Estimating excess length of stay due to healthcare-associated infections: A systematic review and meta-analysis of statistical methodology

BackgroundHealthcare-associated infection (HAI) affects millions of patients worldwide. HAI is associated with increased healthcare costs, owing primarily to increased hospital length of stay (LOS) but calculating these costs is complicated due to time-dependent bias. Accurate estimation of excess LOS due to HAI is essential to ensure we invest in cost-effective infection prevention and control (IPC) measures.AimTo identify and review the main statistical methods that have been employed to estimate differential LOS between patients with, and without, HAI; to highlight and discuss potential biases of all statistical approaches.MethodsA systematic review from 1997 to April 2017 was conducted in PUBMED, CINAHL, PROQUEST and ECONLIT databases. Studies were quality assessed using an adapted Newcastle-Ottawa Scale (NOS). Methods were categorised into time-fixed or time-varying with the former exhibiting time-dependent bias. We use two examples of meta-analysis to illustrate how estimates of excess LOS differ between different studies.FindingsNinety-two studies with estimates on excess LOS were identified. The majority of articles employed time-fixed methods (75%). Studies using time-varying methods are of higher quality according to NOS. Studies using time-fixed methods overestimate additional LOS attributable to HAI. Undertaking meta-analysis is challenging due to a variety of study designs and reporting styles. Study differences are further magnified by heterogeneous populations, case definitions, causative organisms and susceptibilities.ConclusionsMethodologies have evolved over the last 20 years but there is still a significant body of evidence reliant upon time-fixed methods. Robust estimates are required to inform investment in cost-effective IPC interventions

Probabilistic microsimulation to examine the cost-effectiveness of hospital admission screening strategies for carbapenemase-producing enterobacteriaceae (CPE) in the United Kingdom

BackgroundAntimicrobial resistance has been recognised as a global threat with carbapenemase- producing-Enterobacteriaceae (CPE) as a prime example. CPE has similarities to COVID-19 where asymptomatic patients may be colonised representing a source for onward transmission. There are limited treatment options for CPE infection leading to poor outcomes and increased costs. Admission screening can prevent cross-transmission by pre-emptively isolating colonised patients.ObjectiveWe assess the relative cost-effectiveness of screening programmes compared with no- screening.MethodsA microsimulation parameterised with NHS Scotland date was used to model scenarios of the prevalence of CPE colonised patients on admission. Screening strategies were (a) two-step screening involving a clinical risk assessment (CRA) checklist followed by microbiological testing of high-risk patients; and (b) universal screening. Strategies were considered with either culture or polymerase chain reaction (PCR) tests. All costs were reported in 2019 UK pounds with a healthcare system perspective.ResultsIn the low prevalence scenario, no screening had the highest probability of cost-effectiveness. Among screening strategies, the two CRA screening options were the most likely to be cost-effective. Screening was more likely to be cost-effective than no screening in the prevalence of 1 CPE colonised in 500 admitted patients or more. There was substantial uncertainty with the probabilities rarely exceeding 40% and similar results between strategies. Screening reduced non-isolated bed-days and CPE colonisation. The cost of screening was low in relation to total costs.ConclusionThe specificity of the CRA checklist was the parameter with the highest impact on the cost-effectiveness. Further primary data collection is needed to build models with less uncertainty in the parameters

Microbiome for Mars: surveying microbiome connections to healthcare with implications for long-duration human spaceflight, virtual workshop, July 13, 2020

The inaugural “Microbiome for Mars” virtual workshop took place on July 13, 2020. This event assembled leaders in microbiome research and development to discuss their work and how it may relate to long-duration human space travel. The conference focused on surveying current microbiome research, future endeavors, and how this growing field could broadly impact human health and space exploration. This report summarizes each speaker’s presentation in the order presented at the workshop

Probabilistic microsimulation to examine the cost-effectiveness of hospital admission screening strategies for carbapenemase-producing enterobacteriaceae (CPE) in the United Kingdom

BackgroundAntimicrobial resistance has been recognised as a global threat with carbapenemase- producing-Enterobacteriaceae (CPE) as a prime example. CPE has similarities to COVID-19 where asymptomatic patients may be colonised representing a source for onward transmission. There are limited treatment options for CPE infection leading to poor outcomes and increased costs. Admission screening can prevent cross-transmission by pre-emptively isolating colonised patients.ObjectiveWe assess the relative cost-effectiveness of screening programmes compared with no- screening.MethodsA microsimulation parameterised with NHS Scotland date was used to model scenarios of the prevalence of CPE colonised patients on admission. Screening strategies were (a) two-step screening involving a clinical risk assessment (CRA) checklist followed by microbiological testing of high-risk patients; and (b) universal screening. Strategies were considered with either culture or polymerase chain reaction (PCR) tests. All costs were reported in 2019 UK pounds with a healthcare system perspective.ResultsIn the low prevalence scenario, no screening had the highest probability of cost-effectiveness. Among screening strategies, the two CRA screening options were the most likely to be cost-effective. Screening was more likely to be cost-effective than no screening in the prevalence of 1 CPE colonised in 500 admitted patients or more. There was substantial uncertainty with the probabilities rarely exceeding 40% and similar results between strategies. Screening reduced non-isolated bed-days and CPE colonisation. The cost of screening was low in relation to total costs.ConclusionThe specificity of the CRA checklist was the parameter with the highest impact on the cost-effectiveness. Further primary data collection is needed to build models with less uncertainty in the parameters

