Adjustment For Use Research Articles

Association of volatile substance, nitrous oxide and alkyl nitrate use with mental health in UK adolescents.

'Inhalants' have been associated with poorer mental health in adolescence, but little is known of associations with specific types of inhalants. We aimed to investigate associations of using volatile substances, nitrous oxide and alkyl nitrates with mental health problems in adolescence. We conducted a cross-sectional analysis using data from 13- to 14-year-old adolescents across England and Wales collected between September 2019 and March 2020. Multilevel logistic regression examined associations between lifetime use of volatile substances, nitrous oxide and alkyl nitrates with self-reported symptoms of probable depression, anxiety, conduct disorder and auditory hallucinations. Of the 6672 adolescents in the study, 5.1% reported use of nitrous oxide, 4.9% volatile solvents and 0.1% alkyl nitrates. After accounting for multiple testing, adolescents who had used volatile solvents were significantly more likely to report probable depressive (odds ratio = 4.59, 95% CI 3.58, 5.88), anxiety (odds ratio = 3.47, 95% CI 2.72, 4.43) or conduct disorder (odds ratio = 7.52, 95% CI 5.80, 9.76) and auditory hallucinations (odds ratio = 5.35, 95% CI 4.00, 7.17) than those who had not. Nitrous oxide use was significantly associated with probable depression and conduct disorder but not anxiety disorder or auditory hallucinations. Alkyl nitrate use was rare and not associated with mental health outcomes. Adjustment for use of other inhalants, tobacco and alcohol resulted in marked attenuation but socioeconomic disadvantage had little effect. To our knowledge, this study provides the first general population evidence that volatile solvents and nitrous oxide are associated with probable mental health disorders in adolescence. These findings require replication, ideally with prospective designs.

Moderation of the real-world effectiveness of smoking cessation aids by mental health conditions: A population study

Objective To examine whether the real-world effectiveness of popular smoking cessation aids differs between users with and without a history of mental health conditions. Design Nationally-representative cross-sectional survey conducted monthly between 2016–17 and 2020–23. Setting England. Participants 5,593 adults (2,524 with a history of ≥1 mental health conditions and 3,069 without) who had smoked regularly within the past year and had attempted to quit at least once in the past year. Main outcome measures The outcome was self-reported abstinence from quit date up to the survey. Independent variables were use of the following cessation aids during the most recent quit attempt: prescription nicotine replacement therapy (NRT), NRT over-the-counter, varenicline, bupropion, vaping products, face-to-face behavioural support, telephone support, written self-help materials, websites, hypnotherapy, Allen Carr’s Easyway, heated tobacco products, and nicotine pouches. The moderator was history of diagnosed mental health conditions (yes/no). Covariates included sociodemographic characteristics, level of cigarette addiction, and characteristics of the quit attempt. Results Relative to those without, participants with a history of mental health conditions were significantly more likely to report using vaping products (38.8% [95%CI 36.7–40.8] vs. 30.7% [28.9–32.5]), prescription NRT (4.8% [3.9–5.7] vs. 2.7% [2.1–3.3]), and websites (4.0% [3.2–4.8] vs. 2.2% [1.6–2.7]). Groups did not differ significantly in their use of other aids. After adjusting for covariates and use of other cessation aids, those who used vaping products (OR = 1.92, 95%CI 1.61–2.30), varenicline (OR = 1.88, 95%CI 1.19–2.98), or heated tobacco products (OR = 2.33, 95%CI 1.01–5.35) had significantly higher odds of quitting successfully than those who did not report using these aids. There was little evidence that using other cessation aids increased the odds of successful cessation, or that the user’s history of mental health conditions moderated the effectiveness of any aid. Conclusions Use of vaping products, varenicline, or heated tobacco products in a quit attempt was associated with significantly greater odds of successful cessation, after adjustment for use of other cessation aids and potential confounders. There was no evidence to suggest the effectiveness of any popular cessation aid differed according to the user’s history of mental health conditions.

Comparison of risk of peritoneal dialysis-associated peritonitis between roxadustat and recombinant human erythropoietin in peritoneal dialysis patients: a retrospective comparative cohort study

Roxadustat and recombinant human erythropoietin (rhuEPO) have been approved for the treatment of renal anemia in patients undergoing dialysis. The comparison of risk of peritoneal dialysis (PD)-associated peritonitis between roxadustat and rhuEPO in PD patients remains uncertain. We aimed to compare the risk of PD-associated peritonitis between roxadustat and rhuEPO and examine possible modifiers for the comparison in PD patients. A total of 437 PD patients with renal anemia (defined as hemoglobin ≤10.0 g/dL) from 4 centers were selected. Participants were scheduled for follow-up every 1-3 months at each center. We compared differences in baseline characteristics by medication group and 1:1 matching group based on propensity scores. PD-associated peritonitis was defined according to the International Society for Peritoneal Dialysis guidelines. Univariable and multivariable Cox proportional hazard analyses were performed to compare the risk of PD-associated peritonitis between roxadustat and rhuEPO in PD patients. Propensity score matching method was used to examine the robustness of results. A total of 437 participants, including 291 in roxadustat group and 146 in rhuEPO group, were included in the current study, respectively. During a median follow-up of 13.0 (25th-75th, 10.0-15.0) months, PD-associated peritonitis occurred in 68 patients, including 26 of 291 (0.10 episodes per patient-year) patients in the roxadustat group and 42 of 146 (0.27 episodes per patient-year) patients in the rhuEPO group. Overall, compared to patients in the rhuEPO group, the roxadustat group (hazard ratio, 0.345; 95% confidence interval: 0.202-0.589) was associated with a lower risk of PD-associated peritonitis with adjustment of use of roxadustat medication, age, sex, hypertension status, diabetes status, dialysis vintage, serum potassium, hemoglobin, and albumin. Furthermore, the results were consistent with the propensity score analysis. None of the variables, including age, sex, body mass index, PD vintage, presence of residual renal function, hemoglobin, albumin, serum potassium, and C-reactive protein levels, significantly modified the associations. Our study demonstrated that compared with rhuEPO, roxadustat may reduce the risk of PD-associated peritonitis in PD patients, highlighting the importance of roxadustat for the prevention of PD-associated peritonitis in PD patients.

Parental Adjustment Scale: Validation of a brief, five-item measure of parental adjustment for use with families of typically developing children and children with developmental and/or intellectual disabilities in Australia

BackgroundExplores the validity of the five-item parental adjustment scale, a subscale of the previously validated Parenting and Family Adjustment Scales. AimThe aim was to assess the factor structure and convergent validity of a measure of parental adjustment within parents of typically developing children and parents of childiren with developmental and/or intellectual disabilities. Methods and proceduresCross-sectional survey data was analysed from Australian parents of children aged 2-12 years who were typically developing children (N = 683) and had developmental and/or intellectual disabilities (N = 756). Confirmatory factor analyses and multi-group structural equation modelling examined if the factor structure performed similarly across the two populations. Convergent validity was assessed. Outcomes and resultsThe confirmatory factor analysis supported the hypothesised one-factor structure for the parental adjustment scale in both populations. Partial measurement invariance confirmed that the scale was structurally consistent within both parent groups. The convergent validity was supported by significant correlations with the DASS-21 in the disability population and the K10 in the typically developing population. Conclusions and implicationsThis brief, easily administered, five-item scale demonstrates strong potential in assessing parental adjustment, within both parents of typically developing children and parents of children with developmental and/or intellectual disabilities.

Diminished Structural Brain Integrity in Long-term Cannabis Users Reflects a History of Polysubstance Use

BackgroundCannabis legalization and use are outpacing our understanding of its long-term effects on brain and behavior, which is fundamental for effective policy and health practices. Existing studies are limited by small samples, cross-sectional measures, failure to separate long-term from recreational use, and inadequate control for other substance use. Here, we address these limitations by determining the structural brain integrity of long-term cannabis users in the Dunedin Study, a longitudinal investigation of a population-representative birth cohort followed to midlife. MethodsWe leveraged prospective measures of cannabis, alcohol, tobacco, and other illicit drug use in addition to structural neuroimaging in 875 study members at age 45 to test for differences in both global and regional gray and white matter integrity between long-term cannabis users and lifelong nonusers. We additionally tested for dose-response associations between continuous measures of cannabis use and brain structure, including careful adjustments for use of other substances. ResultsLong-term cannabis users had a thinner cortex, smaller subcortical gray matter volumes, and higher machine learning–predicted brain age than nonusers. However, these differences in structural brain integrity were explained by the propensity of long-term cannabis users to engage in polysubstance use, especially with alcohol and tobacco. ConclusionsThese findings suggest that diminished midlife structural brain integrity in long-term cannabis users reflects a broader pattern of polysubstance use, underlining the importance of understanding comorbid substance use in efforts to curb the negative effects of cannabis on brain and behavior as well as establish more effective policy and health practices.

