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After 20 years of stagnation, federal scholarships have finally been increased within the new budget of the Canadian government. Tuition fees, inflation, and costs of living kept rising, which has resulted a rising number of graduate students in the life sciences living below poverty line, despite working far more than 40 h a week on science research in Canada. This does not only negatively affect the students research projects and thus science and innovation in Canada, but also their downstream decisions on whether to continue a research career in Canada and what jobs and economic endeavors to pursue. Graduate students are not just a line item in the budgets of universities, but integral for science and innovation, as well as the future high-quality personnel of the country. This importance should be reflected in all stipends and salaries of graduate students, not just the ones with a government scholarship. [ABSTRACT FROM AUTHOR]

This article discusses two cases of Mycobacterium haemophilum related myelitis in individuals from the same town in Missouri. Both patients presented with neurological symptoms and had spinal cord lesions. The diagnosis was confirmed through spinal cord biopsy and immunohistochemistry testing. Treatment with antibiotics resulted in clinical stability and imaging improvement. The article highlights the challenges in diagnosing and confirming Mycobacterium haemophilum infections and emphasizes the importance of considering specific culture techniques and molecular testing. The authors also suggest that environmental exposure and subclinical immunosuppression may have contributed to the development of the infection in these cases. [Extracted from the article]

Nontuberculous mycobacteria (NTM) infections are caused by environmental exposure. We describe spatial distribution of NTM infections and associations with sociodemographic factors and flooding in Missouri, USA. Our retrospective analysis of mycobacterial cultures reported to the Missouri Department of Health and Social Services surveillance system during January 1, 2008-December 31, 2019, detected geographic clusters of infection. Multilevel Poisson regression quantified smallarea geographic variations and identified characteristics associated with risk for infection. Median county-level NTM infection rate was 66.33 (interquartile range 51-91)/100,000 persons. Risk of clustering was significantly higher in rural areas (rate ratio 2.82, 95% CI 1.90-4.19) and in counties with >5 floodings per year versus no flooding (rate ratio 1.38, 95% CI 1.26-1.52). Higher risk for NTM infection was associated with older age, rurality, and more flooding. Clinicians and public health professionals should be aware of increased risk for NTM infections, especially in similar environments. [ABSTRACT FROM AUTHOR]

Background Nontuberculous mycobacteria (NTM) are ubiquitous in the environment and an increasingly frequent cause of opportunistic infections. Mycobacterium abscessus complex (MABC) is one of the major NTM lung pathogens that disproportionately colonize and infect the lungs of individuals with cystic fibrosis (CF). MABC infection can persist for years, and antimicrobial treatment is frequently ineffective. Methods We sequenced the genomes of 175 isolates longitudinally collected from 30 patients with MABC lung infection. We contextualized our cohort amidst the broader MABC phylogeny and investigated genes undergoing parallel adaptation across patients. Finally, we tested the phenotypic consequences of parallel mutations by conducting antimicrobial resistance and mercury-resistance assays. Results We identified highly related isolate pairs across hospital centers with low likelihood of transmission. We further annotated nonrandom parallel mutations in 22 genes and demonstrated altered macrolide susceptibility co-occurring with a nonsynonymous whiB1 mutation. Finally, we highlighted a 23-kb mercury-resistance plasmid whose loss during chronic infection conferred phenotypic susceptibility to organic and nonorganic mercury compounds. Conclusions We characterized parallel genomic processes through which MABC is adapting to promote survival within the host. The within-lineage polymorphisms we observed have phenotypic effects, potentially benefiting fitness in the host at the putative detriment of environmental survival. [ABSTRACT FROM AUTHOR]

Graduate students are vital to the creation of research and innovation in Canada. The National Graduate Student Finance Survey was launched in 2021 by the Ottawa Science Policy Network to investigate the financial realities of Canadian graduate students. Closing in April 2022, the survey received 1305 responses from graduate students representing various geographical locations, years of study, fields of education, and demographic backgrounds. The results capture a snapshot into graduate student finances, including an in-depth analysis of stipends, scholarships, debt, tuition, and living expenses. In its entirety, we found that the majority of graduate students are facing serious financial concerns. This is largely due to stagnant funding for students both from federal and provincial granting agencies and from within their institutions. This reality is even worse for international students, members of historically underrepresented communities, and those with dependents, all of whom experience additional challenges that impact their financial security. Based on our findings, we propose several recommendations to the Tri-Council agencies (Natural Sciences and Engineering Research Council, Social Science and Humanities Research Council, and Canadian Institute for Health Research) and academic institutions to strengthen graduate student finances and help sustain the future of research in Canada. [ABSTRACT FROM AUTHOR]

