Clinical and economic outcomes of serious postoperative infections following resection of common respiratory and gastrointestinal solid tumors

Unlike infections occurring during periods of chemotherapy-induced neutropenia, postoperative infections in patients with solid malignancy remain largely understudied. The purpose of this population-based study was to evaluate the clinical and economic burden, as well as the relationship of hospital surgical volume and outcomes associated with serious postoperative infection (SPI) – i.e., bacteremia/sepsis, pneumonia, and wound infection – following resection of common solid tumors.^ From the Texas Discharge Data Research File, we identified all Texas residents who underwent resection of cancer of the lung, esophagus, stomach, pancreas, colon, or rectum between 2002 and 2006. From their billing records, we identified ICD-9 codes indicating SPI and also subsequent SPI-related readmissions occurring within 30 days of surgery. Random-effects logistic regression was used to calculate the impact of SPI on mortality, as well as the association between surgical volume and SPI, adjusting for case-mix, hospital characteristics, and clustering of multiple surgical admissions within the same patient and patients within the same hospital. Excess bed days and costs were calculated by subtracting values for patients without infections from those with infections computed using multilevel mixed-effects generalized linear model by fitting a gamma distribution to the data using log link.^ Serious postoperative infection occurred following 9.4% of the 37,582 eligible tumor resections and was independently associated with an 11-fold increase in the odds of in-hospital mortality (95% Confidence Interval [95% CI], 6.7-18.5, P < 0.001). Patients with SPI required 6.3 additional hospital days (95% CI, 6.1 - 6.5) at an incremental cost of $16,396 (95% CI, $15,927–$16,875). There was a significant trend toward lower overall rates of SPI with higher surgical volume (P=0.037). ^ Due to the substantial morbidity, mortality, and excess costs associated with SPI following solid tumor resections and given that, under current reimbursement practices, most of this heavy burden is borne by acute care providers, it is imperative for hospitals to identify more effective prophylactic measures, so that these potentially preventable infections and their associated expenditures can be averted. Additional volume-outcomes research is also needed to identify infection prevention processes that can be transferred from higher- to lower-volume providers.^

Impact of maternal Tdap vaccination on pertussis infection in young infants

Undiagnosed infected mothers often are the source of pertussis illness in young infants. The Centers for Disease Control and Prevention (CDC) recommends Tdap vaccine for post-partum women before hospital discharge. This intervention has been implemented at Ben Taub General Hospital (BTGH) in Houston, TX since January 2008. Our objective was to compare the proportion of infants born at BTGH and developing pertussis to the total number of pertussis cases before and after the intervention. Methods. We conducted a cross-sectional comparative study between the pre-intervention (7/2000 to 12/2007) and post-intervention (1/2008 to 5/2009) periods. Information on pertussis diagnosis was determined using ICD-9 codes, infection control records, and molecular microbiology reports from Texas Children's Hospital (TCH) and BTGH. Only patients ≤ 6 months of age with laboratory-confirmed B. pertussis infection were included in the study. Results. 481 infants had pertussis illness; 353 (73.3%) during pre-intervention and 128 (26.6%) during post-intervention years. The groups were comparable in all measures including age (median 73 vs. 62.5 days; p=0.08), gender (males 54.2%; p=0.47), length of hospitalization (median 9.8 vs. 4 9.5 days; p=0.5), outcomes (2 deaths in each period; p=0.28) and pertussis illness at TCH (95.2% vs. 95.3%; p=0.9). The proportion of pertussis patients born at BTGH, and thus amenable to protection by the intervention, was not statically different between the two periods after adjusting for age, gender and ethnicity (7.3% vs. 9.3%; an OR=1.05, 95% CI 0.5-2.1, p=0.88). Conclusions. Vaccinating only mothers with Tdap in the post-partum period does not reduce the proportion of pertussis in infants age ≤ 6 months. Efforts should be directed at Tdap immunization of not only mothers, but also all household and key contacts of newborns to protect them against pertussis illness before the primary DTaP series is completed.^

Air Force Web Preventive Health Assessment (AF WEBPHA) mental health screening effectiveness

