Unique Individuals Research Articles

Association of Anxiety and Gastrointestinal Comorbidities in Repeat Hospital Admissions in Pediatric Cyclic Vomiting Syndrome.

Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder with recurrent episodes of intense nausea and vomiting and thus may require frequent hospitalizations. There is paucity of data exploring the association of psychiatric and gastrointestinal comorbidities in repeat hospitalizations among pediatric patients with CVS. We analyzed the Pediatric Health Information System database and included all patients up to 18 years of age with a diagnosis of CVS between 2016 and 2020. We excluded patients with chronic conditions, which mimic CVS. The primary outcome variable was 90-day admission rate, which was defined as a visit to emergency department or admission to observation/inpatient unit with a primary diagnosis of CVS within 90 days after an index CVS hospitalization. We evaluated a total of 2,604 hospitalizations represented by 1,370 unique individuals. The overall 90-day admission rate was 28.5%, which steadily decreased from 35.7% in 2016 to 23% in 2019 ( P < 0.001). Patients in the repeat hospitalization cohort were slightly older and more often men. Patients with repeat admissions had an increased proportion of anxiety and other gastrointestinal disorders. Multivariable logistic regression showed that anxiety, gastroesophageal reflux disease, functional dyspepsia, and abdominal migraine were associated with increased odds of repeat admissions. Ninety-day admission rates in pediatric CVS are decreasing overall, although still contributing to significant healthcare expenditure. Anxiety and gastrointestinal comorbidities were associated with increased risk of repeat admissions. Further prospective studies are needed to better understand the complex interactions of these comorbidities and their management affecting the natural course of CVS.

Exploring dental treatment decision-making experiences of people living with dementia and family carers.

People living with dementia can have complex dental care needs. Dentists and patients should make treatment decisions together, yet some people living with dementia may be unable to make their own decisions about their dental care. Dental treatment decision-making and patients' experiences of this process have not been comprehensively researched. This study aimed to explore the dental treatment decision-making perspectives and experiences of people living with dementia and their family members. Semi-structured interviews were undertaken with 8 people living with dementia and 17 family caregivers. A constructivist grounded theory approach was adopted, using a maximum variation sample. Qualitative data collection and analysis occurred concurrently. Data underwent initial open coding followed by more focused coding, supported by reflexive memo writing, which supported data categorisation. People living with dementia reported wanting to be understood as unique individuals with specific needs. All participants described wanting to be actively involved in dental treatment decisions. However, many felt that they were insufficiently involved in treatment decision-making. This perceived underinvolvement meant that some people living with dementia and family members felt the treatment outcomes they sought were neither discussed nor considered. People living with dementia and carers had specific expectations of dental care yet felt passive in decision-making despite their desire to be involved in this process. Dentists should seek to actively establish patients' preferences, regardless of mental capacity and consider these in discussions and decisions about dental treatment.

FEMINIST APPROACHES TO DISINFORMATION STUDIES

Disinformation, inaccurate information spread intentionally for profit, ideology, or harm is a major public issue and a significant object of study across disciplines However, much scholarship treats “disinformation” as an irritant without recognizing that it often harnesses metanarratives about inequality and identity, and disproportionately impacts marginalized communities. For example, counting how many “sockpuppet” accounts contribute to a Twitter hashtag reveals that they do not represent genuine opinions of unique individuals, but does not capture whether they advance cultural narratives about race and gender. Disinformation campaigns are also often mischaracterized as “information warfare” or “psychological operations” and reduced to military-style masculinized logics of conflict and dominance in which “threat” is framed as a matter of “cybersecurity." This leaves out complex dynamics of identity, intersectionality, affect, labor, and material infrastructures. Feminist theory, methods, and perspectives are particularly well suited to exploring such issues. This panel brings together scholars working at different edges of this nascent discipline to explore what disinformation studies can learn from feminist scholars in rhetoric, communication, and science and technology studies.

