simulations

One of the most fundamental baryonic matter components of galaxies is the neutral atomic hydrogen (H$\,{\rm \scriptsize I}$). At low redshifts, this component can be traced directly through the 21-cm transition, but to infer H$\,{\rm \scriptsize I}$ gas content of the most distant galaxies, a viable tracer is needed. We here investigate the fidelity of the fine structure transition of the ($^2P_{3/2} - ^2P_{1/3}$) transition of singly-ionized carbon [C$\,{\rm \scriptsize II}$] at $158\,\mu$m as a proxy for H$\,{\rm \scriptsize I}$ in a set simulated galaxies at $z\approx 6$, following the work by Heintz et al. (2021). We select 11,125 star-forming galaxies from the SIMBA simulations, with far-infrared line emissions post-processed and modeled within the SIGAME framework. We find a strong connection between [C$\,{\rm \scriptsize II}$] and H$\,{\rm \scriptsize I}$, with the relation between this [C$\,{\rm \scriptsize II}$]-to-H$\,{\rm \scriptsize I}$ relation ($\beta_{\rm [C\,{\rm \scriptsize II}]}$) being anti-correlated with the gas-phase metallicity of the simulated galaxies. We further use these simulations to make predictions for the total baryonic matter content of galaxies at $z\approx 6$, and specifically the HI gas mass fraction. We find mean values of $M_{\rm HI}/M_\star = 1.4$, and $M_{\rm HI}/M_{\rm bar,tot} = 0.45$. These results provide strong evidence for H$\,{\rm \scriptsize I}$ being the dominant baryonic matter component by mass in galaxies at $z\approx 6$.Comment: 7 pages, 3 figures. Accepted for publication by ApJ

PROPEL: implementation of an evidence based pelvic floor muscle training intervention for women with pelvic organ prolapse: a realist evaluation and outcomes study protocol

Abstract Background Pelvic Organ Prolapse (POP) is estimated to affect 41%–50% of women aged over 40. Findings from the multi-centre randomised controlled “Pelvic Organ Prolapse PhysiotherapY” (POPPY) trial showed that individualised pelvic floor muscle training (PFMT) was effective in reducing symptoms of prolapse, improved quality of life and showed clear potential to be cost-effective. However, provision of PFMT for prolapse continues to vary across the UK, with limited numbers of women’s health physiotherapists specialising in its delivery. Implementation of this robust evidence from the POPPY trial will require attention to different models of delivery (e.g. staff skill mix) to fit with differing care environments. Methods A Realist Evaluation (RE) of implementation and outcomes of PFMT delivery in contrasting NHS settings will be conducted using multiple case study sites. Involving substantial local stakeholder engagement will permit a detailed exploration of how local sites make decisions on how to deliver PFMT and how these lead to service change. The RE will track how implementation is working; identify what influences outcomes; and, guided by the RE-AIM framework, will collect robust outcomes data. This will require mixed methods data collection and analysis. Qualitative data will be collected at four time-points across each site to understand local contexts and decisions regarding options for intervention delivery and to monitor implementation, uptake, adherence and outcomes. Patient outcome data will be collected at baseline, six months and one year follow-up for 120 women. Primary outcome will be the Pelvic Organ Prolapse Symptom Score (POP-SS). An economic evaluation will assess the costs and benefits associated with different delivery models taking account of further health care resource use by the women. Cost data will be combined with the primary outcome in a cost effectiveness analysis, and the EQ-5D-5L data in a cost utility analysis for each of the different models of delivery. Discussion Study of the implementation of varying models of service delivery of PFMT across contrasting sites combined with outcomes data and a cost effectiveness analysis will provide insight into the implementation and value of different models of PFMT service delivery and the cost benefits to the NHS in the longer term

Challenges and Techniques for Simulating Line Emission

Modeling emission lines from the millimeter to the UV and producing synthetic spectra is crucial for a good understanding of observations, yet it is an art filled with hazards. This is the proceedings of “Walking the Line”, a 3-day conference held in 2018 that brought together scientists working on different aspects of emission line simulations, in order to share knowledge and discuss the methodology. Emission lines across the spectrum from the millimeter to the UV were discussed, with most of the focus on the interstellar medium, but also some topics on the circumgalactic medium. The most important quality of a useful model is a good synergy with observations and experiments. Challenges in simulating line emission are identified, some of which are already being worked upon, and others that must be addressed in the future for models to agree with observations. Recent advances in several areas aiming at achieving that synergy are summarized here, from micro-physical to galactic and circum-galactic scale

The shellfish enigma across the Mesolithic-Neolithic transition in southern Scandinavia

The well-known and widespread replacement of oysters (abundant during the Mesolithic period) by cockles and mussels in many Danish Stone Age shell middens ca. 5900 cal yrs BP coincides with the transition to agriculture in southern Scandinavia. This human resource shift is commonly believed to reflect changing resource availability, driven by environmental and/or climatic change at the Mesolithic-Neolithic transition rather than cultural choice. While several hypotheses have been proposed to explain the “Mesolithic-Neolithic oyster decline”, an explanation based on a sudden freshening of the inner Danish waters has received most attention. Here, for the first time, we test and refute this long-standing hypothesis that declining salinity explains the marked reduction in oysters identified within numerous shell middens across coastal Denmark at the Mesolithic-Neolithic transition using quantitative and qualitative salinity inference from several, independent proxies (diatoms, molluscs and foraminifera) from multiple Danish fjord sites. Alternatively, we attribute the oyster decline to other environmental causes (particularly changing sedimentation), ultimately driven by external climatic forcing. Critical application of such high-quality environmental archives can reinvigorate archaeological debates and can aid in understanding and managing environmental change in increasingly impacted coastal regions

