Effects of reacceleration and source grammage on secondary cosmic rays spectra

The ratio between secondary and primary cosmic ray particles is the main source of information about cosmic ray propagation in the Galaxy. Primary cosmic rays are thought to be accelerated mainly in Supernova Remnant (SNR) shocks and then released in the interstellar medium (ISM). Here they produce secondary particles by occasional collisions with interstellar matter. As a result, the ratio between the fluxes of secondary and primary particles carries information about the amount of matter cosmic rays have encountered during their journey from their sources to Earth. Recent measurements by AMS-02 revealed an unexpected behaviour of two main secondary-to-primary ratios, the Boron-to-Carbon ratio and the anti-proton-to-proton ratio. In this work we discuss how such anomalies may reflect the action of two phenomena that are usually overlooked, namely the fact that some fraction of secondary particles can be produced within the acceleration region, and the non-negligible probability that secondary particles encounter an accelerator (and are reaccelerated) during propagation. Both effects must be taken into account in order to correctly extract information about CR transport from secondary-to-primary ratios

THE KEY ROLE OF THE CLINICAL PHARMACIST IN THE MANAGEMENT OF ANTICANCER THERAPIES: A PILOT STUDY IN THE TREATMENT OF PATIENTS WITH NON-SMALL CELL LUNG CANCER

Lung cancer accounts for a quarter of all mortality cases worldwide. To date, numerous efforts have been done to identify the best therapeutic approach, especially in the advanced stage of the disease, and to extend the overall survival of patients. Careful surveillance of patients during therapy is essential in order to identify undesirable effects and to evaluate possible adverse reactions in case of coadministration. This study aims to compare two types of anticancer therapy, immunotherapy and chemotherapy, administered to NSCLC patients in the Medical Oncology Unit of the ARNAS “Di Cristina Benfratelli” Civic Hospital in Palermo (Italy), and to highlight the key role of clinical pharmacist in the management of anticancer therapies, by analysing the side effects in the short-term postadministration and the adverse drug reactions, in particular drug-drug interactions, in case of comorbidities

The portal vein in patients with cirrhosis is not an excessively inflammatory or hypercoagulable vascular bed, a prospective cohort study

Background A hypercoagulable state is not associated with development of portal vein thrombosis in cirrhosis, as we previously demonstrated. However, some groups demonstrated elevated levels of inflammatory markers and activation of hemostasis in the portal vein (PV) compared to posthepatic veins, but because the liver is involved in clearance of these markers, we hypothesize that interpretation of these data is not straightforward. Aim To determine whether the PV has particular proinflammatory/hypercoagulable characteristics by comparing plasma sampled in the PV, hepatic vein (HV), and the systemic circulation. Methods Plasma samples from 51 cirrhotic patients with portal hypertension undergoing transjugular intrahepatic portosystemic shunt placement, were taken from the PV, HV, and jugular vein (JV). Markers of inflammation (lipopolysaccharide, tumor necrosis factor-alpha, interleukin-6, thiobarbituric acid-reactive substances), neutrophil-extracellular-traps (cfDNA, MPO-DNA), endothelial damage (von Willebrand factor [VWF]), and hemostasis were determined and compared among the three vascular beds. Results Markers of inflammation were slightly, but significantly higher in the PV than in the HV and systemic circulation. VWF and markers of hemostasis were modestly elevated in the PV. Levels of multiple markers were lower in the HV compared with the PV and systemic circulation. Higher model for end-stage liver disease score was associated with a more prothrombotic state in all three sample sites. Conclusion In contrast to published studies, we did not detect a clear proinflammatory or prothrombotic environment in the PV of cirrhotic patients. Many markers are lowest in the HV, indicating that the low levels of these markers in the HV, at least in part, reflect clearance of those markers in the liver

Protocol of a scoping review assessing injury rates and their determinants among healthcare workers in western countries