Use of Overground Supported-Stepping Devices for Non-Ambulant Children, Adolescents, and Adults with Cerebral Palsy: A Scoping Review

Individuals with cerebral palsy functioning at Gross Motor Function Classification System (GMFCS) levels IV and V are unable to use hand-held walkers and require supported-stepping devices with trunk and pelvic support to allow overground stepping in natural environments. This scoping review explored what is known about the use of supported-stepping devices with individuals functioning at GMFCS IV or V. Comprehensive database and hand searches were completed in December 2022. Of 225 unique citations, 68 met the inclusion criteria: 10 syntheses and 58 primary studies including randomized, non-randomized, qualitative, observational and case study designs. Primary studies included 705 unique individuals functioning at GMFCS IV or V, aged 9 months to 47.7 years, while surveys and qualitative studies included 632 therapists. No new experimental studies have been published since previous reviews, however, lived experience and descriptive data suggest that upright positioning and mobility in supported-stepping devices have psycho-social significance with positive impacts on individual self-esteem and autonomy, as well as influencing the perception of others. Improved head and trunk control, use of hands, stepping and independent mobility may promote fitness, functioning, fun, friends, family and future, although environmental and physical challenges may limit use in adolescence and adulthood. Further research on all aspects of supported-stepping device use with individuals at GMFCS IV/V is warranted.

Sex differences in brain volumes and psychological distress: The first hundred brains cohort of the longitudinal adolescent brain study

Neurodevelopment during early childhood and adolescence are recognised as critical periods, with potential life-long lasting impacts on mental health and wellbeing. The time-frame of these neurodevelopmental changes also correspond to one in five individuals aged 9–17 years old being diagnosed with a mental health condition. Furthermore, sex-based differences in the diagnosed prevalence of mental health conditions are also well characterised and can be leveraged to differentiate development of brain structures between sexes throughout childhood and adolescence. During adolescence, early observed mental health symptoms, alongside measures of brain development, may provide utility toward understanding both the onset timing of various mental conditions, and a neurobiological explanation for disproportionate prevalence's among sexes. This study aims to determine sex differences in psychological distress levels and structural brain volume relationships in early adolescents. To address this question, we first present and then utilise the ‘first hundred brains’ (FHB) cohort, a multimodal dataset of 12-to-13 year-olds individuals enrolled in the Longitudinal Adolescent Brain Study (LABS). The FHB dataset consists of 101 unique individuals (47 female), aged 13.01 ± 0.55 years. Psychological distress was measured using the Kessler-10, a self-report questionnaire probing recent experiences of anxiety and depression symptoms. All participants underwent 3T MRI brain scans. T1-weighted structural scans were processed using FreeSurfer's Sequence Adaptive Multimodal segmentation pipeline, with volume measurements from 39 regions of interest included in the analyses. Findings revealed that compared to age matched males, early adolescent females have significantly higher psychological distress as well as significantly larger hippocampi and ventral diencephalon, bilaterally. Correlational analyses revealed a significant positive association between psychological distress scores and right amygdala volumes for males, but not in females, or the combined cohort. In this initial analysis of the FHB dataset, we have identified significant sex differences in psychological distress, brain volumes, and the relationships between these two metrics. With the peak age-of-onset for many psychiatric disorders occurring during adolescence, research focused on youth mental health vulnerability and opportunity for early detection, prevention and improvement is vitally important.

Self-Management and Glycemic Targets in Adult Haitian Immigrants With Type 2 Diabetes: Research Protocol.

Type 2 diabetes (T2D) is a chronic condition affecting more than 34.2 million U.S. adults, and people of African descent have a disproportionate burden. Haitian immigrants' unique cultural and biological factors put them at elevated risk for T2D-related complications. Despite prior research highlighting the success of multimethod approaches to T2D self-management behaviors on glycemic targets, a dearth of studies have used these methods to improve diabetes self-management in this marginalized population. This article describes a repeated-measures design protocol of a going study about self-management behaviors among adult Haitian immigrants with T2D and characterizing their barriers to T2D self-management. We will enroll 100 Haitian immigrants aged 18-64 years who have lived with T2D for at least 1 year. Using multiple recruitment methods and Research Electronic Data Capture, subjective and objective data on T2D self-management practices, glucose variability via continuous glucose monitor, and a comprehensive view of physical activity via actigraphy are collected. Data analysis will follow a two-part approach mirroring the two primary study objectives. Findings from the study will guide the development and testing of a culturally tailored diabetes self-management education program that will contribute essential information about best practices for this population and break barriers that may impede research on unique individuals and subsequent effective self-management.

