Effect of Central Line Duration and Other Risk Factors on Central Line-Associated Bloodstream Infection in Severe Adult Burns Patients at a Large Tertiary Referral Burns Centre: A 5-Year Retrospective Study

Central line-associated bloodstream infection (CLABSI) and catheter-related bloodstream infection (CLABSI with a positive catheter tip culture, CRBSI) are preventable causes of morbidity and mortality for severe adult burns patients. Routine central line changes as a CLABSI prevention strategy in burns patients is controversial due to the paucity of evidence to guide the appropriate timing of line changes. This study aimed to address this evidence gap by investigating risk factors associated with central line sepsis, including the duration of central line insertion, in a population of severe adult burns patients (burns involving ≥20% total body surface area (TBSA)) admitted to the Royal Brisbane and Women’s Hospital Intensive Care Unit over five years (2015–2019 inclusive). On multivariate analysis, central line duration and burn TBSA were identified as independent risk factors for CLABSI, with central line duration the most significant predictor (p = 0.0008; OR 1.177, 95% CI 1.072–1.299). No risk factor independently predicted CRBSI. CLABSI detection occurred a median of 8.5 days (IQR 6.0–11.0) post central line insertion. These findings suggest further research to assess the efficacy of routine line changes prior to the at-risk period of 6–11 days post central line insertion in reducing CLABSI in severe adult burns patients may be beneficial.

How Does COVID-19 Affect the Volatility Spillover Between the Exchange Rate and the Export-oriented Businesses in Iran?

This study concentrates on examining the volatility spillover effects between the exchange rate (IRR to USD) and the leading export-oriented industries (i.e., petrochemical, basic metals and minerals) in Tehran Stock Exchange before and after the COVID-19 pandemic. Using DCC- and asymmetric DCC-GARCH approaches, the data sample (from 15 December 2018 to 24 April 2021) has been partitioned into two sub-samples: before and after the official announcement of COVID-19 outbreak. The results demonstrate that from the pre- to post-COVID-19 periods, first, the average returns of all industries have sharply fallen; second, the volatility of all variables has been significantly augmented in different horizons; third, for all industries, not only has the fractal market hypothesis approved in both separated periods, but also analysing the values of the fractional difference parameter, together with the outcomes of GARCH models, supports in the higher-risk post-COVID-19 period, wherein the effects of exogenous shocks last longer than their impacts in the alternative lower-risk period. Furthermore, our investigations demonstrate that the asymmetric spillover (based on the ADCC-GARCH models) in both pre- and post-COVID-19 periods are confirmed in all three industries, except for minerals after the novel coronavirus.Ultimately, the results not only corroborate the increase in the volatility spillover effects right after the COVID-19 but also substantiate that the exchange rate contributes most of the spillover effects into the petrochemical and minerals industries, which have been almost twice as much as those of the basic metals.

Forecasting model for disease risk period in chickpea x collar rot pathosystem

Collar rot caused by Sclerotium rolfsii Sacc. is one of the major biotic constraints of chickpea production worldwide. It is soil-borne fungi having wider host range and infection mainly occurs at the juvenile stage of crop growth resulting crop failure in no time. The pathogen is greatly influenced by soil temperature (ST) and soil moisture (SM) therefore, experiment formulated to develop a suitable forecasting model for its future use in computer simulation of plant disease prognostication by feeding only soil temperature and moisture data. The popular desi type chickpea variety Anuradha sown at different dates to get a range of soil temperature and soil moisture combination and its corresponding effect on disease incidence was recorded under natural epiphytotic conditions. The data obtained were analyzed using binary logistic regression and discriminant analysis to assess disease risk and non-risk period. The model developed was Y'= -73.9 + 1.251 SM + 0.017 ST. The outcome recorded, a unique statistically significant contribution of soil moisture (p value=0.029) on the establishment of the disease whereas, the effect of soil temperature was detected as statistically non-significant. The model developed and the correctness of the model determined to predict the disease severity with 80 % accuracy.

Perioperative consultative hematology: can you clear my patient for a procedure?

Periprocedural management of antithrombotics is a common but challenging clinical scenario that renders patients vulnerable to potential adverse events such as bleeding and thrombosis. Over the past decade, periprocedural antithrombotic approaches have changed considerably with the advent of direct oral anticoagulants (DOACs), as well as a paradigm shift away from bridging in many warfarin patients. Successfully navigating this high-risk period relies on a number of individualized patient assessments conducted within a framework of standardized, systematic approaches. It also requires a thorough understanding of antithrombotic pharmacokinetics, multidisciplinary coordination of care, and comprehensive patient education and empowerment. In this article, we provide clinicians with a practical, stepwise approach to periprocedural management of antithrombotic agents through case-based examples of relevant clinical scenarios.

