Antibiotic resistance among major pathogens compared to hospital treatment guidelines and antibiotic use in Nordic hospitals 2010-2018

Background The Nordic countries have comparable nationwide antibiotic resistance surveillance systems and individual antibiotic stewardship programmes. The aim of this study was to assess antibiotic resistance among major pathogens in relation to practice guidelines for hospital antibiotic treatment and antibiotic use in Nordic countries 2010-2018. Methods Antibiotic resistance among invasive isolates from 2010-2018 and aggregated antibiotic use were obtained from the European Centre for Disease Prevention and Control. Hospital practice guidelines were obtained from national or regional guidelines. Results Antibiotic resistance levels among Escherichia coli and Klebsiella pneumoniae were similar in all Nordic countries in 2018 and low compared to the European mean. Guidelines for acute pyelonephritis varied; 2nd generation cephalosporin (Finland), 3rd generation cephalosporins (Sweden, Norway), ampicillin with an aminoglycoside or aminoglycoside monotherapy (Denmark, Iceland and Norway). Corresponding guidelines for sepsis of unknown origin were 2nd (Finland) or 3rd (Sweden, Norway, Iceland) generation cephalosporins, carbapenems, (Sweden) combinations of penicillin with an aminoglycoside (Norway, Denmark), or piperacillin-tazobactam (all Nordic countries). Methicillin-resistant Staphylococcus aureus rates were 0-2% and empirical treatment with anti-MRSA antibiotics was not recommended in any country. Rates of penicillin non-susceptibility among Streptococcus pneumoniae were low (Peer reviewe

Transport Jc in Bulk Superconductors: A Practical Approach?

The characterisation of the critical current density of bulk high temperature superconductors is typically performed using magnetometry, which involves numerous assumptions including, significantly, that Jc within the sample is uniform. Unfortunately, magnetometry is particularly challenging to apply where a local measurement of Jc across a feature, such as a grain boundary, is desired. Although transport measurements appear to be an attractive alternative to magnetization, it is extremely challenging to reduce the cross-sectional area of a bulk sample sufficiently to achieve a sufficiently low critical current that can be generated by a practical current source. In the work described here, we present a technique that enables transport measurements to be performed on sections of bulk superconductors. Metallographic techniques and resin reinforcement were used to create an I-shaped sample of bulk superconductor from a section of Gd-Ba-Cu-O containing 15 wt % Ag2O. The resulting superconducting track had a cross-sectional area of 0.44 mm2. The sample was found to support a critical current of 110 A using a field criterion in the narrowed track region of 1 μV cm-1. We conclude, therefore, that it is possible to measure critical current densities in excess of 2.5 x 108 A m-2 in sections of a bulk superconductor.This work was supported by the Engineering and Physical Sciences Research Council, via a Doctoral Training Award (grant number is EP/L504920/1) and funding from grant number EP/K02910X/1. This work was also supported by the Boeing Company. All data are provided in full in the results section of this paper.This is the author accepted manuscript. The final version is available from IEEE via http://dx.doi.org/10.1109/TASC.2016.253764

Лексические средства связности в речи телеведущего в жанре интерактивной белорусскоязычной телебеседы

Материалы XII Междунар. науч. конф. студентов, магистрантов, аспирантов и молодых ученых, Гомель, 16–17 мая 2019 г

Socioeconomic inequalities in the kidney transplantation process : A registry-based study in Sweden

Background. Few studies have examined the association between individual-level socioeconomic status and access to kidney transplantation. This study aims to investigate the association between predialysis income and education, and access to (i) the kidney waitlist (first listing), and (ii) kidney transplantation conditional on waitlist placement. Adjustment will be made for a number of medical and nonmedical factors. Methods. The Swedish Renal Register was linked to national registers for adult patients in Sweden who started dialysis during 1995 to 2013. We employed Cox proportional hazards models. Results. Nineteen per cent of patients were placed on the waitlist. Once on the waitlist, 80% received kidney transplantation. After adjusting for covariates,patients in the highest income quintile were found to have higher access to both the waitlist (hazard ratio [HR], 1.73; 95% confidence interval [CI], 1.53-1.96) and kidney transplantation (HR, 1.33; 95% CI, 1.16-1.53) compared with patients in the lowest incomequintile. Patients with higher education also had better access to the waitlist and kidney transplantation (HR, 2.16; 95% CI, 1.94-2.40; and HR, 1.16; 95% CI, 1.03-1.30, respectively) compared with patients with mandatory education. Conclusions. Socioeconomic status-related inequalities exist with regard to both access to the waitlist, and kidney transplantation conditional on listing. However, the former inequality is substantially larger and is therefore expected to contribute more to societal inequalities. Further studies are needed to explore the potential mechanisms and strategies to reduce these inequalities

Quantifying the treatment effect of kidney transplantation relative to dialysis on survival time : New results based on propensity score weighting and longitudinal observational data from Sweden

Using observational data to assess the treatment effects on outcomes of kidney transplantation relative to dialysis for patients on renal replacement therapy is challenging due to the non-random selection into treatment. This study applied the propensity score weighting approach in order to address the treatment selection bias of kidney transplantation on survival time compared with dialysis for patients on the waitlist. We included 2676 adult waitlisted patients who started renal replacement therapy in Sweden between 1 January 1995, and 31 December 2012. Weibull and logistic regression models were used for the outcome and treatment models, respectively. The potential outcome mean and the average treatment effect were estimated using an inverse-probability-weighted regression adjustment approach. The estimated survival times from start of renal replacement therapy were 23.1 years (95% confidence interval (CI): 21.2−25.0) and 9.3 years (95% CI: 7.8−10.8) for kidney transplantation and dialysis, respectively. The survival advantage of kidney transplantation compared with dialysis was estimated to 13.8 years (95% CI: 11.4−16.2). There was no significant difference in the survival advantage of transplantation between men and women. Controlling for possible immortality bias reduced the survival advantage to 9.1–9.9 years. Our results suggest that kidney transplantation substantially increases survival time compared with dialysis in Sweden and that this consequence of treatment is equally distributed over sex