Ten-Year Cohort Study of Emotional Distress Trajectories After Moderate-Severe Traumatic Brain Injury

ObjectiveTo characterize trajectories of emotional distress across the first decade after moderate-severe traumatic brain injury (TBI) and explore relations with personal and injury-related factors. DesignCohort study with follow-ups at 1, 2, 3, 5, and 10 years post-injury. SettingCommunity. ParticipantsParticipants were sampled from a larger longitudinal study of 4300 individuals recruited from consecutive inpatient TBI admissions to a rehabilitation hospital between 1985 and 2021 (N=4300). We analyzed data from 596 unique individuals (13.86% of total dataset; 70.81% male; Mage=40.11 years, SDage=17.49 years; 7.59% non-English-speaking background) with moderate-severe TBI who had complete data on all personal and injury-related variables (collected on admission) and emotional data at 3 or more time-points. There were 464 participants at the 1-year post-injury time-point, 485 at 2 years, 454 at 3 years, 450 at 5 years, and 248 at 10 years. InterventionsNot applicable. Main Outcome MeasureThe Hospital Anxiety and Depression Scale (HADS). ResultsVisualization of the individual HADS symptoms (line graph) showed that the most highly endorsed symptoms at each time-point were feeling slowed down and restlessness. On average, each symptom reduced across the first decade post-TBI, with an overall mild level of emotional distress at 10 years. However, visualization of participants’ individual trajectories based on the HADS total score (Sankey diagram) revealed significant heterogeneity. Using latent class analysis, we identified 5 distinct trajectory types based on the HADS total score: “Gradual Improving” (38.93%), “Resilience” (36.41%), “Gradual Worsening” (10.40%), and 2 non-linear trajectories of “Worsening-Remitting” (8.22%) and “Improving-Relapsing” (6.04%). Middle age at injury, lower Glasgow Coma Scale score, comorbid spinal and limb injuries, and receipt of pre-injury mental health treatment predicted earlier and/or worsening post-injury emotional distress. ConclusionsEmotional distress across the first decade after moderate-severe TBI is dynamic, heterogeneous, and often chronic, underscoring a need for ongoing monitoring and responsive treatment.

Retrospective testing for the presence of monkeypox virus in a high-risk population from February–June 2022 in Alberta, Canada

A multi-country outbreak of monkeypox virus (MPXV) infections was identified by the World Health Organization in May 2022. The western Canadian province of Alberta identified its first case of MPXV in a returning traveller on June 2, 2022. We undertook a retrospective testing exercise to evaluate whether MPXV may have been circulating in the province earlier. Skin (genital and non-genital) and mucosal lesion swabs submitted for herpes simplex virus (HSV)/varicella zoster virus (VZV)/syphilis testing from male patients attending sexually-transmitted infection clinics across the province of Alberta from January 28 to May 30, 2022 were retrieved from storage. The population tested was selected based on the epidemiology of the current 2022 multi-country MPXV outbreak. Samples underwent viral nucleic acid extraction and testing for the presence of Orthopoxvirus DNA using a commercial real-time polymerase chain reaction (PCR) kit. A total of 392 samples (representing 341 unique individuals of median age 31 years) were retrieved. Of them, 349 (89.0%) samples were submitted for HSV/VZV/syphilis testing, 13 (3.3%) for HSV/VZV only, and 30 (7.7%) for syphilis PCR only. None of the 392 samples tested were found to be positive for Orthopoxvirus DNA. The results of this study indicate that circulation of MPXV in a higher-risk population in Alberta, prior to the first case, was less likely. We recommend that other provinces/territories review their local epidemiology, context and resources prior to conducting similar studies.

Lahaul-Zanskar-Sham Valley Corridor in Indian Trans Himalayan Region Facilitates Dispersal and Gene Flow in Himalayan Ibex.

