Delayed diagnosis of coeliac disease increases cancer risk

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The Ecology of Antibiotic Use in the ICU: Homogeneous Prescribing of Cefepime but Not Tazocin Selects for Antibiotic Resistant Infection

Background: Antibiotic homogeneity is thought to drive resistance but in vivo data are lacking. In this study, we determined the impact of antibiotic homogeneity per se, and of cefepime versus antipseudomonal penicillin/beta-lactamase inhibitor combinations (APP-beta), on the likelihood of infection or colonisation with antibiotic resistant bacteria and/or two commonly resistant nosocomial pathogens (methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa). A secondary question was whether antibiotic cycling was associated with adverse outcomes including mortality, length of stay, and antibiotic resistance

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

A saline tracer test monitored via both surface and cross-borehole electrical resistivity tomography: comparison of time-lapse results

Subsurface solute tracer testing has been widely used as a powerful method for characterizing the hydraulic properties of subsurface for many decades . The success of a tracer test, however, depends on the number and the location of the sampling wells. Only at exceedingly well-equipped research sites it is possible, using conventional sampling methods, to retrieve a complete image of the 3D time-lapse image of the tracer evolution. Given the limitations above, the use of geophysical methods to monitor tracer tests is gaining popularity. Such methods may provide time-lapse 2D/3D data (thus inform on both the subsurface spatial structures - static information - and the fluid presence and motion - dynamic information). Furthermore, they are non-invasive (or minimally invasive), cost-effective and relatively fast in comparison with conventional well-based sampling. As documented in the recent literature, they can be used as a powerful tool to support and validate traditional hydrological tests. The most commonly applied technique for this purpose is electrical resistivity tomography (ERT), both from the surface and in boreholes. To infer reliable results from such a coupled application, however, specific attention must be paid to the experimental set-up and design, especially when the main target of the study is a quantitative estimation of the hydraulic parameters. The sensitivity and resolving power of ERT depend on the type of acquisition methodology; operating from the ground surface only, for example, could lead to severe limitations in terms of resolution and to reliable but qualitative only deductions in term of results. Early applications were limited to imaging solute transport, but did not provide estimates of hydraulic parameters and their spatial variability. In order to quantify the hydraulic parameters of the subsurface, it is essential to make use of hydrological models. The geophysical time-lapse models may be used as equivalent concentration data to infer the timing and location of tracer breakthrough. In conjunction with transport models, such data can be directly interpreted in terms of transport parameters, such as flow velocity and dispersivity. The recent literature on time-lapse ERT applied to saline tracer tests follows this conceptual pathway to different extents . These studies point out the need for a careful analysis of ERT acquisition and inversion characteristics in order to deliver the necessary quantitative information

Non-invasive monitoring of soil static characteristics and dynamic states: a case study highlighting vegetationeffects

In this paper we present the results of long term monitoring and irrigation tests performed on an experimental farm in Southern Sardinia, an area of semi-arid climate. The goal of the study is to understand the soil-vegetation interactions and how they can affect the soil water balance, particularly in view of possible climatic changes. We used long-term electromagnetic induction (EMI) time lapse monitoring and short-term irrigation experiments monitored using ERT (electrical resistivity tomography) and EMI, supported by TDR soil moisture measurements. Mapping of natural gamma-ray emission, texture analysis and laboratory calibration of an electrical constitutive relationship on soil samples complete the dataset. We observe that the growth of vegetation, with the associated below ground allocation of biomass, has a significant impact on the soil moisture dynamics. It is well known that vegetation extracts a large amount of water from the soil particularly in the hot season, but it also reduces evaporation by shadowing the soil surface. Vegetation represents a screen for rainfall and prevents light rainfall infiltration but enhances the wetting process by facilitating the infiltration and the ground water recharge. In many cases, the vegetation creates a positive feedback system. In our study, this mechanisms are well highlighted by the use of non-invasive techniques, that provide data at the scale and resolution necessary to understand the hydrological processes of the topsoil, also in their lateral and depth spatial variability. Unlike remote sensing techniques, non invasive geophysics penetrates the soil subsurface and can effectively image moisture content in the root zone. We also developed a simple conceptual model capable of representing the vegetation-soil interaction with a simple enough parameterization that can be fulfilled by measurements of a non invasive nature, available at a large scale and evidences possible relevant developments of our research