Source Regions of the First Immigration of Fall Armyworm, Spodoptera frugiperda (Lepidoptera: Noctuidae) Invading Australia

Fall armyworm is recognized as one of most highly destructive global agricultural pests. In January 2020, it had first invaded Australia, posing a significant risk to its biosecurity, food security, and agricultural productivity. In this study, the migration paths and wind systems for the case of fall armyworm invading Australia were analyzed using a three-dimensional trajectory simulation approach, combined with its flight behavior and NCEP meteorological reanalysis data. The analysis showed that fall armyworm in Torres Strait most likely came from surrounding islands of central Indonesia on two occasions via wind migration. Specifically, fall armyworm moths detected on Saibai and Erub Islands might have arrived from southern Sulawesi Island, Indonesia, between January 15 and 16. The fall armyworm in Bamaga most likely arrived from the islands around Arafura Sea and Sulawesi Island of Indonesia, between January 26 and 27. The high risk period for the invasion of fall armyworm is only likely to have occurred in January–February due to monsoon winds, which were conducive to flight across the Timor Sea towards Australia. This case study is the first to confirm the immigration paths and timing of fall armyworm from Indonesia to Australia via its surrounding islands.

Screening Computed Tomography Angiography to Identify Patients at Low Risk for Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage

Introduction: Delayed cerebral ischemia (DCI) occurs during a risk period of 3–21 days following aneurysmal subarachnoid hemorrhage (aSAH) and is associated with worse outcomes. The identification of patients at low risk for DCI might permit triage to less intense monitoring and management. While large-vessel vasospasm (LVV) is a distinct clinical entity from DCI, the presence of moderate-to-severe LVV is associated with a higher risk of DCI. Our hypothesis was that the absence of moderate-to-severe LVV on screening computed tomographic angiography (CTA) performed within the first few days of the DCI risk period will accurately identify patients at low risk for subsequent DCI.Methods: This was a retrospective cohort study. Our institutional SAH outcomes registry was queried for all aSAH patients admitted in 2016–2019 who underwent screening CTA brain between days 4 and 8 following ictus. We excluded patients diagnosed with DCI prior to the first CTA performed during this time period. All variables are prospectively entered into the registry, and outcomes including DCI and LVV are prospectively adjudicated. We evaluated the predictive value and accuracy of moderate-to-severe LVV on CTA performed 4–8 days following ictus for the prediction of subsequent DCI.Results: A total of 243 aSAH patients were admitted during the study timeframe. Of the 54 patients meeting the eligibility criteria, 11 (20%) had moderate-to-severe LVV on the screening CTA study performed during the risk period. Seven of the 11 (64%) patients with moderate-to-severe LVV on the days 4–8 screening CTA vs. six of 43 (14%) patients without, subsequently developed DCI. On multivariate analysis, the presence of LVV on days 4–8 screening CTA was an independent predictor of DCI (odds ratio 10.26, 95% CI 1.69–62.24, p = 0.011). NPV for the subsequent development of DCI was 86% (95% CI 77–92%). Sensitivity was 54% (25–81%), specificity 90% (77–97%), and positive predictive value 64% (38–83%).Conclusions: The presence of moderate-to-severe LVV on screening CTA performed between days 4 and 8 following aSAH was an independent predictor of DCI, but achieved only moderate diagnostic accuracy, with NPV 86% and sensitivity 54%. Complementary risk-stratification strategies are likely necessary.

Willingness and Uptake of the COVID-19 Testing and Vaccination in Urban China: An Online Cross-Sectional Survey at Early 2021

Background: Regular testing and vaccination are effective measures to mitigate the ongoing COVID-19 pandemic. Few studies have focused on COVID-19 testing and vaccination uptake may change as the pandemic continues. This study aims to examine willingness and uptake of COVID-19 testing and vaccination during a low-risk period of the COVID-19 pandemic in urban China.Methods: A cross-sectional online survey was conducted among 2244 adults in urban China. Descriptive analyses were performed to compare the respondents’ willingness and uptake of COVID-19 testing and vaccination. Multivariate logistic regressions were fitted to investigate the factors associated with willingness and uptake of the two measures.Findings: In early 2021, 52.45% of the respondents had received or scheduled a COVID-19 test at least once, and a majority (95.63%) were willing to receive testing. 63.28% of the respondents had received/scheduled or were willing to receive a COVID-19 vaccine. Willingness and uptake of COVID-19 testing were not associated with socio-demographic characteristics, except for occupation. Being of older age, migrants, having higher educational attainment and secure employment were associated with a higher uptake of COVID-19 vaccination among the surveyed respondents, while willingness to vaccinate was consistent across socio-demographic characteristics among those who had not been vaccinated. Interpretation: Chinese adults expressed almost universal willingness of COVID-19 testing and relatively low willingness of COVID-19 vaccination at the low-risk period of the COVID-19 pandemic, independent from their socio-demographic characteristics. Maintaining willingness of COVID-19 vaccination are key especially when the pandemic evolved into a low-risk period.