Background Tuberculosis meningitis (TBM) has high mortality and morbidity. Diagnostic delays can impact TBM outcomes. We aimed to estimate the number of potentially missed opportunities (MOs) to diagnose TBM and determine its impact on 90-day mortality. Methods This is a retrospective cohort of adult patients with a central nervous system (CNS) TB International Classification of Diseases, Ninth/Tenth Revision (ICD-9/10) diagnosis code (013*, A17*) identified in the Healthcare Cost and Utilization Project, State Inpatient and State Emergency Department (ED) Databases from 8 states. Missed opportunity was defined as composite of ICD-9/10 diagnosis/procedure codes that included CNS signs/symptoms, systemic illness, or non-CNS TB diagnosis during a hospital/ED visit 180 days before the index TBM admission. Demographics, comorbidities, admission characteristics, mortality, and admission costs were compared between those with and without a MO, and 90-day in-hospital mortality, using univariate and multivariable analyses. Results Of 893 patients with TBM, median age at diagnosis was 50 years (interquartile range, 37–64), 61.3% were male, and 35.2% had Medicaid as primary payer. Overall, 407 (45.6%) had a prior hospital or ED visit with an MO code. In-hospital 90-day mortality was not different between those with and without an MO, regardless of the MO coded during an ED visit (13.7% vs 15.2%, P =.73) or a hospitalization (28.2% vs 30.9%, P =.74). Independent risk of 90-day in-hospital mortality was associated with older age, hyponatremia (relative risk [RR], 1.62; 95% confidence interval [CI], 1.1–2.4; P =.01), septicemia (RR, 1.6; 95% CI, 1.03–2.45; P =.03), and mechanical ventilation (RR, 3.4; 95% CI, 2.25–5.3; P <.001) during the index admission. Conclusions Approximately half the patients coded for TBM had a hospital or ED visit in the previous 6 months meeting the MO definition. We found no association between having an MO for TBM and 90-day in-hospital mortality. [ABSTRACT FROM AUTHOR]

Upon glucose starvation, S. cerevisiae shows a dramatic alteration in transcription, resulting in wide-scale repression of most genes and activation of some others. This coincides with an arrest of cellular proliferation. A subset of such cells enters quiescence, a reversible non-dividing state. Here, we demonstrate that the conserved transcriptional corepressor Tup1 is critical for transcriptional repression after glucose depletion. We show that Tup1-Ssn6 binds new targets upon glucose depletion, where it remains as the cells enter the G0 phase of the cell cycle. In addition, we show that Tup1 represses a variety of glucose metabolism and transport genes. We explored how Tup1 mediated repression is accomplished and demonstrated that Tup1 coordinates with the Rpd3L complex to deacetylate H3K23. We found that Tup1 coordinates with Isw2 to affect nucleosome positions at glucose transporter HXT family genes during G0. Finally, microscopy revealed that a quarter of cells with a Tup1 deletion contain multiple DAPI puncta. Taken together, these findings demonstrate the role of Tup1 in transcriptional reprogramming in response to environmental cues leading to the quiescent state. Author summary: Quiescence is a very common and important state for the cells of many organisms, where cell functions 'pause' but can resume when the right conditions are met. Most microbes exist in a quiescent state and will start growing and dividing again in the presence of nutrients or other cues. In mammals, a quiescent state is used to maintain stem cell populations and cancer cells often evade treatment by entering quiescence. The budding yeast Saccharomyces cerevisiae is an excellent model for studying quiescence because we can easily isolate populations of quiescent cells. Since budding yeast share many proteins and cellular pathways with higher organisms, our findings are applicable to more complex systems, which may be relevant to maintenance of healthy cells or provide insight to treating disease states. We know that a hallmark of quiescence is reduced transcription, and we are interested in how this change occurs. We have examined how the protein Tup1 causes changes in gene expression in cellular quiescence. We also looked at how Tup1-dependent changes depend on other chromatin interacting factors, such as the histone deacetylase Rpd3, the transcription factor Xbp1, or the chromatin remodeling protein Isw2. [ABSTRACT FROM AUTHOR]

Objectives: Sexually transmitted infections (STIs), including chlamydia, gonorrhea, and human immunodeficiency virus (HIV) pose a significant health burden in adolescents. Many adolescents receiving care in the emergency department (ED) are in need of testing, regardless of their chief complaint. Our objective was to determine whether an electronic, risk‐based STI screening program in our ED was associated with an increase in STI testing among at‐risk adolescents. Methods: We conducted a retrospective cohort analysis of patient outcomes in our pediatric ED after integrating an Audio‐enhanced Computer‐Assisted Self‐Interview (ACASI) as standard of care. It obtained a focused sexual history and generated STI testing recommendations. Patient answers and testing recommendations were integrated in real‐time into the electronic health record. Patients who tested positive received treatment according to our standard‐of‐care practices. All patients 15–21 years of age were asked to complete this on an opt‐out basis, regardless of the reason for their ED visit. Exclusions included those unable to independently use a tablet, severe illness, sexual assault, or non‐English speaking. Our primary outcome was to describe STI‐testing recommendations and test results among ACASI participants. We also compared STI testing between ACASI participants and those who were eligible but did not use it. Results: In the first 13 months, 28.9% (1788/6194) of eligible adolescents completed the ACASI and 44.2% (321/790) accepted recommended STI testing. The mean age of participants was 16.6 ± 1.3 years, with 65.4% (1169) being female. Gonorrhea/chlamydia testing was significantly higher among participants vs. non‐participants (20.1% [359/1788] vs 4.8% [212/4406]; p < 0.0001). The proportion of positive STI tests was similar between the two groups: 24.8% (89/359) vs. 24.5% (52/212; p = 0.94) were positive for chlamydia and/or gonorrhea, while 0.6% (2/354) participants vs. 0% non‐participants (p > 0.99) were positive for HIV. Among participants whose chief complaints were unlikely to be related to STIs but accepted recommended testing, 20.9% (37/177) were positive for gonorrhea or chlamydia. Conclusions: Our program facilitated STI testing in the ED and identified many adolescents with STIs, even when their ED complaint was for unrelated reasons. More rigorous implementation is needed to determine the impact of deployment of ACASI to all eligible adolescents and addressing barriers to accepting STI testing recommendations. [ABSTRACT FROM AUTHOR]

Background Health care administrative database research frequently uses standard medical codes to identify diagnoses or procedures. The aim of this review was to establish the diagnostic accuracy of codes used in administrative data research to identify nontuberculous mycobacterial (NTM) disease, including lung disease (NTMLD). Methods We searched Ovid Medline, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from inception to April 2019. We included studies assessing the diagnostic accuracy of International Classification of Diseases, 9th edition, Clinical Modification (ICD-9-CM) diagnosis codes to identify NTM disease and NTMLD. Studies were independently assessed by 2 researchers, and the Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess bias and quality. Results We identified 5549 unique citations. Of the 96 full-text articles reviewed, 7 eligible studies of moderate quality (3730 participants) were included in our review. The diagnostic accuracy of ICD-9-CM diagnosis codes to identify NTM disease varied widely across studies, with positive predictive values ranging from 38.2% to 100% and sensitivity ranging from 21% to 93%. For NTMLD, 4 studies reported diagnostic accuracy, with positive predictive values ranging from 57% to 64.6% and sensitivity ranging from 21% to 26.9%. Conclusions Diagnostic accuracy measures of codes used in health care administrative data to identify patients with NTM varied across studies. Overall the positive predictive value of ICD-9-CM diagnosis codes alone is good, but the sensitivity is low; this method is likely to underestimate case numbers, reflecting the current limitations of coding systems to capture NTM diagnoses. [ABSTRACT FROM AUTHOR]