The U.S. Air Force assesses Active Duty Air Force (ADAF) health annually using the Air Force Web-based Preventative Health Assessment (AF WebPHA). The assessment is based on a self-administered survey used to determine the overall Air Force health and readiness, as well as, the individual health of each airman. Individual survey responses as well as groups of responses generate further computer generated assessment and result in a classification of 'Critical', 'Priority', or 'Routine', depending on the need and urgency for further evaluation by a health care provider. The importance of the 'Priority' and 'Critical' classifications is to provide timely intervention to prevent or limit unfavorable outcomes that may threaten an airman. Though the USAF has been transitioning from a paper form to the online WebPHA survey for the last three years it was not made mandatory for all airmen until 2009. The survey covers many health aspects including family history, tobacco use, exercise, alcohol use, and mental health. ^ Military stressors such as deployment, change of station, and the trauma of war can aggravate and intensify the common baseline worries experienced by the general population and place airmen at additional risks for mental health concerns and illness. This study assesses the effectiveness of the AF WebPHA mental health screening questions in predicting a mental health disorder diagnosis according to International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes generated by physicians or their surrogates. In order to assess the sensitivity, specificity, and positive predictive value of the AF WebPHA as a screening tool for mental health, survey results were compared to ascertain if they generated any mental health disorder related diagnosis for the period from January 1, 2009 to March 31, 2010. ^ Statistical analysis of the AF WebPHA mental health responses when compared with matching ICD-9-CM codes found that the sensitivity for 'Critical' or 'Priority' responses was only 3.4% and that it would correctly predict those who had the selected mental health diagnosis 9% of the time.^

Percutaneous transluminal coronary angioplasty and coronary events in a biethnic Texas community, 1985--1990

The relationship between change in myocardial infarction (MI) mortality rate (ICD codes 410, 411) and change in use of percutaneous transluminal coronary angioplasty (PTCA), adjusted for change in hospitalization rates for MI, and for change in use of aortocoronary bypass surgery (ACBS) from 1985 through 1990 at private hospitals was examined in the biethnic community of Nueces County, Texas, site of the Corpus Christi Heart Project, a major coronary heart disease (CHD) surveillance program. Age-adjusted rates (per 100,000 persons) were calculated for each of these CHD events for the population aged 25 through 74 years and for each of the four major sex-ethnic groups: Mexican-American and Non-Hispanic White women and men. Over this six year period, there were 541 MI deaths, 2358 MI hospitalizations, 816 PTCA hospitalizations, and 920 ACBS hospitalizations among Mexican-American and Non-Hispanic White Nueces County residents. Acute MI mortality decreased from 24.7 in the first quarter of 1985 to 12.1 in the fourth quarter of 1990, a 51.2% decrease. All three hospitalization rates increased: The MI hospitalization rates increased from 44.1 to 61.3, a 38.9% increase, PTCA use increased from 7.1 to 23.2, a 228.0% increase, and ACBS use increased from 18.8 to 29.5, a 56.6% increase. In linear regression analyses, the change in MI mortality rate was negatively associated with the change in PTCA use (beta = $-$.266 $\pm$.103, p = 0.017) but was not associated with the changes in MI hospitalization rate and in ACBS use. The results of this ecologic research support the idea that the increasing use of PTCA, but not ACBS, has been associated with decreases in MI mortality. The contrast in associations between these two revascularization procedures and MI mortality highlights the need for research aimed at clarifying the proper roles of these procedures in the treatment of patients with CHD. The association between change in PTCA use and change in MI mortality supports the idea that some changes in medical treatment may be partially responsible for trends in CHD mortality. Differences in the use of therapies such as PTCA may be related to differences between geographical sites in CHD rates and trends. ^

Prevalence and determinants of hepatitis B co-infection among a United States Veterans Administration cohort with hepatitis C