Willingness and uptake of the COVID-19 testing and vaccination in urban China: an online cross-sectional survey at early 2021 (Preprint)

BACKGROUND Regular testing and vaccination are effective measures to mitigate the ongoing COVID-19 pandemic. Few studies have focused on COVID-19 testing and vaccination uptake may change as the pandemic continues. OBJECTIVE To examine willingness and uptake of COVID-19 testing and vaccination during a low-risk period of the COVID-19 pandemic in urban China. METHODS A cross-sectional online survey was conducted among 2244 adults in urban China. Descriptive analyses were performed to compare the respondents’ willingness and uptake of COVID-19 testing and vaccination. Multivariate logistic regressions were fitted to investigate the factors associated with willingness and uptake of the two measures. RESULTS In early 2021, 52.45% of the respondents had received or scheduled a COVID-19 test at least once, and a majority (95.63%) were willing to receive testing. 63.28% of the respondents had received/scheduled or were willing to receive a COVID-19 vaccine. Willingness and uptake of COVID-19 testing were not associated with socio-demographic characteristics, except for occupation. Being of older age, migrants, having higher educational attainment and secure employment were associated with a higher uptake of COVID-19 vaccination among the surveyed respondents, while willingness to vaccinate was consistent across socio-demographic characteristics among those who had not been vaccinated. CONCLUSIONS Chinese adults expressed almost universal willingness of COVID-19 testing and relatively low willingness of COVID-19 vaccination at the low-risk period of the COVID-19 pandemic, independent from their socio-demographic characteristics. Maintaining willingness of COVID-19 vaccination is key especially when the pandemic evolved into a low-risk period.

Vztah atopického ekzému a pozornosti

PROBLEM: Atopic eczema is linked with several other psychosomatic diseases and disorders like sleeping disorders or low quality, chronic itching, etc. First, it is important to define two related terms that are important not to confuse, namely ADHD and ADD. Both of these attention disorders are inherited neurodevelopmental disorders. ADD is characterized by loss of concentration, distraction, and emotional hypersensitivity. ADHD is an attention deficit hyperactivity disorder. It is characterized by inattention, hyperactivity, and impulsivity. The survey study aims at describing the relation of two variables – atopic eczema and attention. Based on the results of the available studies dealing with the said relation, the topic will be presented to the reader and the existing pieces of knowledge will be summarized. METHODS: The study worked with sources from available scientific databases: PubMed, PsycInfo, Scopus and Web of Science. The following key words were entered for search: atopic eczema, ADHD, ADD, attention, relation. Another criterion selected for search was the period of observation, which we set without determination; that decision was based on the fact that the topic in question is specific. The studies were selected based on their relevance for the goal set. 10 studies were analyzed in total. RESULTS: The analysis results show that studies dealing with the issue of the effect of atopic eczema can be divided into two groups. The first group consists of studies which state, based on research, that persons with diagnosed atopic eczema are endangered by attention disorders. While comparing them with healthy population, i.e., with persons without atopic eczema, it was found that persons with atopic eczema have higher proportional chance of attention disorders, and other health problems linked with the said disease, like low quality of sleep, anxieties, depressions or behaviour disorders were registered as well. The studies under analysis also mention a risk period that may be essential for the development of attention disorder. The other group consists of studies which did not demonstrate a direct causal relation between attention eczema and attention disorders, which, if demonstrated, could lead to setting of preventive and therapeutic plans. The results of some of these studies show the coexistence of atopic eczema and ADHD, but the authors state that both disorders may not have causal relation and that they may be influenced by other factors; they recommend other studies which could clarify the prevalence of ADHD in persons with atopic eczema. DISCUSSION AND CONCLUSION: In conclusion, it can be stated that there is a higher risk of attention disorder, ADHD, in individuals with atopic eczema. However, as studies show, a causal relation between the two variables in question has not been found yet. The results have also shown that this issue is still little explored, in spite of the fact that a number of studies had a large research set. Therefore, further extensive interdisciplinary studies are needed, in order to prove or disprove their mutual causal relation. In case of proving the causal relation, it is further recommended to proceed to determine preventive and therapeutic strategies for attention disorders caused by atopic eczema, in order to positively influence the resulting quality of life of the individuals with the said disorder type.