Wildlife corridors that connect mosaic habitats in heterogeneous mountainous landscapes can be of high significance as they facilitate the genetic and demographic stability of free-ranging populations. Peripheral populations of widespread species are usually ignored in conservation planning. However, these populations retain locally common alleles and are genetic reservoir under the changing climatic conditions. Capra sibirica has widespread distribution, and its southern peripheral population is distributed in the Indian trans-Himalayan region (ITR). In the present study, we studied the spatial distribution and genetic make-up of Himalayan ibex from the ITR following the landscape genetics approach. We obtained 16 haplotypes at the mitochondrial d-loop region and found a stable demography in the past with a recent decline. With 10 nuclear microsatellites, we ascertained 111 unique individuals assigned into two clusters following Bayesian and non-Bayesian clustering analysis with several admixed individuals. We also recorded 25 first-generation migrants that reflected relatively high dispersal and gene-flow across the range. We identified a 19,835 sq.km suitable area with 13,311 sq.km in Ladakh and 6524 sq.km in Lahaul-Spiti. We identified a novel movement corridor for Himalayan ibex across the Lahaul-Zanskar-Sham valley (L-Z-SV) that displayed a fairly good conductance with low genetic divergence among the samples collected on the L-Z-SV corridor. We propose declaring a protected area in the Lahaul and Kargil districts to prioritize dedicated conservation efforts for the Himalayan ibex and other sympatric ungulates that impart a major role in the diet of large carnivore and balancing ecosystem services in the trans-Himalayan region.

Incremental expenditures attributable to daily dispensation and witnessed ingestion for opioid agonist treatment in British Columbia: 2014-20.

While daily witnessed opioid agonist treatment (OAT) ingestion is common in British Columbia (BC), Canada, and elsewhere, sparse evidence supports this resource-intensive practice. Many settings across North America relaxed restrictions for take-home dosing during the COVID-19 pandemic and have reported consistent or improved patient outcomes. This study measured excess expenditures attributed to daily witnessed pharmacy dispensing compared with weekly or biweekly dispensation schedules. This study was a population-level retrospective analysis. We included all methadone, buprenorphine/naloxone and slow-release oral morphine dispensations in BC from 1 January 2014 to 30 December 2020. A total of 24 357 107 OAT dispensations among 51 195 unique individuals with 122 793 person-years of follow-up were included during the study period. Total expenditures for each person-week of OAT with an estimated expenditure under two scenarios are as follows: (1) a weekly dispensation scenario and (2) a biweekly dispensation scenario. We estimated excess expenditures attributable to current dispensing practices of between $38 million (2014) and $47.4 million (2018) compared with a hypothetical weekly dispensing schedule, and $43.9 million (2014) to $54.9 million (2018) compared with biweekly dispensing. The majority of these expenditures (58-64%) were attributed to pharmacy dispensing fees ($23 million in 2014 to $30 million in 2018 compared with weekly dispensing; $26.6 million in 2014 to $34.7 million in 2018 compared with biweekly dispensing). Daily witnessed opioid agonist treatment ingestion results in more than $30 million in excess expenditures annually in the province of British Columbia, Canada compared with the costs of weekly or biweekly dispensation schedules.

Familial Associations of Complete Atrioventricular Block: A National Family Study in Sweden.