Background and aim. Hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection is associated with increased risk of cirrhosis, decompensation, hepatocellular carcinoma, and death. Yet, there is sparse epidemiologic data on co-infection in the United States. Therefore, the aim of this study was to determine the prevalence and determinants of HBV co-infection in a large United States population of HCV patients. ^ Methods. The National Veterans Affairs HCV Clinical Case Registry was used to identify patients tested for HCV during 1997–2005. HCV exposure was defined as two positive HCV tests (antibody, RNA or genotype) or one positive test combined with an ICD-9 code for HCV. HCV infection was defined as only a positive HCV RNA or genotype. HBV exposure was defined as a positive test for hepatitis B core antibodies, hepatitis B surface antigen, HBV DNA, hepatitis Be antigen, or hepatitis Be antibody. HBV infection was defined as only a positive test for hepatitis B surface antigen, HBV DNA, or hepatitis Be antigen within one year before or after the HCV index date. The prevalence of exposure to HBV in patients with HCV exposure and the prevalence of HBV infection in patients with HCV infection were determined. Multivariable logistic regression was used to identify demographic and clinical determinants of co-infection. ^ Results. Among 168,239 patients with HCV exposure, 58,415 patients had HBV exposure for a prevalence of 34.7% (95% CI 34.5–35.0). Among 102,971 patients with HCV infection, 1,431 patients had HBV co-infection for a prevalence of 1.4% (95% CI 1.3–1.5). The independent determinants for an increased risk of HBV co-infection were male sex, positive HIV status, a history of hemophilia, sickle cell anemia or thalassemia, history of blood transfusion, cocaine and other drug use. Age >50 years and Hispanic ethnicity were associated with a decreased risk of HBV co-infection. ^ Conclusions. This is the largest cohort study in the United States on the prevalence of HBV co-infection. Among veterans with HCV, exposure to HBV is common (∼35%), but HBV co-infection is relatively low (1.4%). There is an increased risk of co-infection with younger age, male sex, HIV, and drug use, with decreased risk in Hispanics.^

Trastuzumab use and risk of congestive heart failure in older breast cancer patients

Trastuzumab is a humanized-monoclonal antibody, developed specifically for HER2-neu over-expressed breast cancer patients. Although highly effective and well tolerated, it was reported associated with Congestive Heart Failure (CHF) in clinical trial settings (up to 27%). This leaves a gap where, Trastuzumab-related CHF rate in general population, especially older breast cancer patients with long term treatment of Trastuzumab remains unknown. This thesis examined the rates and risk factors associated with Trastuzumab-related CHF in a large population of older breast cancer patients. A retrospective cohort study using the existing Surveillance, Epidemiology and End Results (SEER) and Medicare linked de-identified database was performed. Breast cancer patients ≥ 66 years old, stage I-IV, diagnosed in 1998-2007, fully covered by Medicare but no HMO within 1-year before and after first diagnosis month, received 1st chemotherapy no earlier than 30 days prior to diagnosis were selected as study cohort. The primary outcome of this study is a diagnosis of CHF after starting chemotherapy but none CHF claims on or before cancer diagnosis date. ICD-9 and HCPCS codes were used to pool the claims for Trastuzumab use, chemotherapy, comorbidities and CHF claims. Statistical analysis including comparison of characteristics, Kaplan-Meier survival estimates of CHF rates for long term follow up, and Multivariable Cox regression model using Trastuzumab as a time-dependent variable were performed. Out of 17,684 selected cohort, 2,037 (12%) received Trastuzumab. Among them, 35% (714 out of 2037) were diagnosed with CHF, compared to 31% (4784 of 15647) of CHF rate in other chemotherapy recipients (p<.0001). After 10 years of follow-up, 65% of Trastuzumab users developed CHF, compared to 47% in their counterparts. After adjusting for patient demographic, tumor and clinical characteristics, older breast cancer patients who used Trastuzumab showed a significantly higher risk in developing CHF than other chemotherapy recipients (HR 1.69, 95% CI 1.54 - 1.85). And this risk is increased along with the increment of age (p-value < .0001). Among Trastuzumab users, these covariates also significantly increased the risk of CHF: older age, stage IV, Non-Hispanic black race, unmarried, comorbidities, Anthracyclin use, Taxane use, and lower educational level. It is concluded that, Trastuzumab users in older breast cancer patients had 69% higher risk in developing CHF than non-Trastuzumab users, much higher than the 27% increase reported in younger clinical trial patients. Older age, Non-Hispanic black race, unmarried, comorbidity, combined use with Anthracycline or Taxane also significantly increase the risk of CHF development in older patients treated with Trastuzumab. ^

Frequencies and risk factors for bisphosphonate-related osteonecrosis of the jaw in cancer patients: A matched case-control study

