Polypharmacy and emergency readmission to hospital after critical illness:a population-level cohort study

From PubMed via Jisc Publications RouterPolypharmacy is common and closely linked to drug interactions. The impact of polypharmacy has not been previously quantified in survivors of critical illness who have reduced resilience to stressors. Our aim was to identify factors associated with preadmission polypharmacy and ascertain whether polypharmacy is an independent risk factor for emergency readmission to hospital after discharge from a critical illness. A population-wide cohort study consisting of patients admitted to all Scottish general ICUs between January 1, 2011 and December 31, 2013, whom survived their ICU stay. Patients were stratified by presence of preadmission polypharmacy, defined as being prescribed five or more regular medications. The primary outcome was emergency hospital readmission within 1 yr of discharge from index hospital stay. Of 23 844 ICU patients, 29.9% were identified with polypharmacy (n=7138). Factors associated with polypharmacy included female sex, increasing age, and social deprivation. Emergency 1-yr hospital readmission was significantly higher in the polypharmacy cohort (51.8% vs 35.8%, P<0.001). After confounder adjustment, patients with polypharmacy had a 22% higher hazard of emergency 1-yr readmission (adjusted hazard ratio 1.22, 95% confidence interval 1.16-1.28, P<0.001). On a linear scale of polypharmacy each additional prescription conferred a 3% increase in hazard of emergency readmission by 1 yr (adjusted hazard ratio 1.03, 95% confidence interval 1.02-1.03, P<0.001). This national cohort study of ICU survivors demonstrates that preadmission polypharmacy is an independent risk factor for emergency readmission. In an ever-growing era of polypharmacy, this risk factor may represent a substantial burden in the at-risk post-intensive care population.126pubpub

Identification of protein carbonyls in serum of the fetal and neonatal pig

Oxidation of serum proteins leads to non-reversible carbonyl formation which alters their function and is associated with stress-related disease processes. The primary objective of this study was to quantify and identify oxidized serum proteins in fetal and newborn piglets. Protein carbonyls were converted to hydrazones with dinitrophenyl hydrazine and quantified spectrophotometrically. For identification, serum protein carbonyls were derivatized with biotin hydrazide, separated by 2D PAGE and stained with FITCavidin. Biotin-labeled proteins were excised from gels and identified by mass spectrometry. At birth, carbonyls were determined to be ∼600 pmole/mg serum protein. Fetuses at 50 and 100 days of gestation had similar levels of protein carbonyls as newborns. Carbonyl levels were also similar for control and runt (birth) piglets between 1 and 21 days of age; however, distribution of many proteins varied by age and was also influenced by birth weight. Major oxidized proteins identified in fetal (f) and newborn (n) pigs included; albumin (f, n), transferrin (f, n), fetuin-A (f, n) alpha fetoprotein (f, n), plasminogen (f, n), fetuin-B (f), alpha-1-antitrypsin (f, n) alpha-1-acid glycoprotein (f) and immunoglobulins (n). While abundance and distribution of oxidized proteins changed over time, these changes appear to primarily reflect relative amounts of those proteins in serum

Identifying a new intermediate polar using \u3cem\u3eXMM-Newton\u3c/em\u3e and \u3cem\u3eINTEGRAL\u3c/em\u3e

The bright X-ray source 2XMMi J180438.7-145647 is fortunate to have long baseline observations in INTEGRAL that complement observations taken by other missions. Optical spectroscopy of this object has suggested a distance of ˜7 kpc and an identification with a low-mass X-ray binary. We instead use the X-ray data from 0.3 to 40 keV to identify the source as a bright intermediate polar (IP) with an estimate for the white dwarf mass of ˜0.60 M⊙. This identification is supported by the presence of an iron triplet, the component lines of which are some of the strongest seen in IPs, and the signature of the spin period of the white dwarf at ˜24 min. We note that the lack of broad-band variability may suggest that this object is a stream-fed IP, similar in many respects to the well-studied IP, V2400 Oph. Phase binning has allowed us to create spectra corresponding to the peaks and troughs of the light curve from which we determine that the spectra appear harder in the troughs, consistent with the behaviour of other IPs binned on their spin periods. This work strongly suggests a misidentification in the optical due to the presence of large columns of enshrouding material. We instead propose a distance to the source of \u3c2.5 kpc to be consistent with the luminosities of other IPs in the dim, hard state. The considerable flux of the source together with the strength of the iron lines may, in future, allow the source to be used to diagnose the properties of the shock-heated plasma and the reflected component of the emission

Methicillin-resistant Staphylococcus aureus acquisition in healthcare workers with cystic fibrosis: a retrospective cross-sectional study.