Abstract EP35: Longitudinal Lipidomic Profiling Of Left Ventricular Mass In American Indians: The Strong Heart Study

Background: Dyslipidemia is a major risk factor for CVD. Left ventricular mass (LVM) is an independent predictor of heart failure and other cardiovascular events. It is unclear whether and how altered plasma lipidome (all lipids in a plasma sample) affects LVM. The relationship between longitudinal change in plasma lipidome and change in LVM is also unstudied in any racial/ethnic group. Objective: To identify molecular lipid species associated with LVM, independent of traditional risk factors. Methods: Using an untargeted LC-MS, we repeatedly measured 1,542 lipids in 3,162 fasting plasma samples collected at two time points (2001-2003, 2006-2009, mean 5.5 years apart) from 1,581 American Indians in the Strong Heart Family Study. All participants were free of overt CVD at both time points. LVM was measured by M-mode echocardiography and LVM index (LVMI) was calculated as LVM/height 2.7 . Lipids associated with LVMI were identified by generalized estimating equation (GEE) models, adjusting for age, sex, center, BMI, smoking, blood pressure, renal function, LDL-c, and diabetes. We first conducted the analysis at each time point, separately, and then combined the results by meta-analysis. The longitudinal association between change in lipids and change in LVMI was examined by GEE, adjusting for the same covariates plus baseline lipids and LVMI. Multiple testing was controlled by false discovery rate at 0.05. Results: The mean age of participants was 39.8 years (62.5% women) at baseline and 45.1 years at follow-up. We identified 325 lipids (125 known), largely fatty acyls, sterol lipids, sphingolipids, glycerolipids, and glycerophospholipids, significantly associated with LVMI at both time points. Longitudinal changes in 17 lipids, including glycerolipids, glycerophospholipids, and sphingolipids, were either positively (ORs: 1.09 -1.95) or negatively (ORs: 0.50 - 0.69) associated with change in LVMI over 5 years of follow-up. Changes in lipids explain up to 1.58% of the variability in the change of LVMI during follow-up. Additional adjustments for use of anti-hypertensive and lipid-lowering drugs did not change the results. Conclusion: Altered fasting plasma lipidome and its longitudinal change over time were significantly associated with LVMI beyond clinical factors and baseline lipids. Our results shed light on the mechanisms through which dyslipidemia may affect LV remodeling, thereby contributing to heart failure or other cardiovascular events.

Plasma levels of leucocyte elastase-generated cross linked fibrin degradation products (E-XDP) are elevated in chronic venous disease.

Patients with chronic venous disease (CVD) have elevated levels of leucocyte elastase (LE) released from the activation of leucocytes. In acute deep venous thrombosis (DVT), LE can degrade fibrin from the thrombus resulting in cross-linked fibrin degradation products (E-XDP) being released into the bloodstream. In patients with CVD the levels and significance of circulating E-XDP are unknown. We aimed to investigate the association between plasma E-XDP concentration and severity of CVD. Levels of E-XDP were quantified with a specific enzyme-linked immunosorbent assay (ELISA) in plasma from 142 consecutively recruited CVD patients (mean age 64 years, (range 23–89), 81 were females and 61 males). Patients were also divided into three groups based on CVD severity using the C-class of the Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification, with C 0–1 class as the reference group, C 2–3 as the second group and C 4–6 as the third group with the most severely affected patients. We found significantly elevated levels of E-XDP in patients with C 4–6 compared with patients with C 0–1 (p = 0.007) and increased with increasing disease severity across the groups (p = 0.02). Significant independent association was observed between levels of E-XDP and the classes C 4–6 after adjustment for age and sex (p < 0.05), but the association was no longer significant after further adjustment for use of statins, use of anticoagulants and history of DVT (p = 0.247). This exploratory study shows that E-XDP levels are elevated in patients with CVD, encouraging further studies on the role of E-XDP in CVD.

Ergodic site response model for subduction zone regions

We present an ergodic site response model with regional adjustments for use with subduction zone ground-motion models. The model predicts site amplification of peak ground acceleration, peak ground velocity, and 5% damped pseudo-spectral accelerations of the orientation-independent horizonal component for oscillator periods from 0.01 to 10 s. The model depends on the time-averaged shear-wave velocity in the upper 30 m ( VS30), basin depth, and region and is independent of subduction earthquake type. It has three components: a linear site-amplification term in the form of VS30-scaling, a nonlinear term that depends on VS30 and shaking intensity parameterized by peak ground acceleration at the reference-rock velocity condition of 760 m/s, and a basin sediment-depth term for Japan and Cascadia conditioned on the depth to the 2.5 km/s shear-wave velocity isosurface ( Z2.5). A global VS30-scaling model is provided along with regional adjustments for Japan, Taiwan, South America, Alaska, and Cascadia. The nonlinear model is global, with a functional form that has often been used to fit nonlinear responses inferred from simulations, but here we calibrate it empirically. Relative to a prior model for shallow earthquakes in active tectonic regions, our subduction zone global VS30-scaling is comparable at short periods (&lt;1.0 s) but weaker at long periods, while the nonlinear site response is generally less pronounced but extends to lower levels of shaking. Basin depth models are conditioned on the difference of the actual Z2.5 and a VS30-conditioned mean Z2.5. Sites with positive differential depths have increased long-period site responses and decreased short-period responses, with the opposite occurring for negative differential depths.

Linking personality and health to use of space in the gray partridge: perspectives for management

Behavioral adjustments are of critical importance for the survival of animals when exposed to risk and resource variations in their environment. Moving to safer habitats allows prey to reduce the risk of mortality triggered by predation. This response has been well studied at the population level to assist in identifying key habitat components for wildlife conservation. However, while individuals may differ in their response to risk and thus in their survival expectancy, the determinants of individual adjustments in space and habitat use are largely unknown in management and conservation studies. Using GPS monitoring, we investigated the relationship between individual traits (morphometry, personality, health status) and adjustments in the use of space relative to risky features (hedgerows, roads/tracks, woodlands, built-up areas) with regard to predation risk. We used the gray partridge (Perdix perdix) as a study model (captive-reared birds released into the farmlands). During the diel cycle, predation risk mainly occurs by carnivores at night, whereas human hunting pressure occurs during the day. We found that personality and health status had an effect on adjustments in the use of space as response to risky features. At night, when carnivore activity is expected to be high, bolder individuals were farther from hedgerows relative to the day. Similarly, individuals in good health were located farther from hedgerows, roads/tracks, and woodland at night relative to the day. We discuss the need for better consideration of individual traits in management and conservation programs, with a particular focus on recovery programs that rely on translocation of captive-reared individuals.

Mortality in STEMI patients without standard modifiable risk factors: a sex-disaggregated analysis of SWEDEHEART registry data

In cardiovascular disease, prevention strategies targeting standard modifiable cardiovascular risk factors (SMuRFs; hypertension, diabetes, hypercholesterolaemia, and smoking) are crucial; however, myocardial infarction in the absence of SMuRFs is not infrequent. The outcomes of individuals without SMuRFs are not well known. We retrospectively analysed adult patients with first-presentation ST-elevation myocardial infarction (STEMI) using data from the Swedish myocardial infarction registry SWEDEHEART. Clinical characteristics and outcomes of adult patients (age ≥18 years) with and without SMuRFs were examined overall and by sex. Patients with a known history of coronary artery disease were excluded. The primary outcome was all-cause mortality at 30 days after STEMI presentation. Secondary outcomes included cardiovascular mortality, heart failure, and myocardial infarction at30 days. Endpoints were also examined up to discharge, and to the end of a 12-year follow-up. Multivariable logistic regression models were used to compare in-hospital mortality, and Cox-proportional hazard models and Kaplan-Meier analysis for long-term outcomes. Between Jan 1, 2005, and May 25, 2018, 9228 (14·9%) of 62 048 patients with STEMI had no SMuRFs reaching diagnostic thresholds. Median age was similar between patients with SMuRFs and patients without SMuRFs (68 years [IQR 59-78]) vs 69 years [60-78], p<0·0001). SMuRF-less patients had a similar rate of percutaneous coronary intervention to those with at least one modifiable risk factor, but were significantly less likely to receive statins, angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockade (ARB), or β-blockers at discharge. By 30 days after presentation, all-cause mortality was significantly higher in SMuRF-less patients (hazard ratio 1·47 [95% CI 1·37-1·57], p<0·0001). SMuRF-less women had the highest 30-day mortality (381 [17·6%] of 2164), followed by women with SMuRFs (2032 [11·1%] of 18 220), SMuRF-less men (660 [9·3%] of 7064), and men with SMuRFs (2117 [6·1%] of 34 600). The increased risk of 30-day all-cause mortality in SMuRF-less patients remained significant after adjusting for age, sex, left ventricular ejection fraction, creatinine, and blood pressure, but was attenuated on inclusion of pharmacotherapy prescription (ACEI or ARB, β-blocker, or statin) at discharge. Additionally, SMuRF-less patients had a significantly higher rate of in-hospital all-cause mortality than patients with one or more SMuRF (883 [9·6%] vs 3411 [6·5%], p<0·0001). Myocardial infarction and heart failure at 30 days were lower in SMuRF-less patients. All-cause mortality remained increased in the SMuRF-less group for more than 8 years in men and up to the 12-year endpoint in women. Individuals who present with STEMI in the absence of SMuRFs have a significantly increased risk of all-cause mortality, compared with those with at least one SMuRF, which was particularly evident in women. The increased early mortality rates are attenuated after adjustment for use of guideline-indicated treatments, highlighting the need for evidence-based pharmacotherapy during the immediate post-infarct period irrespective of perceived low risk. Swedish Heart and Lung Foundation, National Health and Medical Research Council (Australia).

Dietary Inflammatory Potential and Risk of Cardiovascular Disease Among Men and Women in the U.S.

BackgroundInflammation plays an important role in cardiovascular disease (CVD) development. Diet modulates inflammation; however, it remains unknown whether dietary patterns with higher inflammatory potential are associated with long-term CVD risk. ObjectivesThis study sought to examine whether proinflammatory diets are associated with increased CVD risk. MethodsWe prospectively followed 74,578 women from the Nurses’ Health Study (NHS) (1984–2016), 91,656 women from the NHSII (1991–2015), and 43,911 men from the Health Professionals Follow-up Study (1986–2016) who were free of CVD and cancer at baseline. Diet was assessed by food frequency questionnaires every 4 years. The inflammatory potential of diet was evaluated using a food-based empirical dietary inflammatory pattern (EDIP) score that was pre-defined based on levels of 3 systemic inflammatory biomarkers. ResultsDuring 5,291,518 person-years of follow-up, we documented 15,837 incident CVD cases, including 9,794 coronary heart disease (CHD) cases and 6,174 strokes. In pooled analyses of the 3 cohorts, after adjustment for use of anti-inflammatory medications and CVD risk factors including body mass index, a higher dietary inflammatory potential, as indicated by higher EDIP scores, was associated with an increased risk of CVD (hazard ratio [HR] comparing the highest to lowest quintiles: 1.38; 95% confidence interval [CI]: 1.31 to 1.46; p for trend <0.001), CHD (HR: 1.46; 95% CI: 1.36 to 1.56; p for trend <0.001), and stroke (HR: 1.28; 95% CI: 1.17- to 1.39; p for trend <0.001). These associations were consistent across cohorts and between sexes, and they remained significant after further adjustment for other dietary quality indices. In a subset of study participants (n = 33,719), a higher EDIP was associated with a higher circulating profile of proinflammatory biomarkers, lower levels of adiponectin, and an unfavorable blood lipid profile (p < 0.001). ConclusionsDietary patterns with a higher proinflammatory potential were associated with higher CVD risk. Reducing the inflammatory potential of the diet may potentially provide an effective strategy for CVD prevention.

HARGREAVES &amp; SAMANI SUBESTIMA A EVAPOTRANSPIRAÇÃO DA CEBOLA NO ALTO VALE DO ITAJAÍ

HARGREAVES &amp; SAMANI SUBESTIMA A EVAPOTRANSPIRAÇÃO DA CEBOLA NO ALTO VALE DO ITAJAÍ&#x0D; &#x0D; &#x0D; JAQUELINI GARCIA1; JOÃO CÉLIO DE ARAÚJO2 E FRANCISCO OLMAR GERVINI DE MENEZES JÚNIOR3&#x0D; &#x0D; 1 Instituto Federal Catarinense, Campus Rio do Sul. Estrada do Redentor, 5665, Canta Galo, CEP 89163-356, Rio do Sul,SC, Brasil. E-mail: jaquelini.garcia@hotmail.com&#x0D; 2 Instituto Federal Catarinense, Campus Rio do Sul. Estrada do Redentor, 5665, Canta Galo, CEP 89163-356, Rio do Sul, SC, Brasil. E-mail: joao.araujo@ifc.edu.br.&#x0D; 3Empresa de Pesquisa Agropecuária e Extensão Rural de Santa Catarina, Estação Experimental de Ituporanga. Estrada Geral Lageado Águas Negras, 459, Águas Negras, CEP 88400-000, Ituporanga, SC, Brasil. Email: franciscomenezes@epagri.sc.gov.br&#x0D; &#x0D; &#x0D; 1 RESUMO&#x0D; &#x0D; A cultura da cebola é amplamente difundida na região do Alto Vale do Itajaí, SC, que desempenha papel de destaque na produção nacional. Esta pesquisa teve por objetivo avaliar a eficiência da equação Hargreaves &amp; Samani (HS) na estimativa da evapotranspiração da cultura da cebola produzida na região do Alto Vale do Itajaí, SC. O experimento foi conduzido em ambiente protegido utilizando o cultivar Bola Precoce. Para a estimativa da lâmina de água a ser aplicada, utilizou-se da equação de determinação da evapotranspiração de referência de HS. Os tratamentos consistiram em: lâmina calculada por HS, 70% da lâmina calculada por HS, 130% da lâmina calculada por HS e precipitação local. O delineamento experimental foi de blocos ao acaso. Avaliou-se o número de folhas, diâmetro de pseudocaule, diâmetro, classificação e estimativa de produtividade dos bulbos, biomassa fresca/seca dos bulbos, além da biomassa seca da parte aérea. A lâmina de água baseada em 130% da equação apresentou bulbos com maior diâmetro, biomassa fresca/seca, maior percentual de bulbos classe 3 e maior estimativa de produtividade. Conclui-se que a equação de HS subestima a evapotranspiração da cultura e requer ajustes para ser utilizada na região do Alto Vale do Itajaí, SC.&#x0D; &#x0D; Palavras-chave: Allium cepa, ETo, irrigação, produtividade.&#x0D; &#x0D; &#x0D; GARCIA, J.; ARAÚJO, J. C. de; MENEZES JÚNIOR, F. O. G. de.&#x0D; HARGREAVES &amp; SAMANI UNDERSTATES THE EVAPOTRANSPIRATION OF ONION IN THE UPPER VALLEY OF ITAJAÍ&#x0D; &#x0D; &#x0D; 2 ABSTRACT&#x0D; &#x0D; The onion crop is widespread in Itajaí Upper Valley region, SC, which plays a prominent role in national production. This research aimed to evaluate the efficiency of the Hargreaves &amp; Samani (HS) equation in estimating the evapotranspiration of the onion crop produced in Itajaí Upper Valley region, Santa Catarina State. The experiment was conducted in a greenhouse using the cultivar Bola Precoce. To estimate the water depth to be applied, the reference evapotranspiration HS equation was used. The treatments consisted of: depth calculated by HS, 70% of depth calculated by HS, 130% of depth calculated by HS and local precipitation. The experimental design was randomized blocks. The number of leaves, pseudostem diameter, classification and estimate of bulb productivity, fresh / dry biomass of the bulbs, in addition to the dry biomass of the shoot were evaluated. The water depth based on 130% of the equation showed bulbs with larger diameter, fresh / dry biomass, higher percentage of class 3 bulbs and higher estimate of productivity. Therefore, the HS equation underestimates the evapotranspiration for Itajaí Upper Valley region, SC, requiring adjustments for use.&#x0D; &#x0D; Keywords: Allium cepa, ETo, irrigation, productivity.

Urinary tract infections and risk of squamous cell carcinoma bladder cancer: A Danish nationwide case-control study.

Schistosoma haematobium infection can lead to squamous cell carcinomas (SCC) of the bladder. Whether this also applies to more common urinary tract infections (UTIs) is unclear. We therefore aimed to investigate the association between UTIs, reflected by the use of specific antibiotics and risk of SCC of the bladder. We conducted a Danish nationwide case-control study and identified histologically verified bladder cancer cases (2000-2015; n = 12,271) and age- and sex-matched cancer-free controls. We computed odds ratios (ORs) with 95% confidence intervals (CI) associating the use of UTI-specific antibiotics with SCC bladder cancer, using conditional logistic regression. We applied a 2-year lag-time to minimize reverse causation. To aid interpretation, similar analyses were performed for other bladder cancer types and other antibiotics. We identified 333 SCC cases (2.7% of all bladder cancers). Compared to no use (0-1 prescription), high-use (≥10 prescriptions) of UTI-specific antibiotics was associated with SCC with an OR of 11.4 (CI 7.6-17.2) and a clear dose-response pattern (ptrend < 0.001). Use of phenoxymethylpenicillin, an antibiotic not used against UTIs, was not associated with SCC after adjustment for use of UTI-specific antibiotics (OR 0.5). Furthermore, UTI-specific antibiotic use was not associated with urothelial carcinomas (n = 11,029; OR 1.13; CI 0.97-1.32). Excluding patients with known urogenital disease did not influence the SCC estimates (overall OR 10.8; CI 6.2-18.9). Data on smoking were lacking, however, a quantitative bias analysis suggested this to be of limited importance. In conclusion, common UTIs are strong, dose-dependent and specifically associated with risk of SCC of the bladder.

Demonstration of Retrofitted Concrete Cubes, Cylinders and Prisms using Basalt and Glass Wrap

Nowadays improvement in infrastructure construction is raising its place in the present scenario. But around the globe many reinforced masonry and concrete buildings are constructed annually. There are massive numbers of structures which become worse due to adjustments in use, adjustments in loading condition and modifications in design configuration, inferior construction, and material used or natural calamities. Thus, repairing and retrofitting of this structure for secure usage of has a top notch marketplace. There are several conditions wherein a civil structure might require retrofitting. In this paper an attempt has been taken to study the strength enhancement of concrete cylinders and prisms using Basalt fibre wrap, Nitro wrap and nylon wrap.. Cubes, cylinders and prisms are tested for compressive strength test, split tensile strength test, flexural strength. Then the conventional specimens and synthetic wrapped results are compared

Leading Organizational Change: Semester-Long Project

For organizational change to happen, people have to change their behaviors. Leaders of organizational change therefore need to develop their abilities to influence others, sell issues, and overcome resistance to gain buy-in within organizations. This article describes the framework for a semester-long project in which MBA students practice these skills by planning and executing an organizational change project of their own design. In the process, they obtain developmental feedback on their growing change-management skills. The instructor does not need to arrange contact with organizations in which these change projects take place, as students are charged with developing their projects and negotiating necessary access if needed. The project works best with weekly feedback and is, therefore, more appropriate for smaller classes or classes with capable teaching assistants. Adjustments for use in larger classes are also provided.

One-year costs of medical admissions with and without a 30-day readmission and enhanced risk adjustment

BackgroundTo overcome the limitations of administrative data in adequately adjusting for differences in patients’ risk of readmissions, recent studies have added supplemental data from patient surveys and other sources (e.g., electronic health records). However, judging the adequacy of enhanced risk adjustment for use in assessment of 30-day readmission as a hospital quality indicator is not straightforward. In this paper, we evaluate the adequacy of risk adjustment by comparing the one-year costs of those readmitted within 30 days to those not after excluding the costs of the readmission.MethodsIn this two-step study, we first used comprehensive administrative and survey data on a nationally representative Medicare cohort of hospitalized patients to compare patients with a medical admission who experienced a 30-day readmission to patients without a readmission in terms of their overall Medicare payments during 12 months following the index discharge. We then examined the extent to which a series of enhanced risk adjustment models incorporating code-based comorbidities, self-reported health status and prior healthcare utilization, reduced the payment differences between the admitted and not readmitted groups.ResultsOur analytic cohort consisted 4684 index medical hospitalization of which 842 met the 30-day readmission criteria. Those readmitted were more likely to be older, White, sicker and with higher healthcare utilization in the previous year. The unadjusted subsequent one-year Medicare spending among those readmitted ($56,856) was 60% higher than that among the non-readmitted ($35,465). Even with enhanced risk adjustment, and across a variety of sensitivity analyses, one-year Medicare spending remained substantially higher (46.6%, p < 0.01) among readmitted patients.ConclusionsEnhanced risk adjustment models combining health status indicators from administrative and survey data with previous healthcare utilization are unable to substantially reduce the cost differences between those medical admission patients readmitted within 30 days and those not. The unmeasured patient severity that these cost differences most likely reflect raises the question of the fairness of programs that place large penalties on hospitals with higher than expected readmission rates.

Aerial-hawking bats adjust their use of space to the lunar cycle

BackgroundAnimals change their habitat use in response to spatio-temporal fluctuation of resources. Some resources may vary periodically according to the moonphase. Yet it is poorly documented how animals, particularly nocturnal mammals, adjust their use of space in response to the moonphase.Here, we asked if an obligate nocturnal mammal, the aerial-hawking common noctule bat (Nyctalus noctula), adjusts its 3-dimensional flight behaviour and habitat use to the lunar period. Using miniaturized GPS loggers, we recorded 3-dimensional flight tracks of N. noctula and related these to a canopy height model derived from aerial laser scans to investigate whether bats adjust forest strata use to moonlight intensities.ResultsNoctules frequently foraged above the canopy of coniferous forest at low moonlight intensities, but switched to using open grasslands and arable fields in nights with high moonlight intensities. During the few occasions when noctules used the forest during moonlit nights, they mostly restricted their use of space to flying below the canopy level. The median overall flight altitude of N. noctula equalled 13 ± 16 m but reached up to 71 m above ground (97.5% quantile).ConclusionsOur findings argue against general lunar phobic behaviour of aerial-hawking bats. We suggest that the preferred use of open fields around full moon may be a strategy of noctules to increase the success of hunting airborne insects at night. Specifically, the adjustment in use of space may allow bats to hunt for insects that emerge and disperse over open fields during bright moonlight.

Fish consumption, fish oil supplements and risk of atherosclerosis in the Troms\xf8 study

BackgroundWhether long-chain n–3 PUFAs of marine origin have an anti-atherogenic effect in the general population has hardly been studied. In this population-based study, we hypothesized that fatty fish and fish oil intake protect against development of novel atherosclerotic plaques and is associated with reduced plaque size.MethodsWe obtained questionnaire-based information on fish consumption and carotid ultrasonography from 3900 persons aged 45–74 years. The questionnaires were validated by measuring serum concentrations of PUFAs and triglycerides in a subgroup. At follow-up seven years later, 2983 (76%) went through a second ultrasound scanning. Logistic regression and general linear models were used to analyze the outcome (plaque presence and plaque area) as a function of fish consumption, including analyses stratified on fish oil supplements.ResultsAt baseline, lean fish intake < 1 time/week vs. 1–1.9 times/week was associated with risk of plaque (OR 1.34, 95% CI 1.03–1.76). Fatty fish intake and use of fish oil supplements were not statistically significantly associated with atherosclerosis at baseline. In persons without plaque at baseline, total fish consumption ≥3 times/week vs. 1–1.9 times/week was associated with risk of novel plaque (OR 1.32, 95% CI 1.01–1.73) and larger plaque area (1.76 mm2 vs. 1.46 mm2, p = 0.02) at follow-up. Adjustments for use of fish oil supplements had no impact on the associations, and no interactions were seen between total, fatty or lean fish consumption and fish oil intake.ConclusionsWe found no protective effect of fatty fish eating or fish oil supplements on atherosclerotic plaque formation or plaque area in a general population. Lean fish consumption was associated with a reduced risk for plaque in cross-sectional analysis, suggesting that the beneficial effects of fish consumption on atherosclerosis may be mediated through other mechanisms than n-3 PUFAs.

Use of medical care biases associations between Parkinson disease and other medical conditions.

To examine how use of medical care biases the well-established associations between Parkinson disease (PD) and smoking, smoking-related cancers, and selected positively associated comorbidities. We conducted a population-based, case-control study of 89,790 incident PD cases and 118,095 randomly selected controls, all Medicare beneficiaries aged 66 to 90 years. We ascertained PD and other medical conditions using ICD-9-CM codes from comprehensive claims data for the 5 years before PD diagnosis/reference. We used logistic regression to estimate age-, sex-, and race-adjusted odds ratios (ORs) between PD and each other medical condition of interest. We then examined the effect of also adjusting for selected geographic- or individual-level indicators of use of care. Models without adjustment for use of care and those that adjusted for geographic-level indicators produced similar ORs. However, adjustment for individual-level indicators consistently decreased ORs: Relative to ORs without adjustment for use of care, all ORs were between 8% and 58% lower, depending on the medical condition and the individual-level indicator of use of care added to the model. ORs decreased regardless of whether the established association is known to be positive or inverse. Most notably, smoking and smoking-related cancers were positively associated with PD without adjustment for use of care, but appropriately became inversely associated with PD with adjustment for use of care. Use of care should be considered when evaluating associations between PD and other medical conditions to ensure that positive associations are not attributable to bias and that inverse associations are not masked.

Consultancy Services and Their Impact in Financial Reporting - Case of Albania

Abstract As part of an effective strategy of risk management and internal control, security services and consultancy are focused on providing reliable and qualitative information, which includes the best information at the moment of decision making by the company and they have their impact in the process of making important decisions. The values it carries report of consultancy services, which should have adjustments in use and excellence, are recognized as definitions of quality. Security services are independent professional services in the field of accounting that improve the quality of the information or its contents for stakeholders in the decision making process. As elsewhere, also Albania has started offering security services, consultancy and these services are expanding more and more in the field of accounting, especially over the last decade. Through a descriptive analyze, in this paper, we will rely mainly on the development and application of consultancy services in different sectors like telecommunication, energy and water supply in Albania. In this study we will focus on the in consultancy services in the field of accounting, also the from processing of data collected in the questionnaire will be given a clear description of actuality in Albania which will be to a great help in giving end to the necessary recommendations of stakeholders for this service.