Treating Viral Respiratory Tract Infections with Antibiotics in Hospitals: No Longer a Case of Mistaken Identity

Widespread use of antibiotics in hospitalized patients contributes to the development of multidrug resistant organisms that make many infections increasingly difficult to treat. Despite calls to prescribe antibiotics judiciously, many physicians continue to order antibiotics for inpatients who do not need them. This Issue Brief investigates antibiotic use in hospitalized adults with a confirmed viral infection, a group of patients that may not benefit from such therapy. Understanding the factors that lead to inappropriate antibiotic use may help change clinical practice and limit antibiotic resistance

Shear wave splitting across the Iceland hot spot: Results from the ICEMELT experiment

We report on observations of upper mantle anisotropy from the splitting of teleseismic shear waves (SKS, SKKS, and PKS) recorded by the ICEMELT broadband seismometer network in Iceland. In a ridge-centered hot spot locale, mantle anisotropy may be generated by flow-induced lattice-preferred orientation of olivine grains or the anisotropic distribution of magma. Splitting measurements of teleseismic shear waves may thus provide diagnostic information on upper mantle flow and/or the distribution of retained melt associated with the Iceland mantle plume. In eastern Iceland, fast polarization directions lie between N10°W and N45°W and average N24°W; delay times between the fast and slow shear waves are generally 0.7–1.35 s. In western Iceland, in contrast, the fast polarization directions, while less well constrained, yield an average value of N23°E and delay times are smaller (0.2–0.95 s). We propose that splitting in eastern Iceland is caused by a 100- to 200-km-thick anisotropic layer in the upper mantle. The observed fast directions in eastern Iceland, however, do not correspond either to the plate spreading direction or to a pattern of radial mantle flow from the center of the Iceland hot spot. We suggest that the relatively uniform direction and magnitude of splitting in eastern Iceland, situated on the Eurasian plate, may therefore reflect the large-scale flow field of the North Atlantic upper mantle. We hypothesize that the different pattern of anisotropy beneath western Iceland, part of the North American plate, is due to the different absolute motions of the two plates. By this view, splitting in eastern and western Iceland is the consequence of shear by North American and Eurasian plate motion relative to the background mantle flow. From absolute plate motion models, in which the Eurasian plate is approximately stationary and the North American plate is moving approximately westward, the splitting observations in both eastern and western Iceland can be satisfied by a background upper mantle flow in the direction N34°W and a velocity of 3 cm/yr in a hot spot reference frame. This inference can be used to test mantle flow models. In particular, it is inconsistent with kinematic flow models, which predict southward flow, or models where flow is dominated by subduction-related sources of mantle buoyancy, which predict westward flow. Our observations are more compatible with the flow field predicted from global seismic tomography models, which in particular include the influence of the large-scale lower mantle upwelling beneath southern Africa. While the hypothesized association between our observations and this upwelling is presently speculative, it makes a very specific and testable prediction about the flow field and hence anisotropy beneath the rest of the Atlantic basin.This work was supported by the National Science Foundation under grants EAR-9316137, OCE-9402991, and EAR-9707193.Peer Reviewe

Body Composition, Physical Activity and Fitness in Children with Moderate-to-Severe Intellectual Disability

Introduction: The prevalence of overweight and obesity has been rising in most parts of the world over the past two decades (1, 2). This rise could pose even a greater problem for people with intellectual disability (ID) because they are more likely to be obese than people without ID (3). Furthermore, research has shown that a sedentary lifestyle is more prevalent among people with ID than otherwise healthy people in modern society (4). In the general population, the adverse effects of obesity on health begin early in life and physical inactivity and adiposity are associated with metabolic diseases and cancers (5). In contrast, higher levels of physical activity and aerobic fitness have been associated with lower risk for metabolic diseases (6, 7). Although it is anticipated that children with ID experience the same adverse effects of health from obesity and lack of physical activity and aerobic fitness, it has not been comprehensively studied. In this context the purpose of this study was to investigate body composition, physical activity and fitness among children with moderate-to-severe ID

Regional anaesthesia in patients on antithrombotic drugs - a joint ESAIC/ESRA guideline : Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline Regional anaesthesia in patients on antithrombotic drugs - a joint ESAIC/ESRA guideline. This clinical practice guideline serves as a useful decision aid for Nordic anaesthesiologists providing regional anaesthesia to adult patients on antithrombotic drugs.Non peer reviewe

Transfusion strategies in bleeding critically ill adults : A clinical practice guideline from the European Society of Intensive Care Medicine: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline Transfusion strategies in bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine. This trustworthy clinical practice guideline serves as a useful decision aid for Nordic anaesthesiologists caring for critically ill patients with bleeding.Non peer reviewe

Clinical practice guideline on the management of septic shock and sepsis-associated organ dysfunction in children : Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

Background The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. The guideline can serve as a useful decision aid for clinicians managing children with suspected and confirmed septic shock and sepsis-associated organ dysfunction.Non peer reviewe

Surviving sepsis campaign : International guidelines for management of sepsis and septic shock in adults 2021-endorsement by the Scandinavian society of anaesthesiology and intensive care medicine

The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. The guideline serves as a useful bedside decision aid for clinicians managing adults with suspected and confirmed septic shock and sepsis-associated organ dysfunction.Non peer reviewe

ESAIC focused guideline for the use of cardiac biomarkers in perioperative risk evaluation : Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

Publisher Copyright: © 2024 The Author(s). Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.Background: The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline “ESAIC focused guideline for the use of cardiac biomarkers in perioperative risk evaluation.” The guideline can provide guidance to Nordic anaesthesiologists on the perioperative use of cardiac biomarkers in patients undergoing non-cardiac surgery.Peer reviewe

Awake proning in patients with COVID-19-related hypoxemic acute respiratory failure : Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

Publisher Copyright: © 2023 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.Background: Awake proning in spontaneously breathing patients with hypoxemic acute respiratory failure was applied during the coronavirus disease 2019 (COVID-19) pandemic to improve oxygenation while avoiding tracheal intubation. An updated systematic review and meta-analysis on the topic was published. Methods: The Clinical practice committee (CPC) of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) assessed the clinical practice guideline “Awake proning in patients with COVID-19-related hypoxemic acute respiratory failure: A rapid practice guideline” for possible endorsement. The Appraisal of Guidelines for REsearch and Evaluation (AGREE) II tool was used. Results: Four out of six SSAI CPC members completed the appraisal. The individual domain totals were: Scope and Purpose 90%; Stakeholder Involvement 89%; Rigour of Development 74%; Clarity of Presentation 85%; Applicability 75%; Editorial Independence 98%; Overall Assessment 79%. Conclusion: The SSAI CPC endorses the clinical practice guideline “Awake proning in patients with COVID-19-related hypoxemic acute respiratory failure: A rapid practice guideline”. This guideline serves as a useful decision aid for clinicians caring for critically ill patients with COVID-19-related acute hypoxemic respiratory failure and can be used to provide guidance on use of prone positioning in this group of patients.Peer reviewe

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms