Association between proton pump inhibitor therapy and clostridium difficile infection: a contemporary systematic review and meta-analysis.

Abstract Introduction Emerging epidemiological evidence suggests that proton pump inhibitor (PPI) acid-suppression therapy is associated with an increased risk of Clostridium difficile infection (CDI). Methods Ovid MEDLINE, EMBASE, ISI Web of Science, and Scopus were searched from 1990 to January 2012 for analytical studies that reported an adjusted effect estimate of the association between PPI use and CDI. We performed random-effect meta-analyses. We used the GRADE framework to interpret the findings. Results We identified 47 eligible citations (37 case-control and 14 cohort studies) with corresponding 51 effect estimates. The pooled OR was 1.65, 95% CI (1.47, 1.85), I2 = 89.9%, with evidence of publication bias suggested by a contour funnel plot. A novel regression based method was used to adjust for publication bias and resulted in an adjusted pooled OR of 1.51 (95% CI, 1.26–1.83). In a speculative analysis that assumes that this association is based on causality, and based on published baseline CDI incidence, the risk of CDI would be very low in the general population taking PPIs with an estimated NNH of 3925 at 1 year. Conclusions In this rigorously conducted systemic review and meta-analysis, we found very low quality evidence (GRADE class) for an association between PPI use and CDI that does not support a cause-effect relationship

Outcomes in Knot vs Knotless Surgery in Labrum Tears

A Bankart lesion is a tear of the anterior and inferior glenoid labrum. The primary method of repairing this lesion is to sew the detached part back to the joint, however there is a relatively newer method of doing so that does not involve tying a knot in the joint which may cause less joint irritation. The question our research project attempted to answer was: How do the long-term outcomes associated with knotless Bankart labrum repairs compare with the knot repairs? A retrospective cohort study was done with Rothman Institute Bankart lesion patients from 2010-2016. Data was gathered over phone calls and responses to certain categorical questions like motion, function, stability and return to OR were measured on a scale 0-3. The mean score of these categories was calculated and many of them were close to identical. One category where there was some degree of difference was stability (0=no subluxation, 3=recurrent dislocation). Those who had the knot surgery reported a mean of 1.53 level of instability and those who had the knotless surgery reported a mean of 1.13. It was previously hypothesized that the knotless surgery would have fewer detrimental effects and although this is possible with a lower instability rating, the results were not statistically significant since the p-value was 0.43. However, it is possible that this result can be clinically significant for surgeons when deciding which surgical technique to employ

Evaluation of the current knowledge limitations in breast cancer research: a gap analysis

BACKGROUND A gap analysis was conducted to determine which areas of breast cancer research, if targeted by researchers and funding bodies, could produce the greatest impact on patients. METHODS Fifty-six Breast Cancer Campaign grant holders and prominent UK breast cancer researchers participated in a gap analysis of current breast cancer research. Before, during and following the meeting, groups in seven key research areas participated in cycles of presentation, literature review and discussion. Summary papers were prepared by each group and collated into this position paper highlighting the research gaps, with recommendations for action. RESULTS Gaps were identified in all seven themes. General barriers to progress were lack of financial and practical resources, and poor collaboration between disciplines. Critical gaps in each theme included: (1) genetics (knowledge of genetic changes, their effects and interactions); (2) initiation of breast cancer (how developmental signalling pathways cause ductal elongation and branching at the cellular level and influence stem cell dynamics, and how their disruption initiates tumour formation); (3) progression of breast cancer (deciphering the intracellular and extracellular regulators of early progression, tumour growth, angiogenesis and metastasis); (4) therapies and targets (understanding who develops advanced disease); (5) disease markers (incorporating intelligent trial design into all studies to ensure new treatments are tested in patient groups stratified using biomarkers); (6) prevention (strategies to prevent oestrogen-receptor negative tumours and the long-term effects of chemoprevention for oestrogen-receptor positive tumours); (7) psychosocial aspects of cancer (the use of appropriate psychosocial interventions, and the personal impact of all stages of the disease among patients from a range of ethnic and demographic backgrounds). CONCLUSION Through recommendations to address these gaps with future research, the long-term benefits to patients will include: better estimation of risk in families with breast cancer and strategies to reduce risk; better prediction of drug response and patient prognosis; improved tailoring of treatments to patient subgroups and development of new therapeutic approaches; earlier initiation of treatment; more effective use of resources for screening populations; and an enhanced experience for people with or at risk of breast cancer and their families. The challenge to funding bodies and researchers in all disciplines is to focus on these gaps and to drive advances in knowledge into improvements in patient care

The diversity of Type II supernova versus the similarity in their progenitors

High-quality collections of Type II supernova (SN) light curves are scarce because they evolve for hundreds of days, making follow-up observations time consuming and often extending over multiple observing seasons. In light of these difficulties, the diversity of SNe II is not fully understood. Here we present ultraviolet and optical photometry of 12 SNe II monitored by the Las Cumbres Observatory Global Telescope Network during 2013 to 2014, and compare them with previously studied SNe having well-sampled light curves. We explore SN II diversity by searching for correlations between the slope of the linear light-curve decay after maximum light (historically used to divide SNe II into IIL and IIP) and other measured physical properties. While SNe IIL are found to be on average more luminous than SNe IIP, SNe IIL do not appear to synthesize more $^{56}$Ni than SNe IIP. Finally, optical nebular spectra obtained for several SNe in our sample are found to be consistent with models of red supergiant progenitors in the 12–16 M$_{⊙}$ range. Consequently, SNe IIL appear not to account for the deficit of massive red supergiants as SN II progenitors.The authors acknowledge the ASASSN, La Silla Quest, and LOSS surveys for discovering new SNe that made this study possible. This material is based upon work supported by the National Science Foundation (NSF) under Grant No. 1313484. MDS gratefully acknowledges generous support provided by the Danish Agency for Science and Technology and Innovation realized through a Sapere Aude Level 2 grant. MF is supported by the European Union FP7 programme through ERC grant number 320360. SJS acknowledges funding from the European Research Council under the European Union's Seventh Framework Programme (FP7/2007-2013)/ERC Grant agreement No. [291222] and STFC grants ST/I001123/1 and ST/L000709/1. AVF's group at UC Berkeley is grateful for financial assistance from NSF grant AST-1211916, the TABASGO Foundation, Gary and Cynthia Bengier, and the Christopher R. Redlich Fund. This work was supported by the NSF under grants PHY-1125915 and AST-1109174. M.S. acknowledges support from EU/FP7-ERC grant no [615929]. This paper is based on observations made with the Swift, LCOGT, Gemini, and Keck Observatories; we thank their respective staffs for excellent assistance. The W. M. Keck Observatory is operated as a scientific partnership among the California Institute of Technology, the University of California, and NASA; the observatory was made possible by the generous financial support of the W. M. Keck Foundation. Based on observations collected at the European Organization for Astronomical Research in the Southern hemisphere, Chile as part of PESSTO, (the Public ESO Spectroscopic Survey for Transient Objects Survey) ESO program ID 188.D-3003.This is the final version of the article. It first appeared from Oxford University Press via http://dx.doi.org/10.1093/mnras/stw87

Narrowband Biphotons: Generation, Manipulation, and Applications

In this chapter, we review recent advances in generating narrowband biphotons with long coherence time using spontaneous parametric interaction in monolithic cavity with cluster effect as well as in cold atoms with electromagnetically induced transparency. Engineering and manipulating the temporal waveforms of these long biphotons provide efficient means for controlling light-matter quantum interaction at the single-photon level. We also review recent experiments using temporally long biphotons and single photons.Comment: to appear as a book chapter in a compilation "Engineering the Atom-Photon Interaction" published by Springer in 2015, edited by A. Predojevic and M. W. Mitchel

Inflammatory cytokines and biofilm production sustain Staphylococcus aureus outgrowth and persistence: A pivotal interplay in the pathogenesis of Atopic Dermatitis

Individuals with Atopic dermatitis (AD) are highly susceptible to Staphylococcus aureus colonization. However, the mechanisms driving this process as well as the impact of S. aureus in AD pathogenesis are still incompletely understood. In this study, we analysed the role of biofilm in sustaining S. aureus chronic persistence and its impact on AD severity. Further we explored whether key inflammatory cytokines overexpressed in AD might provide a selective advantage to S. aureus. Results show that the strength of biofilm production by S. aureus correlated with the severity of the skin lesion, being significantly higher (P < 0.01) in patients with a more severe form of the disease as compared to those individuals with mild AD. Additionally, interleukin (IL)-β and interferon γ (IFN-γ), but not interleukin (IL)-6, induced a concentration-dependent increase of S. aureus growth. This effect was not observed with coagulase-negative staphylococci isolated from the skin of AD patients. These findings indicate that inflammatory cytokines such as IL1-β and IFN-γ, can selectively promote S. aureus outgrowth, thus subverting the composition of the healthy skin microbiome. Moreover, biofilm production by S. aureus plays a relevant role in further supporting chronic colonization and disease severity, while providing an increased tolerance to antimicrobials

The association between histamine 2 receptor antagonist use and Clostridium difficile infection: a systematic review and meta-analysis.

Background Clostridium difficile infection (CDI) is a major health problem. Epidemiological evidence suggests that there is an association between acid suppression therapy and development of CDI. Purpose We sought to systematically review the literature that examined the association between histamine 2 receptor antagonists (H2RAs) and CDI. Data source We searched Medline, Current Contents, Embase, ISI Web of Science and Elsevier Scopus from 1990 to 2012 for all analytical studies that examined the association between H2RAs and CDI. Study selection Two authors independently reviewed the studies for eligibility. Data extraction Data about studies characteristics, adjusted effect estimates and quality were extracted. Data synthesis Thirty-five observations from 33 eligible studies that included 201834 participants were analyzed. Studies were performed in 6 countries and nine of them were multicenter. Most studies did not specify the type or duration of H2RAs therapy. The pooled effect estimate was 1.44, 95% CI (1.22–1.7), I2 = 70.5%. This association was consistent across different subgroups (by study design and country) and there was no evidence of publication bias. The pooled effect estimate for high quality studies was 1.39 (1.15–1.68), I2 = 72.3%. Meta-regression analysis of 10 study-level variables did not identify sources of heterogeneity. In a speculative analysis, the number needed to harm (NNH) with H2RAs at 14 days after hospital admission in patients receiving antibiotics or not was 58, 95% CI (37, 115) and 425, 95% CI (267, 848), respectively. For the general population, the NNH at 1 year was 4549, 95% CI (2860, 9097). Conclusion In this rigorous systematic review and meta-analysis, we observed an association between H2RAs and CDI. The absolute risk of CDI associated with H2RAs is highest in hospitalized patients receiving antibiotics

The Impact of Caregiver and Community Education On Influenza Vaccination Acceptance

Introduction: Pediatric populations are particularly vulnerable to influenza, and rely on parental approval of the pediatric influenza vaccine (PIV). We conducted a survey to better understand our community’s perspective on the PIV. Methods: An urban pediatric clinic’s records were gathered for the 2017-2019 flu seasons (i.e., pre-survey period). Surveys were distributed during the 2019-2020 flu season to assess vaccination status and their reasoning for acceptance or rejection of the PIV for their child(ren). Children vaccination rates were divided into 3 groups: 6 months-3 years, 3-5 years, and 5-18 years. Results: During the 2017-2018 flu season, the overall vaccination rate (n=1791) was 34.1%. For the 2018-2019 flu season, the overall vaccination rate (n=1795) was 41.7%. During the 2019-2020 flu season, the overall vaccination rate (n=1620) increased to 45.3%. This was a statistically significant increase from 2018-2019 flu season (p=0.035). The most common reason to vaccinate was, I do not want my child to get the flu/the shot reduces the likelihood of child getting the flu (52.2% in \u3c5 years age group, 56.5% in \u3e5 years age group). The most common reason to not vaccinate was, I do not want the flu shot for my child (35.7% in \u3c5 years age group, 38.6% in \u3e5 years age group). Discussion: Understanding community perceptions will allow for efficacious educational materials and allow healthcare providers to tailor their strategies for the sake of preventive medicine and community health

Screening for Inhalational Anthrax Due to Bioterrorism: Evaluating Proposed Screening Protocols

Eleven known cases of bioterrorism-related inhalational anthrax (IA) were treated in the United States during 2001. We retrospectively compared 2 methods that have been proposed to screen for IA. The 2 screening protocols for IA were applied to the emergency department charts of patients who presented with possible signs or symptoms of IA at Inova Fairfax Hospital (Falls Church, Virginia) from 20 October 2001 through 3 November 2001. The Mayer criteria would have screened 4 patients (0.4%; 95% CI, 0.1%-0.9%) and generated charges of 1900 dollars. If 29 patients (2.6%; 95% CI, 1.7%-3.7%) with \u3eor=5 symptoms (but without fever and tachycardia) were screened, charges were 13,325 dollars. The Hupert criteria would have screened 273 patients (24%; 95% CI, 22%-27%) and generated charges of 126,025 dollars. In this outbreak of bioterrorism-related IA, applying the Mayer criteria would have identified both patients with IA and would have generated fewer charges than applying the Hupert criteria

The impact of emotional well-being on long-term recovery and survival in physical illness: a meta-analysis

This meta-analysis synthesized studies on emotional well-being as predictor of the prognosis of physical illness, while in addition evaluating the impact of putative moderators, namely constructs of well-being, health-related outcome, year of publication, follow-up time and methodological quality of the included studies. The search in reference lists and electronic databases (Medline and PsycInfo) identified 17 eligible studies examining the impact of general well-being, positive affect and life satisfaction on recovery and survival in physically ill patients. Meta-analytically combining these studies revealed a Likelihood Ratio of 1.14, indicating a small but significant effect. Higher levels of emotional well-being are beneficial for recovery and survival in physically ill patients. The findings show that emotional well-being predicts long-term prognosis of physical illness. This suggests that enhancement of emotional well-being may improve the prognosis of physical illness, which should be investigated by future research