Background Staphylococcus aureus bloodstream infections (BSIs) are associated with significant morbidity and mortality. Ceftriaxone is convenient for outpatient parenteral antimicrobial therapy (OPAT), but data for this indication are limited. Methods Adult patients with methicillin-susceptible Staphylococcus aureus (MSSA) BSI discharged on OPAT with cefazolin, oxacillin, or ceftriaxone for at least 7 days were included. We compared outcomes of ceftriaxone vs either oxacillin or cefazolin. Ninety-day all-cause mortality, readmission due to MSSA infection, and microbiological failure were examined as a composite outcome and compared among groups. Rates of antibiotic switches due to intolerance were assessed. Results Of 243 patients included, 148 (61%) were discharged on ceftriaxone and 95 (39%) were discharged on either oxacillin or cefazolin. The ceftriaxone group had lower rates of intensive care unit care, endocarditis, and shorter duration of bacteremia, but higher rates of cancer diagnoses. There was no significant difference in the composite adverse outcome in the oxacillin or cefazolin group vs the ceftriaxone group (18 [19%] vs 31 [21%]; P =.70), comprising microbiological failure (6 [6.3%] vs 9 [6.1%]; P =.94), 90-day all-cause mortality (7 [7.4%] vs 15 [10.1%]; P =.46), and readmission due to MSSA infection (10 [10.5%] vs 13 [8.8%]; P =.65). Antibiotic intolerance necessitating a change was similar between the 2 groups (4 [4.2%] vs 6 [4.1%]; P =.95). Conclusions For patients with MSSA BSI discharged on OPAT, within the limitations of the small numbers and retrospective design we did not find a significant difference in outcomes for ceftriaxone therapy when compared with oxacillin or cefazolin therapy. [ABSTRACT FROM AUTHOR]

One of the main contributing factors to child obesity is the absence of education and knowledge children have towards certain foods when they are making food choices. In most cases, children will pick energy-dense food over foods with more nutritional value and do not understand the consequences of their decisions. Our proposed solution to help overcome this problem is an educational gaming application called FoodKnight. Games have the ability to engage children more than traditional teaching methods used in schools, and capitalising on this exciting approach would be beneficial for children. FoodKnight incorporates stealth learning to disguise the teaching of healthy food choices while playing a game; a step-counter is also included to encourage the user to be active. The overall feedback FoodKnight received from 38 participants regarding the initial prototype was positive. Minor issues found with the game were addressed and implemented in an update. FoodKnight has been implemented in the Android mobile platform to increase accessibility. [ABSTRACT FROM AUTHOR]

Objective: Audio-enhanced computer-assisted self-interviews (ACASIs) are useful adjuncts for clinical care but are rarely integrated into the electronic health record (EHR). We created a flexible framework for integrating an ACASIs with clinical decision support (CDS) into the EHR. We used this program to identify adolescents at risk for sexually transmitted infections (STIs) in the emergency department (ED). We provide an overview of the software platform and qualitative user acceptance.Materials and Methods: We created an ACASI with a CDS algorithm to identify adolescents in need of STI testing. We offered it to 15- to 21-year-old patients in our ED, regardless of ED complaint. We collected user feedback via the ACASI. These were programmed into REDCap (Research Electronic Data Capture), and an iOS application utilizing Apple ResearchKit generated a tablet compatible representation of the ACASI for patients. A custom software program created an HL7 (Health Level Seven) message containing a summary of responses, CDS recommendations, and STI test orders, which were transmitted to the EHR.Results: In the first year, 1788 of 6227 (28.7%) eligible adolescents completed the survey. Technical issues led to decreased use for several months. Patients rated the system favorably, with 1583 of 1787 (88.9%) indicating that they were "somewhat" or "very comfortable" answering questions electronically and 1291 of 1787 (72.2%) preferring this format over face-to-face interviews or paper questionnaires.Conclusions: We present a novel use for REDCap to combine patient-answered questionnaires and CDS to improve care for adolescents at risk for STIs. Our program was well received and the platform can be used across disparate patients, topics, and information technology infrastructures. [ABSTRACT FROM AUTHOR]

Using interview and survey data they gathered in 1995-97 from managers and employees in 45 establishments, the authors investigate how high-performance work practices, such as self-directed teams and offline teams, affected workers' earnings in the apparel, steel, and medical electronics industries. An analysis with extensive controls for personal characteristics and other variables shows a positive relationship between high-performance practices and earnings in the apparel and steel industries. In medical electronics and imaging, the same statistically significant association disappears when a control variable for education is added, suggesting that there is a strong relationship between formal education and high-performance systems in that industry. [ABSTRACT FROM AUTHOR]

What distinctions are there between vocational (career and technical) education and academic learning in college? In this essay, we compare broad academic and vocational program goals, embodied skills, tasks, and jobs, with a focus primarily on community college students. There is considerable overlap between the two types of education, so a separation of tracks presents a false dichotomy. In addition, vocational certificates, which often have little academic content, have attracted attention lately as a path to good jobs. New evidence indicates that degrees offer more substantial advantages than certificates in the labor market. We argue for an alternative framework for thinking about the optimal accumulation of skills in college. Rejecting the traditional distinction between vocational education and academic learning, we posit that educational paths are best understood as accumulations of general education followed by terminal work-related education. We label this the Gen-Tech framework and consider its explanatory power and implications for colleges and students. [ABSTRACT FROM AUTHOR]