L’utilisation des réseaux sociaux (Snapchat, WhatsApp et Instagram) et le cyberbullying

100% des jeunes possèdent un téléphone portable, 99% ont un ordinateur et 97% ont accès à Internet (Waller et al., 2016). Ces nouveaux moyens technologiques font partie de notre quotidien. Depuis l’apparition de ces réseaux, un nouveau mouvement est né : le cyberbullying. Ce harcèlement par Internet consiste à l’utilisation de technologies modernes de communication afin de nuire aux autres de manière délibérée et agressive. Quand les jeunes arrivent en classe, ils apportent avec eux l’entier de leur vécu quotidien, familial ou encore émotionnel. Les problèmes liés à l’utilisation massive de ces réseaux font partie de notre quotidien d’enseignant. Malheureusement, les études faites jusqu’au jour d’aujourd’hui portent en majeure partie sur les élèves entre 13 ans et plus. Mais qu’en est-il des jeunes âgés entre 9 et 12 ans ? Notre travail de recherche porte donc sur l’utilisation des réseaux sociaux (Snapchat, Instagram et WhatsApp) et le cyberbullying. Deux outils différents ont été utilisés lors de cette recherche : des questionnaires afin d’avoir des résultats quantitatifs et deux entretiens afin d’avoir un point de vue qualitatif. Nos résultats montrent que WhatsApp est le réseau social le plus utilisé, suivi d’Instagram en deuxième position et finalement de Snapchat. Les élèves considèrent le nombre de dangers et de conflits sur les réseaux comme très faibles. Ils avouent tout de même donner plus d’informations personnelles sur WhatsApp que sur les autres réseaux choisis dans l’étude. Concernant leur vision du contrôle des parents, ils l’estiment très faible. Cependant, il s’agit uniquement de leur avis, il serait intéressant de savoir la réalité des faits en interrogeant les parents. Les deux sujets interrogés savent définir le cyberbullying et connaissent les différents acteurs agissant au sein de cette forme de harcèlement. Ils sont également conscients des différents risques, conséquences ou sentiments que peut ressentir une cyber-victime mais n’abordent pas du tout ceux concernant le témoin ou le cyber-harceleur. En conclusion, notre recherche montre que les réseaux sociaux font partie intégrante du quotidien d’un grand nombre d’élèves. Il est donc essentiel que les enseignants s’interrogent sur les moyens de gérer les problèmes que ceux-ci peuvent amener en classe mais également les moyens de les éviter

Deep phenotyping of the unselected COPSAC2010 birth cohort study

BACKGROUND: We hypothesize that perinatal exposures, in particular the human microbiome and maternal nutrition during pregnancy, interact with the genetic predisposition to cause an abnormal immune modulation in early life towards a trajectory to chronic inflammatory diseases such as asthma and others. OBJECTIVE: The aim of this study is to explore these interactions by conducting a longitudinal study in an unselected cohort of pregnant women and their offspring with emphasis on deep clinical phenotyping, exposure assessment, and biobanking. Exposure assessments focus on the human microbiome. Nutritional intervention during pregnancy in randomized controlled trials are included in the study to prevent disease and to be able to establish causal relationships. METHODS: Pregnant women from eastern Denmark were invited during 2008–2010 to a novel unselected ‘COPSAC(2010)’ cohort. The women visited the clinic during pregnancy weeks 24 and 36. Their children were followed at the clinic with deep phenotyping and collection of biological samples at nine regular visits until the age of 3 and at acute symptoms. Randomized controlled trials of high‐dose vitamin D and fish oil supplements were conducted during pregnancy, and a trial of azithromycin for acute lung symptoms was conducted in the children with recurrent wheeze. RESULTS: Seven hundred and thirty‐eight mothers were recruited from week 24 of gestation, and 700 of their children were included in the birth cohort. The cohort has an over‐representation of atopic parents. The participant satisfaction was high and the adherence equally high with 685 children (98%) attending the 1 year clinic visit and 667 children (95%) attending the 2 year clinic visit. CONCLUSIONS: The COPSAC(2010) birth cohort study provides longitudinal clinical follow‐up with highly specific end‐points, exposure assessments, and biobanking. The cohort has a high adherence rate promising strong data to elucidate the interaction between genomics and the exposome in perinatal life leading to lifestyle‐related chronic inflammatory disorders such as asthma

Are European Blue Economy ambitions in conflict with European environmental visions?

We report the outcomes of a comprehensive study of the potential consequences of the implementation of the EU Maritime Spatial Planning Directive (MSPD) in Danish waters. The analyses are anchored in a framework developed in support of data-driven Ecosystem-Based Maritime Spatial Planning. The data for the models include not only human stressors but also information on the distribution of ecosystem components ranging from planktonic communities over benthic communities to fish, seabirds and marine mammals. We have established a baseline, based on state-of-the-art data sets, with respect to combined effects upon ecosystem components. Future scenarios for the developments in human stressors were estimated for 2030 and 2050 based on information on existing policies, strategies and plans and were compared to the baseline. In addition, we developed a scenario for implementation of the Marine Strategy Framework Directive (MSFD), i.e. working towards meeting the objectives of Good Environmental Status. Our results indicate that (1) combined human stressors will possibly increase in 2030 and 2050 compared to the baseline, (2) increased combined human stressors are likely to lead to a worsening of the environmental and ecological status sensu the Marine Strategy Framework Directive and the Water Framework Directive (WFD), and (3) the MSPD implementation process appears to conflict with the MSFD and WFD objectives. Accordingly, we are sceptical of claims of an untapped potential for Blue Growth in Danish marine waters.publishedVersio