Bisphosphonates represent a unique class of drugs that effectively treat and prevent a variety of bone-related disorders including metastatic bone disease and osteoporosis. High tolerance and high efficacy rates quickly ranked bisphosphonates as the standard of care for bone-related diseases. However, in the early 2000s, case reports began to surface that linked bisphosphonates with osteonecrosis of the jaw (ONJ). Since that time, studies conducted have corroborated the linkage. However, as with most disease states, many factors can contribute to the onset of disease. The aim of this study was to determine which comorbid factors presented an increased risk for developing ONJ in cancer patients.^ Using a case-control study design, investigators used a combination of ICD-9 codes and chart review to identify confirmed cases of ONJ at The University of Texas M. D. Anderson Cancer Center (MDACC). Each case was then matched to five controls based on age, gender, race/ethnicity, and primary cancer diagnosis. Data querying and chart review provided information on variables of interest. These variables included bisphosphonate exposure, glucocorticoids exposure, smoking history, obesity, and diabetes. Statistical analysis was conducted using PASW (Predictive Analytics Software) Statistics, Version 18 (SPSS Inc., Chicago, Illinois).^ One hundred twelve (112) cases were identified as confirmed cases of ONJ. Variables were run using univariate logistic regression to determine significance (p < .05); significant variables were included in the final conditional logistic regression model. Concurrent use of bisphosphonates and glucocorticoids (OR, 18.60; CI, 8.85 to 39.12; p < .001), current smokers (OR, 2.52; CI, 1.21 to 5.25; p = .014), and presence of diabetes (OR, 1.84; CI, 1.06 to 3.20; p = .030) were found to increase the risk for developing ONJ. Obesity was not associated significantly with ONJ development.^ In this study, cancer patients that received bisphosphonates as part of their therapeutic regimen were found to have an 18-fold increase in their risk of developing ONJ. Other factors included smoking and diabetes. More studies examining the concurrent use of glucocorticoids and bisphosphonates may be able to strengthen any correlations.^

El cuestionario sobre el problema de la intersexualidad en las competiciones deportivas : Construcción, validación, aplicación

Se presenta en este estudio el Cuestionario sobre el problema de la Intersexualidad en las Competiciones Deportivas (C-ICD). Los principales objetivos del estudio son los siguientes: construcción del C-ICD; validación del C-ICD; aplicación del C-ICD. Los análisis estadísticos llevados a cabo comprobaron una buena validez y fiabilidad de la herramienta, así como las descriptivas de la escala y el análisis de la varianza permitieron obtener información de interés sobre la aplicación de la misma

El cuestionario sobre el problema de la intersexualidad en las competiciones deportivas : Construcción, validación, aplicación

Se presenta en este estudio el Cuestionario sobre el problema de la Intersexualidad en las Competiciones Deportivas (C-ICD). Los principales objetivos del estudio son los siguientes: construcción del C-ICD; validación del C-ICD; aplicación del C-ICD. Los análisis estadísticos llevados a cabo comprobaron una buena validez y fiabilidad de la herramienta, así como las descriptivas de la escala y el análisis de la varianza permitieron obtener información de interés sobre la aplicación de la misma

El cuestionario sobre el problema de la intersexualidad en las competiciones deportivas : Construcción, validación, aplicación

Se presenta en este estudio el Cuestionario sobre el problema de la Intersexualidad en las Competiciones Deportivas (C-ICD). Los principales objetivos del estudio son los siguientes: construcción del C-ICD; validación del C-ICD; aplicación del C-ICD. Los análisis estadísticos llevados a cabo comprobaron una buena validez y fiabilidad de la herramienta, así como las descriptivas de la escala y el análisis de la varianza permitieron obtener información de interés sobre la aplicación de la misma

Particulate organic matter (POM) of samples from the Lena River delta

Particulate organic matter (POM) derived from permafrost soils and transported by the Lena River represents a quantitatively important terrestrial carbon pool exported to Laptev Sea sediments (next to POM derived from coastal erosion). Its fate in a future warming Arctic, i.e., its remobilization and remineralization after permafrost thawing as well as its transport pathways to and sequestration in marine sediments, is currently under debate. We present one of the first radiocarbon (14C) data sets for surface water POM within the Lena Delta sampled in the summers of 2009 - 2010 and spring 2011 (n = 30 samples). The bulk D14C values varied from -55 to -391 per mil translating into 14C ages of 395 to 3920 years BP. We further estimated the fraction of soil-derived POM to our samples based on (1) particulate organic carbon to particulate nitrogen ratios (POC : PN) and (2) on the stable carbon isotope (d13C) composition of our samples. Assuming that this phytoplankton POM has a modern 14C concentration, we inferred the 14C concentrations of the soil-derived POM fractions. The results ranged from -322 to -884 per mil (i.e., 3060 to 17 250 14C years BP) for the POC : PN-based scenario and from -261 to -944 per mil (i.e., 2370 to 23 100 14C years BP) for the d13C-based scenario. Despite the limitations of our approach, the estimated D14C values of the soil-derived POM fractions seem to reflect the heterogeneous 14C concentrations of the Lena River catchment soils covering a range from Holocene to Pleistocene ages better than the bulk POM D14C values. We further used a dual-carbon-isotope three-end-member mixing model to distinguish between POM contributions from Holocene soils and Pleistocene Ice Complex (IC) deposits to our soil-derived POM fraction. IC contributions are comparatively low (mean of 0.14) compared to Holocene soils (mean of 0.32) and riverine phytoplankton (mean of 0.55), which could be explained with the restricted spatial distribution of IC deposits within the Lena catchment. Based on our newly calculated soil-derived POM D14C values, we propose an isotopic range for the riverine soil-derived POM end member with D14C of -495 ± 153 per mil deduced from our d13C-based binary mixing model and d13C of -26.6 ± 1 per mil deduced from our data of Lena Delta soils and literature values. These estimates can help to improve the dual-carbon-isotope simulations used to quantify contributions from riverine soil POM, Pleistocene IC POM from coastal erosion, and marine POM in Siberian shelf sediments.