A cluster of cefepime-induced neutropenia (CIN) was identified from June 2017 to May 2018 in a regional outpatient parenteral antimicrobial therapy population. Our data suggest prolonged courses of cefepime (≥2 weeks), administered by rapid intravenous push, were associated with a higher risk of CIN. [ABSTRACT FROM AUTHOR]

Bourbon virus (BRBV) is an emerging tick-borne RNA virus in the orthomyxoviridae family that was discovered in 2014. Although fatal human cases of BRBV have been described, little is known about its pathogenesis, and no antiviral therapies or vaccines exist. We obtained serum from a fatal case in 2017 and successfully recovered the second human infectious isolate of BRBV. Next-generation sequencing of the St. Louis isolate of BRBV (BRBV-STL) showed >99% nucleotide identity to the original reference isolate. Using BRBV-STL, we developed a small animal model to study BRBV-STL tropism in vivo and evaluated the prophylactic and therapeutic efficacy of the experimental antiviral drug favipiravir against BRBV-induced disease. Infection of Ifnar1-/- mice lacking the type I interferon receptor, but not congenic wild-type animals, resulted in uniformly fatal disease 6 to 10 days after infection. RNA in situ hybridization and viral yield assays demonstrated a broad tropism of BRBV-STL with highest levels detected in liver and spleen. In vitro replication and polymerase activity of BRBV-STL were inhibited by favipiravir. Moreover, administration of favipiravir as a prophylaxis or as post-exposure therapy three days after infection prevented BRBV-STL-induced mortality in immunocompromised Ifnar1-/- mice. These results suggest that favipiravir may be a candidate treatment for humans who become infected with BRBV. [ABSTRACT FROM AUTHOR]

Introduction: Effective smoking cessation medications are readily available but may be underutilized in hospital settings. In our large, tertiary care hospital, we aimed to (1) characterize patient tobacco use prevalence across medical specialties, (2) determine smoking cessation pharmacotherapy prescription variation across specialties, and (3) identify opportunities for improvement in practice.Methods: Using electronic health records at Barnes Jewish Hospital, we gathered demographic data, admitting service, admission route, length of stay, self-reported tobacco use, and smoking cessation prescriptions over a 6-year period, from 2010 to 2016. We then compared tobacco use prevalence and smoking cessation prescriptions across medical specialties using a cross-sectional, retrospective design.Results: Past 12-month tobacco use was reported by patients in 27.9% of inpatient admissions; prescriptions for smoking cessation pharmacotherapy were provided during 21.5% of these hospitalizations. The proportion of patients reporting tobacco use was highest in psychiatry (55.3%) and lowest in orthopedic surgery (17.1%). Psychiatric patients who reported tobacco use were most likely to receive pharmacotherapy (71.8% of admissions), and plastic surgery patients were least likely (4.7% of admissions). Compared with Caucasian tobacco users, African American patients who used tobacco products were less likely to receive smoking cessation medications (adjusted odds ratio [aOR] = 0.65; 95% confidence interval [CI] = 0.62 to 0.68).Conclusions: Among hospitalized tobacco users, safe and cost-effective pharmacotherapies are under-prescribed. We identified substantial variation in prescribing practices across different medical specialties and demographic groups, suggesting the need for an electronic medical record protocol that facilitates consistent tobacco use cessation pharmacotherapy treatment.Implications: Tobacco use cessation pharmacotherapy is underutilized during hospitalization, and prescription rates vary greatly across medical specialties and patient characteristics. Hospitals may benefit from implementing policies and practices that standardize and automate the offer of smoking pharmacotherapy for all hospitalized patients who use tobacco. [ABSTRACT FROM AUTHOR]