Complete atrioventricular block (CAVB) is a major reason for implantation of permanent pacemakers, but knowledge of CAVB inheritance is sparse. This nationwide study aimed to determine the occurrence of CAVB in first-, second-, and third-degree relatives (full siblings, half-siblings, and cousins). The Swedish multigeneration register was linked to the Swedish nationwide patient register for the period 1997 to 2012. All Swedish full sibling, half-sibling, and cousin pairs born to Swedish parents between 1932 and 2012 were included. Competing risks and time-to-event, subdistributional hazard ratios (SHRs) according to Fine and Gray and hazard ratios using Cox proportional hazards model were estimated using robust SEs and considering the relatedness of relatives (full siblings, half-siblings, cousins). Additionally, odds ratios (ORs) for CAVB were calculated for traditional cardiovascular comorbidities. The study population (N=6 113 761) consisted of 5 382 928 full siblings, 1 266 391 half-siblings, and 3 750 913 cousins. In total, 6442 (0.11%) unique individuals were diagnosed with CAVB. Of these, 4200 (65.2%) were males. SHRs for CAVB were 2.91 for full siblings (95% CI, 2.43-3.49), 1.51 for half-siblings (0.56-4.10), and 3.54 for cousins (1.73-7.26) of affected individuals. Age-stratified analysis showed higher risk in young individuals born from 1947 to 1986: SHR, 5.30 (3.78-7.43) for full siblings, SHR, 3.30 (1.06-10.31) for half-siblings, and SHR, 3.15 (1.39-7.17) for cousins. Similar familial HRs according to Cox proportional hazard model and ORs were obtained without any major differences. Apart from familial relationship, CAVB was associated with hypertension (OR, 1.83), diabetes (OR, 1.41), coronary heart disease (OR, 2.08), heart failure (OR, 5.01), and structural heart disease (OR, 4.59). Risk of CAVB among relatives of affected individuals depends on relationship degree, being strongest in young siblings. The familial association extending to third-degree relatives indicates presence of genetic components in the cause of CAVB.

Genetic diversity and population structure of Himalayan tahr (Hemitragus jemlahicus) from Western Himalaya

Abstract Himalayan tahr is a group-living animal of high-altitude Himalaya, distributed all across the subalpine range that also formed an important prey base for large carnivores in Himalaya. The species is threatened due to habitat fragmentation, illegal poaching, and anthropogenic activities. We undertook population genetic assessment of Himalayan tahr from Western Himalaya and observed comparable genetic diversity at both mitochondrial and nuclear microsatellite loci. Bayesian skyline plots showed stable demography in the past several thousand years. We identified 27 unique individuals with a select panel of seven loci and the Bayesian structure analysis inferred two genetic clusters. The present study is the first report on the population genetic make-up of Himalayan tahr and can be used for long-term genetic monitoring of the species.

Association of Long-term Exposure to Air Pollution With Late-Life Depression in Older Adults in the US

Emerging evidence has suggested harmful associations of air pollutants with neurodegenerative diseases among older adults. However, little is known about outcomes regarding late-life mental disorders, such as geriatric depression. To investigate if long-term exposure to air pollution is associated with increased risk of late-life depression diagnosis among older adults in the US. This population-based longitudinal cohort study consisted of US Medicare enrollees older than 64 years. Data were obtained from the US Centers for Medicare and Medicaid Services Chronic Conditions Warehouse. The participants were continuously enrolled in the Fee-for-Service program and both Medicare Part A and Part B. After the 5-year washout period at entry, a total of 8 907 422 unique individuals were covered over the study period of 2005 to 2016, who contributed to 1 526 690 late-onset depression diagnoses. Data analyses were performed between March 2022 and November 2022. The exposures consisted of residential long-term exposure to fine particulate matter (PM2.5), measured in micrograms per cubic meter; nitrogen dioxide (NO2), measured in parts per billion; and ozone (O3), measured in parts per billion. Late-life depression diagnoses were identified via information from all available Medicare claims (ie, hospital inpatient, skilled nursing facility, home health agency, hospital outpatient, and physician visits). Date of the first occurrence was obtained. Hazard ratios and percentage change in risk were estimated via stratified Cox proportional hazards models accounting for climate coexposures, neighborhood greenness, socioeconomic conditions, health care access, and urbanicity level. A total of 8 907 422 Medicare enrollees were included in this study with 56.8% being female individuals and 90.2% being White individuals. The mean (SD) age at entry (after washout period) was 73.7 (4.8) years. Each 5-unit increase in long-term mean exposure to PM2.5, NO2, and O3 was associated with an adjusted percentage increase in depression risk of 0.91% (95% CI, 0.02%-1.81%), 0.61% (95% CI, 0.31%- 0.92%), and 2.13% (95% CI, 1.63%-2.64%), respectively, based on a tripollutant model. Effect size heterogeneity was found among subpopulations by comorbidity condition and neighborhood contextual backgrounds. In this cohort study among US Medicare enrollees, harmful associations were observed between long-term exposure to air pollution and increased risk of late-life depression diagnosis.