Magnetic resonance imaging based signal intensity mapping predicts appropriate therapies after prophylactic ventricular tachycardia substrate ablation in patients with previous myocardial infarction and secondary prevention implantable cardioverter-defibrillator implantation

The aim of this study was to determine the capability of ceMRI based signal intensity (SI) mapping to predict appropriate ICD therapies after PVTSA.

Inteligencia contextual y pericia en el fútbol

Para los entrenadores la inteligencia en el juego es uno de los intangibles que predicen el éxito en la competición. De ahí que el objetivo de este estudio fuera analizar la percepción que jugadores de fútbol de diferente nivel de pericia tenían de su inteligencia para el juego. Se aplicó el Cuestionario de Inteligencia Contextual en el Deporte (ICD) que evalúa tres dimensiones: Inteligencia Anticipatoria, Inteligencia Táctica e Inteligencia Competitiva. En este estudio participaron 690 jugadores de fútbol de diferente nivel competitivo. Los resultados mostrarion que a medida que aumentaba el nivel competitivo se incrementaba la percepción de los jugadores sobre su inteligencia contextual. Este estudio confirma el papel que para los jugadores posee el sentirse 308 competentes para solucionar los problemas tácticos de su deporte y que este sentimiento aumenta con su nivel de competencia.

Inteligencia contextual y pericia en el fútbol

Para los entrenadores la inteligencia en el juego es uno de los intangibles que predicen el éxito en la competición. De ahí que el objetivo de este estudio fuera analizar la percepción que jugadores de fútbol de diferente nivel de pericia tenían de su inteligencia para el juego. Se aplicó el Cuestionario de Inteligencia Contextual en el Deporte(ICD) que evalúa tres dimensiones: Inteligencia Anticipatoria, Inteligencia Táctica e Inteligencia Competitiva. En este estudio participar on 690 jugadores de fútbol de diferente nivel competitivo. Los resultados mostrarion que a medida que aumentaba el nivel competitivo se incrementaba la percepción de los jugadores sobre su inteligencia contextual. Este estudio confirma el papel que para los jugadores posee el sentirse competentes para solucionar los problemas tácticos de su deporte y que este sentimiento aumenta con su nivel de competencia.

Autopercepción de inteligencia contextual para jugar y de competencia decisional en el fútbol

En el presente estudio se analizó la autopercepción de competencia decisional y la inteligencia contex- tual de jugadores de fútbol de diferente nivel de pericia. Además, se exploraron las relaciones existen- tes entre las autopercepciones de competencia para decidir y de inteligencia contextual en jugadores de fútbol, para lo cual participaron voluntariamente 467 jugadores (M = 20,26, DT = 4,83). El nivel de peri- cia de los participantes se estableció en tres diferentes: Autonómico (N = 141), nacional (N = 253) e internacional (N = 73), de un total de 46 clubes españoles así como de varias selecciones nacionales. Se utilizaron dos instrumentos en forma de cuestionarios. El primero fue el Cuestionario de Inteligencia Contextual Percibida en el deporte (ICD) y el segundo el de Estilos de Toma de Decisión en el Deporte (CETD). Los resultados mostraron que la competencia decisional y la inteligencia contextual están rela- cionadas y mejoran según aumenta el nivel deportivo.