Introduction Healthcare workers (HCWs) are exposed to various risk factors and risky behaviours that may seriously affect their health and ability to work. The aim of this protocol is to detail the steps to follow in order to carry out a scoping review to assess the prevalence/incidence of injuries among HCWs. Methods and analysis The study will be carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocols guidelines. Studies will be selected according to the following criteria: P (HCWs), E (exposure to injuries), C (different types of exposure and different categories of HCWs) and O (prevalence/incidence and determinants of injuries). A time filter has been set (literature between 2000 and 2018) to enable updated, direct comparison between the findings and the epidemiological data available at national and local \u20acIstituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro' (National Institute for Insurance Against Accidents at Work) centres in Italy. No language restriction will be applied. Ethics and dissemination Formal ethical approval is not required; primary data will not be collected, as they have already been published. The results will be disseminated through peer-reviewed publication(s), conference presentation(s) and the press

Effects of the COVID-19 Pandemic on Incidence and Epidemiology of Catheter-Related Bacteremia, Spain

We compared hospital-acquired catheter-related bacte-remia (CRB) episodes diagnosed at acute care hospitals in Catalonia, Spain, during the COVID-19 pandemic in 2020 with those detected during 2007-2019. We com-pared the annual observed and predicted CRB rates by using the negative binomial regression model and calcu-lated stratified annual root mean squared errors. A total of 10,030 episodes were diagnosed during 2007-2020. During 2020, the observed CRB incidence rate was 0.29/103 patient-days, whereas the predicted CRB rate was 0.14/103 patient-days. The root mean squared er-ror was 0.153. Thus, a substantial increase in hospital-acquired CRB cases was observed during the COVID-19 pandemic in 2020 compared with the rate predicted from 2007-2019. The incidence rate was expected to increase by 1.07 (95% CI 1-1.15) for every 1,000 COVID-19-re-lated hospital admissions. We recommend maintaining all CRB prevention efforts regardless of the coexistence of other challenges, such as the COVID-19 pandemic

Randomized Clinical Trial of the Need for Antibiotic Treatment for Low-Risk Catheter-Related Bloodstream Infection Caused by Coagulase-Negative Staphylococci

According to clinical guidelines, the management of catheter-related bloodstream infections (CRBSI) due to coagulase-negative staphylococci (CoNS) includes catheter removal and antibiotic treatment for 5 to 7 days. However, in low-risk episodes, it remains uncertain whether antibiotic therapy is necessary. This randomized clinical trial aims to determine whether the non-administration of antibiotic therapy is as safe and effective as the recommended strategy in low-risk episodes of CRBSI caused by CoNS. With this purpose, a randomized, open-label, multicenter, non-inferiority clinical trial was conducted in 14 Spanish hospitals from 1 July 2019 to 31 January 2022. Patients with low-risk CRBSI caused by CoNS were randomized 1:1 after catheter withdrawal to receive/not receive parenteral antibiotics with activity against the isolated strain. The primary endpoint was the presence of any complication related to bacteremia or to antibiotic therapy within 90 days of follow-up. The secondary endpoints were persistent bacteremia, septic embolism, time until microbiological cure, and time until the disappearance of a fever. EudraCT: 2017-003612-39 INF-BACT-2017. A total of 741 patients were assessed for eligibility. Of these, 27 were included in the study; 15 (55.6%) were randomized to the intervention arm (non-antibiotic administration) and 12 (44.4%) to the control arm (antibiotic therapy as per standard practice). The primary endpoint occurred in one of the 15 patients in the intervention group (septic thrombophlebitis) and in no patients in the control group. The median time until microbiological cure was 3 days (IQR 1-3) in the intervention arm and 1.25 days (IQR 0.5-2.62) in the control arm, while the median time until fever resolution was zero days in both arms. The study was stopped due to the insufficient number of recruited patients. These results seem to indicate that low-risk CRBSI caused by CoNS can be managed without antibiotic therapy after catheter removal; efficacy and safety are not affected

Trends in the epidemiology of catheter-related bloodstream infections; towards a paradigm shift, Spain, 2007 to 2019