Seasonal movements and ecological markers as evidence for migration of common minke whales photo-identified in the eastern North Pacific

In the eastern North Pacific Ocean, common minke whales (Balaenoptera acutorostrata) are widespread but encountered relatively infrequently. It is generally believed that they make annual migrations between higher latitudes in the summer and lower latitudes in the winter; however, in some temperate coastal regions where common minke whales have been sighted year-round they have been referred to as resident. To determine movement patterns of common minke whales found in coastal waters of British Columbia and Washington we examined photo-identification data that were collected opportunistically from 2005–12. These data were from four non-overlapping areas between 48°N and 53°N. Despite year-round search efforts, common minke whales were only encountered between April and October. Most of the 44 unique individuals identified in 405 encounters displayed fidelity to areas both within and among years. Five of these whales made relatively large-scale intra-annual movements between areas on six occasions. They were documented to move up to 424km in a northerly direction in spring and up to 398km in a southerly direction in autumn. The seasonal patterns of these movements provide new insights into the foraging ranges and migrations of the individuals. Ecological markers provide evidence that the common minke whales photographed undertake annual long distance migrations. Scars believed to be from cookiecutter shark (Isistius brasiliensis) bites were observed on 43 individuals and the majority of whales documented with good quality images each year had acquired new scars since the previous year. Furthermore, the commensal barnacle Xenobalanus globicipitis was observed on three individuals. Since these sharks and barnacles are from relatively warm waters, it can be inferred that they interacted with the common minke whales at lower latitudes. These findings may have important implications for the definition and management of common minke whale stocks and/or populations in the eastern North Pacific.

Abstract WP139: Current Practice Trends In The Management Of Cervical Artery Dissection - Preliminary Results

Introduction: Cervical artery dissection (CAD) is a well-recognized cause of acute ischemic stroke, especially in young adults, accounting for up to 20-25% of all cases. Several studies reported an incidence between 2.5-5 per 100,000 in the general population. However, the actual incidence may be higher as many patients remain asymptomatic. Even though CAD is one of the leading causes of ischemic stroke, there is a lack of consensus in management. Our study surveyed practicing clinicians involved in the management of CAD to characterize current practice trends and provide a foundation for future research. Methods: An online case-based questionnaire with 11 questions regarding the management of cervical artery dissection was developed and piloted internally with 12 Mayo Clinic cerebrovascular neurologist/neurosurgeons. The survey was finalized, and initially sent to the STOP-CAD study group. We then sent the survey to practicing vascular neurologists across different academic institutions. Surveys were sent to 126 unique individuals. Results: A total of 42 clinicians completed the questionnaires. The response rate was 33% (42/126). Aspirin antiplatelet monotherapy was seen as the most appropriate therapy for asymptomatic CAD (81% [34/42]). Anticoagulation was the treatment of choice for cases with CAD and concomitant intraluminal thrombus (74% [31/42]). Most (74% [31/42]) of the participants recommended repeat imaging at three months. However, no consistent response regarding the type of antithrombotic agent for symptomatic CAD without intramural thrombus or cases with pseudoaneurysm. There was marked variability regarding the duration of antithrombotic therapy, ranging from three months to life-long treatment. Conclusion: Marked variability was seen in the management of CAD, especially regarding the choice of antithrombotic agent in symptomatic and complicated (stenosis or pseudoaneurysm) cases and the duration of such therapy, which reflects the lack of definitive clinical trial data. Ongoing research is needed to better guide the optimal management of these patients.

1334 THE OXFORD COGNITIVE COMORBIDITY AND AGEING RESEARCH DATABASE (ORCHARD): DESCRIPTION OF A LARGE ACUTE CARE RESEARCH DATABASE

