Epidemiology, Microbiology, and Clinical Outcomes Among Patients With Intravenous Drug Use-Associated Infective Endocarditis in New Brunswick

Background: Within the context of Canada’s opioid crisis, medical complications associated with intravenous drug use (IVDU) are increasing. Infective endocarditis (IE) is a serious complication of IVDU, and understanding the characteristics of these patients could aid health systems, clinicians, and patients in the optimization of treatment and prevention of IVDU-IE. / Methods: At a tertiary care hospital in southern New Brunswick, we conducted a retrospective chart review to identify patients with IVDU-IE admitted between January 1, 2013, and December 31, 2017. We collected data related to the epidemiology, microbiology, clinical manifestations, echocardiography, complications during hospital admission, and outcomes. / Results: Forty-two cases of IVDU-IE met inclusion criteria. The rate of IVDU-IE increased from 2.28 per 100,000 population in 2014 to 4.00 in 2017, which, although not statistically significant, reflects patterns in other jurisdictions. Most patients (72.4%) were male, and the mean age was 38.3 (±11.5) years. Most patients (79.3%) injected opioids. The most common clinical sign was fever (90.5%), and Staphylococcus aureus (61.9%) was the most common microorganism. The tricuspid valve was most commonly infected (58.5%), 50% of cases had heart failure as a complication during admission, and 45.2% of cases required valve replacement or repair. The 2-year survival rate after admission for initial IVDU-IE episode was 62.0% (95% confidence interval: 36.5-79.7). / Conclusion: IVDU-IE is common in New Brunswick and may be increasing. Despite the relatively young age of this patient population, IVDU-IE is associated with significant morbidity and mortality. Expanding effective harm reduction and addiction treatment strategies for this cohort is recommended. // Contexte: Dans le contexte de la crise des opioïdes au Canada, les complications médicales liées à l'utilisation de drogues par voie intraveineuse (UDIV) sont en augmentation. L'endocardite infectieuse (EI) est une complication grave de l'UDIV, et la compréhension des caractéristiques de ces patients pourrait aider les systèmes de santé, les cliniciens et les patients à optimiser le traitement et la prévention de l’EI liée à l’UDIV (EI-UDIV). / Méthodes: Dans un hôpital de soins tertiaires du sud du Nouveau-Brunswick, nous avons effectué un examen rétrospectif des dossiers afin d'identifier les patients atteints de l’EI-UDIV admis entre le 1er janvier 2013 et le 31 décembre 2017. Nous avons recueilli des données relatives à l'épidémiologie, la microbiologie, les manifestations cliniques, l'échocardiographie, les complications lors de l'admission à l'hôpital et les bilans. / Résultats: Quarante-deux cas d'EI-UDIV ont répondu aux critères d'inclusion. Le taux d'EI-UDIV est passé de 2,28 pour 100 000 habitants en 2014 à 4,00 en 2017, ce qui, bien que non significatif statistiquement, reflète les tendances observées dans d'autres juridictions. La plupart des patients (72,4 %) étaient des hommes, et l'âge moyen était de 38,3 ans (±11,5). La plupart des patients (79,3 %) s'injectaient des opioïdes. Le signe clinique le plus fréquent était la fièvre (90,5 %), et le Staphylococcus aureus (61,9 %) était le micro-organisme le plus couramment observé. La valve tricuspide était le plus souvent infectée (58,5 %), 50 % des cas avaient une insuffisance cardiaque en tant que complication lors de l'admission, et 45,2 % des cas ont nécessité un remplacement ou une réparation de la valve. Le taux de survie à deux ans après l'admission pour l'épisode initial d'EI-UDIV était de 62,0 % (intervalle de confiance à 95 % : 36,5-79,7). / Conclusion: L'EI-UDIV est fréquent au Nouveau-Brunswick et pourrait être en augmentation. Malgré l'âge relativement jeune de cette population de patients, l'UDIV-IE est associée à une morbidité et une mortalité importantes. Il est recommandé d'étendre les stratégies efficaces de réduction des risques et de traitement des dépendances pour cette cohorte

Opioid agonist treatment and risk of death or rehospitalization following injection drug use–associated bacterial and fungal infections: A cohort study in New South Wales, Australia