Altres ajuts: Departament de Salut. Generalitat de Catalunya ("Pla estratègic de recerca i innovació en salut (PERIS) 2019-2021"); Ministerio de Asuntos Económicos y Transformación Digital; Red Española de Investigación en Patología Infecciosa (REIPI).Background: Catheter-related bloodstream infections (CRBSI) are frequent healthcare-associated infections and an important cause of death. Aim: To analyse changes in CRBSI epidemiology observed by the Infection Control Catalan Programme (VINCat). Methods: A cohort study including all hospital-acquired CRBSI episodes diagnosed at 55 hospitals (2007-2019) in Catalonia, Spain, was prospectively conducted. CRBSI incidence rates were adjusted per 1,000patientdays. To assess the CRBSI rate trend per year, negative binomial models were used, with the number of events as the dependent variable, and the year as the main independent variable. From each model, the annual rate of CRBSI diagnosed per 1,000patientdays and the incidence rate ratio (IRR) with its 95% confidence intervals (CI) were reported. Results: During the study, 9,290 CRBSI episodes were diagnosed (mean annual incidence rate:0.20episodes/1,000patientdays). Patients' median age was 64.1years; 36.6% (3,403/9,290) were female. In total, 73.7% (n=6,845) of CRBSI occurred in non-intensive care unit (ICU) wards, 62.7% (n=5,822) were related to central venous catheter (CVC), 24.1% (n=2,236) to peripheral venous catheters (PVC) and 13.3% (n=1,232) to peripherally-inserted central venous catheters (PICVC). Incidence rate fell over the study period (IRR:0.94;95%CI:0.93-0.96), especially in the ICU (IRR:0.88;95%CI:0.87-0.89). As a whole, while episodes of CVC CRBSI fell significantly (IRR:0.88;95%CI:0.87-0.91), peripherally-inserted catheter CRBSI (PVC and PICVC) rose, especially in medical wards (IRR PICVC:1.08;95%CI:1.05-1.11; IRR PVC: 1.03; 95% 1.00-1.05). Conclusions: Over the study, CRBSIs associated with CVC and diagnosed in ICUs decreased while episodes in conventional wards involving peripherally-inserted catheters increased. Hospitals should implement preventive measures in conventional wards

Risk factors for infections caused by carbapenem-resistant Enterobacterales: an international matched case-control-control study (EURECA)

Cases were patients with complicated urinary tract infection (cUTI), complicated intraabdominal (cIAI), pneumonia or bacteraemia from other sources (BSI-OS) due to CRE; control groups were patients with infection caused by carbapenem-susceptible Enterobacterales (CSE), and by non-infected patients, respectively. Matching criteria included type of infection for CSE group, ward and duration of hospital admission. Conditional logistic regression was used to identify risk factors. Findings Overall, 235 CRE case patients, 235 CSE controls and 705 non-infected controls were included. The CRE infections were cUTI (133, 56.7%), pneumonia (44, 18.7%), cIAI and BSI-OS (29, 12.3% each). Carbapenemase genes were found in 228 isolates: OXA-48/like, 112 (47.6%), KPC, 84 (35.7%), and metallo-beta-lactamases, 44 (18.7%); 13 produced two. The risk factors for CRE infection in both type of controls were (adjusted OR for CSE controls; 95% CI; p value) previous colonisation/infection by CRE (6.94; 2.74-15.53; <0.001), urinary catheter (1.78; 1.03-3.07; 0.038) and exposure to broad spectrum antibiotics, as categorical (2.20; 1.25-3.88; 0.006) and time-dependent (1.04 per day; 1.00-1.07; 0.014); chronic renal failure (2.81; 1.40-5.64; 0.004) and admission from home (0.44; 0.23-0.85; 0.014) were significant only for CSE controls. Subgroup analyses provided similar results. Interpretation The main risk factors for CRE infections in hospitals with high incidence included previous coloni-zation, urinary catheter and exposure to broad spectrum antibiotics

Lorenz Revisited: The Adaptive Nature of Children’s Supernatural Thinking

Certain characteristics of childhood immaturity (e.g., infantile facial features) may have been favored by natural selection to evoke positive feelings in adults. We propose that some aspects of cognitive immaturity might also endear young children to adults. In two studies, adults rated expressions of mature and immature thinking attributed to children. Immature thinking in which children expressed a supernatural explanation elicited positive affect reactions, whereas other forms of immature thinking, which made no attribution to supernatural causation, were responded to negatively. This pattern was found for parents and others, males and females, American and Spanish college students, and for target children 3 to 9 years of age. We suggest that persistence of supernatural thinking in adulthood causes people to view the expressions of such thinking in children in a positive manner, fostering nurturance of young children who display them

Cognitive “babyness”: Developmental differences in the power of young children's supernatural thinking to influence positive and negative affect.

Perceptions of maturational status may play an important role in facilitating caretaking and resources toward children expressing them. Previous work has revealed evidence that cues of cognitive immaturity foster positive perceptions in adults toward young children at a time during their lives when they are most dependent on adult care. In the current series of studies, the authors investigated when during development these biases emerge. They tested American and Spanish adolescents ranging from 10 to 17 years of age. Each participant rated a series of vignettes presenting different expressions of immature and mature thinking attributed to young children. Results revealed that older adolescents performed similarly to adults tested in previous studies (D. F. Bjorklund, C. Hernández Blasi, & V. A. Periss, 2010), rating positively expressions of supernatural thinking (e.g., animism) compared with other forms of immature cognition labeled as natural (e.g., overestimation). Both male and female participants 14 years and older favored children expressing the immature supernatural cognition on traits reflecting positive affect (e.g., endearing, likeable), while associating greater negative affect (e.g., sneaky, impatient with) with children expressing immature natural cognition. However, younger adolescents consistently rated all forms of immature thinking less positively than mature thinking, suggesting that a positive bias for some forms of immature thinking develops during adolescence. Based on an evolutionary developmental framework, the authors suggest that supernatural thinking may have a unique role in humans, fostering positive perceptions of young children in older adolescents (and adults) as they prepare themselves for the possible role of parenthood. (PsycINFO Database Record (c) 2012 APA, all rights reserved)(journal abstract).Las impresión del estado de maturational pueden tener un papel importante en facilitar caretake y recursos hacia niños que los expresan. El trabajo previo ha revelado pruebas de que los ejemplos de la inmadurez cognitiva promueven las impresión seguras en adultos hacia niños pequeños a la vez durante sus vidas cuando están más en función del cuidado adulto. En la serie actual de estudios, los escritores investigaron cuándo durante el desarrollo estos prejuicios aparecen. Evaluaron a adolescentes estadounidenses y españoles que se extendían las 10 a 17 años de edad. Cada participante evaluó a series of viñetas que presentaban las expresiones diferentes de la idea inmadura y madura atribuida a niños pequeños. Los resultados revelaron que adolescentes más viejos funcionaron de forma semejante a adultos evaluados en estudios previos (D. F. Bjorklund, C Hernández Blasi, & V A Periss2010), evaluar las expresiones de idea sobrenatural (por ej. el animismo) absolutamente comparado con las otras formas de la cognición inmadura calificar de natural (por ej. la sobreestimación). Tantos participantes machos y de sexo femenino 14 años como niños predilectos más viejos que expresan la cognición sobrenatural inmadura sobre rasgos que reflejan la emoción segura (por ejemplo, atractivo, simpático) mientras asociar la emoción negativa más grande (por ejemplo, furtivo, impaciente con) con niños expresar la cognición natural inmadura. Sin embargo adolescentes más jovenes evaluaron todas formas de la idea inmadura constantemente less absolutamente que la idea madura, indicar que un prejuicio seguro para algunos formularios de la idea inmadura se desarrolla durante la adolescencia. Sobre la base de una base del desarrollo evolutiva, los escritores sugieren que la idea sobrenatural pudiera tener un papel único en seres humanos, promoviendo las impresión seguras de niños pequeños en adolescentes más viejos (y adultos) cuando se preparan para el papel posible de la paternidad. (Registro de base de datos de PsycINFO (c) 2012 APA, todos derechos ses reservado) (la abstracción de revista) Traducciones con tecnología de LEC