Abstract Background Guidelines recommend that all older hospital patients are screened for cognitive comorbidity (i.e. dementia, delirium) and frailty to inform care and target multidisciplinary team resources based mainly on evidence from studies in outpatient or specialty-specific settings. Unselected hospital-wide data are needed to inform guidance and service design and delivery, so we set up the Oxford Cognitive Comorbidity and Ageing Research Database (ORCHARD) using routinely-acquired electronic patient record (EPR) data. Methods ORCHARD includes pseudonymised EPR data on all patients &amp;gt;65 years with unplanned admission to one of four general hospitals in Oxfordshire, serving a population of 660,000. Data collected include cognitive screening (mandatory for &amp;gt;70 years) comprising dementia history, delirium diagnosis (Confusion Assessment Method—CAM), and 10-point Abbreviated Mental Test; together with nursing risk assessments, frailty, diagnoses, comorbidities (Charlson index), observations, illness acuity, laboratory tests and brain imaging. Outcomes include length of stay, delayed transfers of care, discharge destination, readmissions, death and dementia through linkage to electronic mental health records. Results ORCHARD (2017-2019) includes data from 90,303 consecutive, unselected hospital admissions across all specialties (n=60,535 [67%] inpatient versus n=29,768 [33%] day case; n=73,385 [81%] medical versus n=16,918 [19%] surgical or other). Admissions data were linked to 46,533 unique individuals (n=23,724 [52%] female) with a mean/SD age of 78.3/9.6, Index of Multiple Deprivation Decile of 7.5/2.3 and Charlson Comorbidity of 8.1/9.4 at first admission. Frailty was prevalent, with 15,423 (33%) scoring moderate and 2,471 (5%) high on the Hospital Frailty Risk Score. Complete cognitive screening data are available for 34,416 (67%) unique individuals ≥70 years with inpatient admission. Conclusion ORCHARD is a large and rich data resource that will enable studies on the burden and impact of cognitive and physical frailty in-hospital, with relevance to the design and delivery of clinical services, and understanding of healthcare resource use hospital-wide and by specialty.

Mortality in pediatric oncology and stem cell transplant patients with bloodstream infections.

Bloodstream infections (BSI) continue to represent a significant source of morbidity for pediatric oncology patients, however less is known regarding this population's risk of death. We sought to evaluate the risk of BSI and death at a large pediatric cancer center. We retrospectively collected inpatient data from pediatric oncology and hematopoietic stem cell transplant (HSCT) patients over a 9-year period. We performed univariate and multivariable modeling to assess risk of BSI and mortality examining the following variables: demographics, underlying malignancy, history of HSCT, central line type, and febrile neutropenia (FN). During the study period, 6763 admissions from 952 patients met inclusion criteria. BSI occurred in 367 admissions (5.4%) from 231 unique individuals. Risk factors for BSI include younger age, diagnoses of hemophagocytic lymphohistiocytosis or acute myeloid leukemia, ethnicity, and history of HSCT. Mortality for those with BSI was 6.5%, compared to 0.7% without (OR 7.2, CI 4.1 - 12.7, p<0.0001). In patients with BSI, admissions with FN were associated with reduced mortality compared to admissions without FN (OR 0.21, CI 0.05 - 0.94, p=0.04). In both univariate and multivariable analysis, no other risk factor was significantly associated with mortality in patients with BSI. BSI is a significant source of mortality in pediatric oncology and HSCT patients. While demographic variables contribute to the risk of BSI, they did not influence mortality. These findings highlight the importance of BSI prevention to reduce the risk of death in pediatric oncology patients. Future studies should focus on comprehensive BSI prevention.

The global prevalence and ethnic heterogeneity of iron-refractory iron deficiency anaemia

BackgroundIron-refractory iron deficiency anaemia (IRIDA) is an autosomal recessive iron deficiency anaemia caused by mutations in the TMPRSS6 gene. Iron deficiency anaemia is common, whereas IRIDA is rare. The prevalence of IRIDA is unclear. This study aimed to estimate the carrier frequency and genetic prevalence of IRIDA using Genome Aggregation Database (gnomAD) data.MethodsThe pathogenicity of TMPRSS6 variants was interpreted according to the American College of Medical Genetics and Genomics (ACMG) and the Association for Molecular Pathology (AMP) standards and guidelines. The minor allele frequency (MAF) of TMPRSS6 gene disease-causing variants in 141,456 unique individuals was examined to estimate the global prevalence of IRIDA in seven ethnicities: African/African American (afr), American Admixed/Latino (amr), Ashkenazi Jewish (asj), East Asian (eas), Finnish (fin), Non-Finnish European (nfe) and South Asian (sas). The global and population-specific carrier frequencies and genetic prevalence of IRIDA were calculated using the Hardy–Weinberg equation.ResultsIn total, 86 pathogenic/likely pathogenic variants (PV/LPV) were identified according to ACMG/AMP guideline. The global carrier frequency and genetic prevalence of IRIDA were 2.02 per thousand and 1.02 per million, respectively.ConclusionsThe prevalence of IRIDA is greater than previous estimates.