Background People with cystic fibrosis (CF) may work in healthcare settings risking nosocomial pathogen acquisition. The aim of this study was to determine the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection in adult healthcare workers with CF (HCWcf). Methods Data was collected in this observational study on MRSA acquisition from 405 CF patients attending an adult CF centre in Australia between 2001–2012. Demographic and clinical characteristics were compared between HCWcf and non-HCWcf. A sub-analysis was subsequently performed to compare demographic and clinical characteristics between those patients (HCWcf versus non-HCWcf) that acquired MRSA. We also investigated rates of chronic MRSA infection and the outcome of eradication treatment in HCWcf. Results A higher proportion of HCWcf acquired MRSA [n = 10/21] compared to non-HCWcf [n = 40/255] (P &lt;0.001). The odds of MRSA acquisition were 8.4 (95 % CI, 3.0 – 23.4) times greater in HCWcf than non-HCWcf. HCWcf with MRSA were older (P = 0.02) and had better lung function (P = 0.009), yet hospitalisation rates were similar compared to non-HCWcf with MRSA. Chronic MRSA infection developed in 36/50 CF patients (HCWcf, n = 6; non-HCWcf, n = 30), with eradication therapy achieved in 5/6 (83 %) HCWcf. Conclusions The rate of MRSA incidence was highest in HCWcf and the workplace is a possible source of acquisition. Vocational guidance should include the potential for MRSA acquisition for CF patients considering healthcare professions

Drug-Resistant Tuberculosis--Current Dilemmas, Unanswered Questions, Challenges and Priority Needs

Tuberculosis was declared a global emergency by the World Health Organization (WHO) in 1993. Following the declaration and the promotion in 1995 of directly observed treatment short course (DOTS), a cost-effective strategy to contain the tuberculosis epidemic, nearly 7 million lives have been saved compared with the pre-DOTS era, high cure rates have been achieved in most countries worldwide, and the global incidence of tuberculosis has been in a slow decline since the early 2000s. However, the emergence and spread of multidrug-resistant (MDR) tuberculosis, extensively drug-resistant (XDR) tuberculosis, and more recently, totally drug-resistant tuberculosis pose a threat to global tuberculosis control. Multidrug-resistant tuberculosis is a man-made problem. Laboratory facilities for drug susceptibility testing are inadequate in most tuberculosis-endemic countries, especially in Africa; thus diagnosis is missed, routine surveillance is not implemented, and the actual numbers of global drug-resistant tuberculosis cases have yet to be estimated. This exposes an ominous situation and reveals an urgent need for commitment by national programs to health system improvement because the response to MDR tuberculosis requires strong health services in general. Multidrug-resistant tuberculosis and XDR tuberculosis greatly complicate patient management within resource-poor national tuberculosis programs, reducing treatment efficacy and increasing the cost of treatment to the extent that it could bankrupt healthcare financing in tuberculosis-endemic areas. Why, despite nearly 20 years of WHO-promoted activity and >12 years of MDR tuberculosis–specific activity, has the country response to the drug-resistant tuberculosis epidemic been so ineffectual? The current dilemmas, unanswered questions, operational issues, challenges, and priority needs for global drug resistance screening and surveillance, improved treatment regimens, and management of outcomes and prevention of DR tuberculosis are discussed

Ultraviolet Emission Line Ratios of Cataclysmic Variables

We present a statistical analysis of the ultraviolet emission lines of cataclysmic variables (CVs) based on $\approx 430$ ultraviolet spectra of 20 sources extracted from the International Ultraviolet Explorer Uniform Low Dispersion Archive. These spectra are used to measure the emission line fluxes of N V, Si IV, C IV, and He II and to construct diagnostic flux ratio diagrams. We investigate the flux ratio parameter space populated by individual CVs and by various CV subclasses (e.g., AM Her stars, DQ Her stars, dwarf novae, nova-like variables). For most systems, these ratios are clustered within a range of $\sim 1$ decade for log Si IV/C IV $\approx -0.5$ and log He II/C IV $\approx -1.0$ and $\sim 1.5$ decades for log N V/C IV $\approx -0.25$. These ratios are compared to photoionization and collisional ionization models to constrain the excitation mechanism and the physical conditions of the line-emitting gas. We find that the collisional models do the poorest job of reproducing the data. The photoionization models reproduce the Si IV/C IV line ratios for some shapes of the ionizing spectrum, but the predicted N V/C IV line ratios are simultaneously too low by typically $\sim 0.5$ decades. Worse, for no parameters are any of the models able to reproduce the observed He II/C IV line ratios; this ratio is far too small in the collisional and scattering models and too large by typically $\sim 0.5$ decades in the photoionization models.Comment: LaTeX format, uses aaspp4.sty, 28 pages, 11 Postscript figures, accepted for publication in The Astrophysical Journal 10/16/9

On the Role of Intrinsic Value in Terms of Environmental Education

AbstractAn understanding of instrumentally valuable nature resulted from anthropocentrism is incapable of producing long-term, real solutions to deal with environmental problems. It is obvious that these problems cannot be handled staying within the current understanding of nature-human relationship and without broaden the extent of ethics in a way to involve non-human entities. Human beings are prone to protect what they consider as intrinsically valuable. Further, they have a tendency to value the things around them and it can be improved. Thus, a big part of this can be succeeded through environmental education. Therefore, in this paper, I discuss the role of intrinsic value in terms of environmental education to handle the environmental problems, and investigate a new account of subjective intrinsic value about nature