Background AU Injecting-related: Pleaseconfirmthatallheadinglevelsarerepresentedcorrectly bacterial and fungal infections are associated : with significant morbidity and mortality among people who inject drugs (PWID), and they are increasing in incidence. Following hospitalization with an injecting-related infection, use of opioid agonist treatment (OAT; methadone or buprenorphine) may be associated with reduced risk of death or rehospitalization with an injecting-related infection. Methods and findings Data came from the Opioid Agonist Treatment Safety (OATS) study, an administrative linkage cohort including all people in New South Wales, Australia, who accessed OAT between July 1, 2001 and June 28, 2018. Included participants survived a hospitalization with injecting-related infections (i.e., skin and soft-tissue infection, sepsis/bacteremia, endocarditis, osteomyelitis, septic arthritis, or epidural/brain abscess). Outcomes were all-cause death and rehospitalization for injecting-related infections. OAT exposure was classified as time varying by days on or off treatment, following hospital discharge. We used separate Cox proportional hazards models to assess associations between each outcome and OAT exposure. The study included 8,943 participants (mean age 39 years, standard deviation [SD] 11 years; 34% women). The most common infections during participants’ index hospitalizations were skin and soft tissue (7,021; 79%), sepsis/bacteremia (1,207; 14%), and endocarditis (431; 5%). During median 6.56 years follow-up, 1,481 (17%) participants died; use of OAT was associated with lower hazard of death (adjusted hazard ratio [aHR] 0.63, 95% confidence interval [CI] 0.57 to 0.70). During median 3.41 years follow-up, 3,653 (41%) were rehospitalized for injecting-related infections; use of OAT was associated with lower hazard of these rehospitalizations (aHR 0.89, 95% CI 0.84 to 0.96). Study limitations include the use of routinely collected administrative data, which lacks information on other risk factors for injecting-related infections including injecting practices, injection stimulant use, housing status, and access to harm reduction services (e.g., needle exchange and supervised injecting sites); we also lacked information on OAT medication dosages. Conclusions Following hospitalizations with injection drug use–associated bacterial and fungal infections, use of OAT is associated with lower risks of death and recurrent injecting-related infections among people with opioid use disorder

Introgressive Hybridization of Schistosoma haematobium Group Species in Senegal: Species Barrier Break Down between Ruminant and Human Schistosomes

The file attached is the Published/publisher’s pdf version of the article.Copyright: © 2013 Webster et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Seeking creativity: A case study on information problem solving in professional music

This study explored the information seeking behavior of a professional jazz musician during creative work. It aimed at revealing information seeking activities necessary to execute present-day musical projects. A single case was studied in depth. First, a narrative interview was conducted to reveal project phases and corresponding information seeking behavior. Second, hereupon a semi-structured interview was taken to identify information seeking activities per phase. Results indicate that the musician deliberately searched for musical information especially in the first project phases. The internet was used as main source. Both data and goal driven strategies were applied, of which the latter were relatively scarce. This means that in this case the musician sporadically searched information based on a contemplated search plan. Future research should aim at generalizing findings of this case. It should further validate the underlying analytical framework that proved to be useful for describing and categorizing musical information seeking behavior

Pre-cooling for endurance exercise performance in the heat: a systematic review.

PMCID: PMC3568721The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1741-7015/10/166. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Endurance exercise capacity diminishes under hot environmental conditions. Time to exhaustion can be increased by lowering body temperature prior to exercise (pre-cooling). This systematic literature review synthesizes the current findings of the effects of pre-cooling on endurance exercise performance, providing guidance for clinical practice and further research

I Rest My Case! The Possibilities and Limitations of Blockchain-Based IP Protection

We have identified, mapped and discussed existing research on Blockchain-based solutions for intellectual property (IP) protection, an investigation that emerged from a case in antibody production for scientific and medical applications. To that end, we have performed a systematic literature review and created an instrument that classifies the contributions according to the materiality of the object they protect (from immaterial to physical), the type of protection (authorship notarization or prevention of illegal use) and the type of research (conceptual or empirical). Our results can be used to understand which avenues to pursue in the effort to create a new generation of more effective technology-assisted IP protection systems, a priority for 152 signatory countries of the patent cooperation treaty

Intraspecific Combinations of Flower and Leaf Volatiles Act Together in Attracting Hawkmoth Pollinators

Insects pinpoint mates, food and oviposition sites by olfactory cues. Recognizing and localizing a suitable target by olfaction is demanding. Odor sources emit characteristic blends of compounds that have to be identified against an environmentally derived olfactory background. This background, however, does not necessarily disturb the localization of a source. Rather, the contrary. Sex pheromones become more attractive to male moths when being presented against a relevant plant background. Here we asked whether such olfactory coaction also characterizes foraging cues. The tobacco hornworm Manduca sexta feeds on nectar from wild tobacco Nicotiana attenuata and sacred datura Datura wrightii flowers. We tested how leaf-derived volatile blends as a background affect the moths' approach to flower blends. We found coaction when a flower blend was presented against a conspecific leaf volatile background but not when the blend was presented against volatiles emitted by the other host plant or by a non-host plant. Hence, our results reveal a species-specific coaction between flower blend and leaf volatile background. The ability to integrate information from different odor sources on one plant might provide the moth with a fine-grained analysis of food site quality