Healthcare costs after kidney transplantation compared to dialysis based on propensity score methods and real world longitudinal register data from Sweden

Abstract This study aimed to estimate the healthcare costs of kidney transplantation compared with dialysis using a propensity score approach to handle potential treatment selection bias. We included 693 adult wait-listed patients who started renal replacement therapy between 1998 and 2012 in Region Skåne and Stockholm County Council in Sweden. Healthcare costs were measured as annual and monthly healthcare expenditures. In order to match the data structure of the kidney transplantation group, a hypothetical kidney transplant date of persons with dialysis were generated for each dialysis patient using the one-to-one nearest-neighbour propensity score matching method. Applying propensity score matching and inverse probability-weighted regression adjustment models, the potential outcome means and average treatment effect were estimated. The estimated healthcare costs in the first year after kidney transplantation were €57,278 (95% confidence interval (CI) €54,467–60,088) and €47,775 (95% CI €44,313–51,238) for kidney transplantation and dialysis, respectively. Thus, kidney transplantation leads to higher healthcare costs in the first year by €9,502 (p = 0.066) compared to dialysis. In the following two years, kidney transplantation is cost saving [€36,342 (p < 0.001) and €44,882 (p < 0.001)]. For patients with end-stage renal disease, kidney transplantation reduces healthcare costs compared with dialysis over three years after kidney transplantation, even though the healthcare costs are somewhat higher in the first year. Relating the results of existing estimates of costs and health benefits of kidney transplantation shows that kidney transplantation is clearly cost-effective compared to dialysis in Sweden

Intake of Dairy Products as a Risk Factor for Rheumatoid Arthritis; A Nested Case-Control Study

Background/Purpose: There has been increasing interest in diet as a factor that may contribute to the development of rheumatoid arthritis (RA). There is limited and somewhat contradictory information on the impact of dairy products in this context. The purpose of this study was to investigate the relation between intake of various dairy products and the risk of RA in a nested case-control study.Methods: Participants in a population-based survey conducted in 1991-1996 who were subsequently diagnosed with RA (from inclusion until December 2016) were identified through register linkage and validated in a structured review of case records. Four controls for each validated case, matched for sex, year of birth, and year of inclusion, were selected from the study cohort. The controls were alive and free of RA when the index person was diagnosed with RA. At inclusion in the survey, diet was assessed using a modified diet history method, consisting of a seven-day food record, a food questionnaire, and a structured interview. Reported intakes of dairy products were divided into groups based on quartiles, with the lowest quartile set as the reference in all analyses. Based on conditional logistical regression, including adjustments for total energy intake and for potential confounders that have been associated with diet and RA (i.e. current smoking, physical activity and alcohol intake), odds ratios (ORs) for RA were estimated, with 95% confidence intervals (CI). Potential misreporters of total energy intake were excluded. Assessed types of dairy products included regular (non-fermented) milk, fermented milk, cream, cheese, and butter.Results: There were 305 incident cases of RA (76 % females, 67 % anti-citrullinated protein antibody and/or rheumatoid factor positive, mean age 68.9 years at onset and mean duration of 12 years from screening to RA diagnosis). The group with highest intake of regular milk ( >398 g/day) had a significantly increased risk of RA (multi-adjusted OR 1.86; 95% CI 1.08-3.22). High intake of cheese with >11% fat ( >56 g/day) was inversely associated with risk of RA (adjusted OR 0.53; 95% CI 0.31-0.92) and a trend of lower risk across quartiles of cheese intake was observed. Intake of cream, fermented milk or butter did not have a significant impact on the risk of developing RA. Associations for intakes of cheese and regular milk with the risk of RA remained significant in multivariable analysis, including both exposures (Table 1).Conclusion: High intake of regular milk appears to increase the risk of RA, whereas high intake of cheese may reduce the risk. Potential explanations for these patterns include differential effects of dairy product depending on the extent of processing and fermentation, that may affect the gut microbiota and modulate the risk of developing RA

Socioeconomic Inequalities in the Kidney Transplantation Process: A Registry-Based Study in Sweden

Background. Few studies have examined the association between individual-level socioeconomic status and access to kidney transplantation. This study aims to investigate the association between predialysis income and education, and access to (i) the kidney waitlist (first listing), and (ii) kidney transplantation conditional on waitlist placement. Adjustment will be made for a number of medical and nonmedical factors. Methods. The Swedish Renal Register was linked to national registers for adult patients in Sweden who started dialysis during 1995 to 2013. We employed Cox proportional hazards models. Results. Nineteen per cent of patients were placed on the waitlist. Once on the waitlist, 80% received kidney transplantation. After adjusting for covariates, patients in the highest income quintile were found to have higher access to both the waitlist (hazard ratio [HR], 1.73; 95% confidence interval [CI], 1.53-1.96) and kidney transplantation (HR, 1.33; 95% CI, 1.16-1.53) compared with patients in the lowest income quintile. Patients with higher education also had better access to the waitlist and kidney transplantation (HR, 2.16; 95% CI, 1.94-2.40; and HR, 1.16; 95% CI, 1.03-1.30, respectively) compared with patients with mandatory education. Conclusions. Socioeconomic status-related inequalities exist with regard to both access to the waitlist, and kidney transplantation conditional on listing. However, the former inequality is substantially larger and is therefore expected to contribute more to societal inequalities. Further studies are needed to explore the potential mechanisms and strategies to reduce these inequalities