Three Warm Jupiters around Solar-analog Stars Detected with TESS*

We report the discovery and characterization of three giant exoplanets orbiting solar-analog stars, detected by the TESS space mission and confirmed through ground-based photometry and radial velocity measurements taken at La Silla observatory with FEROS. TOI-2373 b is a warm Jupiter orbiting its host star every ∼13.3 days, and is one of the most massive known exoplanet with a precisely determined mass and radius around a star similar to the Sun, with an estimated mass of m _p = ${9.3}_{-0.2}^{+0.2}\,{M}_{\mathrm{jup}}$ and a radius of r _p = ${0.93}_{-0.2}^{+0.2}\,{R}_{\mathrm{jup}}$ . With a mean density of $\rho ={14.4}_{-1.0}^{+0.9}\,{\rm{g}}\,{\mathrm{cm}}^{-3}$ , TOI-2373 b is among the densest planets discovered so far. TOI-2416 b orbits its host star on a moderately eccentric orbit with a period of ∼8.3 days and an eccentricity of e = ${0.32}_{-0.02}^{+0.02}$ . TOI-2416 b is more massive than Jupiter with m _p = ${3.0}_{-0.09}^{+0.10}\,{M}_{\mathrm{jup}}$ , however is significantly smaller with a radius of r _p = ${0.88}_{-0.02}^{+0.02},{R}_{\mathrm{jup}}$ , leading to a high mean density of $\rho ={5.4}_{-0.3}^{+0.3}\,{\rm{g}}\,{\mathrm{cm}}^{-3}$ . TOI-2524 b is a warm Jupiter near the hot Jupiter transition region, orbiting its star every ∼7.2 days on a circular orbit. It is less massive than Jupiter with a mass of m _p = ${0.64}_{-0.04}^{+0.04}\,{M}_{\mathrm{jup}}$ , and is consistent with an inflated radius of r _p = ${1.00}_{-0.03}^{+0.02}\,{R}_{\mathrm{jup}}$ , leading to a low mean density of $\rho ={0.79}_{-0.08}^{+0.08}\,{\rm{g}}\,{\mathrm{cm}}^{-3}$ . The newly discovered exoplanets TOI-2373 b, TOI-2416 b, and TOI-2524 b have estimated equilibrium temperatures of ${860}_{-10}^{+10}$ K, ${1080}_{-10}^{+10}$ K, and ${1100}_{-20}^{+20}$ K, respectively, placing them in the sparsely populated transition zone between hot and warm Jupiters

Local Recurrence Risk Score to Predict Relapse after Stereotactic Body Radiation Therapy for Lung Tumors

International audienceBackground: After stereotactic body radiation therapy (SBRT) for lung tumors, follow-up CT scans remain a pitfall. The early detection of local relapse is essential to propose a new treatment. We aim to create a local recurrence predictive score using pre- and post-therapeutic imaging criteria and test it on a validation cohort.Methods: Between February 2011 and July 2016, lung tumors treated by SBRT with available pretreatment fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) and follow-up CT scans were retrospectively analyzed. The risk factors associated with relapse were identified by univariate logistic regression on a train cohort. The score was created using these factors, merging clinical and imaging criteria associated with local relapse, and then tested on an independent validation cohort. Overall and local relapse-free survival at 1 and 3 years were recorded.Results: Twenty-eight patients were included in the train cohort and ten in the derivation cohort (male 74%, median age 70 ± 12 years). Five variables significantly associated with local recurrence (female gender; sequential enlargement; craniocaudal growing; bulging margins; standardized uptake value (SUVmax > 5.5)) were combined to create the score on five points. With the threshold >2.5/5, the sensitivity and specificity of the score on the validation cohort were 100% and 88%, respectively. Overall survival and local relapse-free survival at 1 and 3 years were 89% and 42%, and 89% and 63%, respectively.Conclusion: The local recurrence risk score created has high sensitivity (100%) and specificity (88%), upon independent validation cohort, to detect local relapse. This score is easy to use in daily clinical practice

The pro-apoptotic properties of a phytonutrient rich infusion of A. cherimola leaf extract on AML cells

Annonaceae family has broad uses in herbal medicine for treatment of several diseases, whether through seeds’ or leaves’ extracts. The present study investigates the antiproliferative and antitumor activity of Annona cherimola aqueous leaf (AAL) extract/infusion in acute myeloid leukemia (AML) cell lines in vitro. High-resolution LC-MS was first used to analyze the composition of the aqueous extract. Cell proliferation assay, Annexin V staining, cell cycle analysis, dual Annexin V/PI staining, cell death quantification by ELISA, ROS level detection and Western Blotting were then performed to elucidate the therapeutic effects of AAL extract. The results obtained revealed a potent antioxidant activity of AAL extract. Moreover, the extract exhibited dose- and time-dependent antiproliferative effects on AML cell lines by decreasing cell viability with an IC50 of 5.03% (v/v) at 24 h of treatment of KG-1 cells. This decrease in viability was accompanied with a significant increase in apoptotic cell death with cell cycle arrest and flipping of the phosphatidylserine from the inner to the outer leaflet of the cell membrane. The respective overexpression and downregulation of proapoptotic proteins like cleaved caspase-8, cleaved PARP-1 and Bax and antiapoptotic proteins like Bcl-2 further validated the apoptotic pathway induced by AAL on AML cells. Finally, LC-MS revealed the presence of several compounds like fatty acids, terpenes, phenolics, cinnamic acids and flavonoids that could contribute to the antioxidant and anti-cancer effects of this herbal infusion. In addition to the generally known nutritional effects of the Annona cherimola fruit and leaves, the presented data validates the antioxidant and anti-cancerous effects of the leaf infusion on AML cell lines, proposing its potential therapeutic use against acute myeloid leukemia with future in vivo and clinical trials