Comparing Effectiveness of AHDriFT Systems and Sherman Traps for Surveying Small Mammals in Northeastern Indiana

Abstract Traditional small mammal survey methods (e.g., Sherman traps) are beneficial in certain conditions but tend to require substantial effort and funds and can introduce various biases. The recently described adapted-Hunt drift fence technique (AHDriFT) camera trap system (i.e., camera traps combined with drift fences) can survey small terrestrial vertebrates and does not require much time in the field. Our objective was to compare the efficiency and effectiveness of AHDriFT systems and traditional Sherman traps for surveying small mammal communities. We conducted surveys with both methods in four sites of varying habitat types at the Eagle Marsh Nature Preserve (Fort Wayne, Indiana) from February to July in 2020 and May to August in 2021. We conducted 640 trap nights (one trap set on one calendar night) of Sherman trap surveys and 551 trap nights of AHDriFT system surveys. We captured 192 small mammals of three species with Sherman traps and obtained 532 images of unique small mammal individuals of seven species with AHDriFT systems. Our AHDriFT systems resulted in two times greater species richness (Z = −6.21, P &amp;lt; 0.01), 16 times greater species evenness (Z = −4.83, P &amp;lt; 0.01), and 23 times greater Shannon's diversity values (Z = −4.87, P &amp;lt; 0.01) than Sherman traps. The AHDriFT systems also documented the presence of four species that the Sherman traps did not (northern short-tailed shrew Blarina brevicauda, common shrew Sorex cinereus, long-tailed weasel Neogale frenata, eastern chipmunk Tamias striatus). Overall, AHDriFT system surveys provided 1.5–5 times more observations per dollar spent and required 90% less time in the field than Sherman trap surveys. These results suggest that AHDriFT systems may be a more efficient and effective method of surveying small mammal communities.

Real-world experience with cefiderocol therapy for Pseudomonas aeruginosa and other multidrug resistant gram-negative infections within the Veterans Health Administration, 2019-2022.

Single-center and regional studies have reported outcomes after treatment with cefiderocol, a novel siderophore cephalosporin. We report on real-world use, clinical outcomes, and microbiological outcomes with cefiderocol therapy within the Veterans' Health Administration (VHA). Prospective, observational descriptive study. Veterans' Health Administration, 132 sites across the United States, during 2019-2022. This study included patients admitted to any VHA medical center who received cefiderocol for ≥2 days. Data were obtained from the VHA Corporate Data Warehouse and through manual chart review. We extracted clinical and microbiologic characteristics and outcomes. In total, 8,763,652 patients received 1,142,940,842 prescriptions during the study period. Of these, 48 unique individuals received cefiderocol. The median age of this cohort was 70.5 years (IQR, 60.5-74), and the median Charlson comorbidity score was 6 (IQR, 3-9). The most common infectious syndromes were lower respiratory tract infection in 23 patients (47.9%) and urinary tract infection in 14 patients (29.2%). The most common pathogen cultured was P. aeruginosa in 30 patients (62.5%). The clinical failure rate was 35.4% (17 of 48), and 15 (88.2%) of these 17 patients died within 3 days of clinical failure. The 30-day and 90-day all-cause mortality rates were 27.1% (13 of 48) and 45.8% (22 of 48), respectively. The 30-day and 90-day microbiologic failure rates were 29.2% (14 of 48) and 41.7% (20 of 48), respectively. In this nationwide VHA cohort clinical and microbiologic failure occurred in >30% of patients treated with cefiderocol, and >40% of these died within 90 days. Cefiderocol is not widely used, and many of the patients who received it had substantial comorbidities.