Objective: To review and analyze the literature to determine whether wearable technologies can predict health outcomes.Materials and methods: We queried Ovid Medline 1946 -, Embase 1947 -, Scopus 1823 -, the Cochrane Library, clinicaltrials.gov 1997 - April 17, 2018, and IEEE Xplore Digital Library and Engineering Village through April 18, 2018, for studies utilizing wearable technology in clinical outcome prediction. Studies were deemed relevant to the research question if they involved human subjects, used wearable technology that tracked a health-related parameter, and incorporated data from wearable technology into a predictive model of mortality, readmission, and/or emergency department (ED) visits.Results: Eight unique studies were directly related to the research question, and all were of at least moderate quality. Six studies developed models for readmission and two for mortality. In each of the eight studies, data obtained from wearable technology were predictive of or significantly associated with the tracked outcome.Discussion: Only eight unique studies incorporated wearable technology data into predictive models. The eight studies were of moderate quality or higher and thereby provide proof of concept for the use of wearable technology in developing models that predict clinical outcomes.Conclusion: Wearable technology has significant potential to assist in predicting clinical outcomes, but needs further study. Well-designed clinical trials that incorporate data from wearable technology into clinical outcome prediction models are required to realize the opportunities of this advancing technology. [ABSTRACT FROM AUTHOR]

Introduction Childhood trauma is a risk factor for the development of psychosis. Furthermore, a number of theories propose specific mechanisms by which childhood trauma may contribute to more severe positive and negative psychotic symptoms, some of which are supported empirically. The robustness of this empirical evidence is unclear due to mixed results and methodological limitations of individual studies. A systematic review and meta-analysis of the evidence for associations between childhood trauma and severity of hallucinations, delusions, and negative psychotic symptoms in clinical populations with a diagnosed psychotic disorder is needed. Method A systematic search was conducted. Reference lists of relevant review articles were hand-searched, and authors contacted for data and additional unpublished studies. Study reporting bias and quality was assessed. Results In total, 6667 studies were identified and of these 41 studies met inclusion criteria. Of these, 29 studies (4680 participants) were meta-analyzed. Among individuals with psychosis, childhood trauma was significantly correlated with severity of hallucinations (r =.199, P <.001) and delusions (r =.172, P <.001) but contrary to our hypothesis, not correlated with severity of negative symptoms (r =.049, P =.095). Severity of childhood neglect was correlated with negative symptoms (r =.142, P =.005). Conclusion The results lend support for cognitive and biological theories that traumas in childhood may lead to hallucinations and delusions within psychotic disorders and have important implications for clinical practice. [ABSTRACT FROM AUTHOR]

The article focuses on the divergent missions of community college for vocation and transfer education. It discusses how college students now prefer bachelor degrees rather than associate degrees as the wage gap between people of both degrees rise, using short-term achievements like work-based certifications and competency-based awards.

A study was performed to determine the potential influence of a rapid response system (RRS) employing real-time clinical deterioration alerts (RTCDAs) on patient outcomes involving 8 general medicine units. Introduction of the RRS occurred in 2006 with staged addition of the RTCDAs in 2009. Statistically significant year-to-year decreases in mortality were observed through 2014 ( r = -.794; P = .002). Similarly, year-to-year decreases in the number of cardiopulmonary arrests (CPAs; r = -.792; P = .006) and median lengths of stay ( r = -.841; P = .001) were observed. There was a statistically significant year-to-year increase in the number of RRS activations for these units ( r = .939; P < .001) that was inversely correlated with the occurrence of CPAs ( r = -.784; P = .007). In this single-institution retrospective study, introduction of a RRS employing RTCDAs was associated with lower hospital mortality, CPAs, and hospital length of stay. [ABSTRACT FROM AUTHOR]

This chapter examines why typical reforms at community colleges in recent years have not improved institutional graduation rates. It argues that substantially increasing college completion requires comprehensive institutional reform with a focus on measurable student success, an intentional and cohesive package of programmatic components, and a culture of evidence. [ABSTRACT FROM AUTHOR]

High rates of mental illness among students and discontinuation with university studies are regularly reported. The current study sought to explore relationships between motivation, university adaptation and indicators of mental health and well-being and academic performance of 184 first-year university students (73% female, mean age = 19.3 years). As expected, intrinsic motivation was associated with greater subjective well-being, meaning in life and academic performance. Extrinsic motivations showed few relationships to outcome variables, while amotivation was consistently associated with poor outcomes. Hierarchical regression revealed that after accounting for adjustment, motivational orientations provided a small, though significant, contribution to the prediction of outcomes. These results are discussed in relation to Self-Determination Theory, the eudaimonic/hedonic dichotomy and implications for career counselling and teaching. [ABSTRACT FROM AUTHOR]

Background: Hospital readmission occurs often and is difficult to predict. Polypharmacy has been identified as a potential risk factor for hospital readmission. However, the overall impact of the number of discharge medications on hospital readmission is still undefined. Methods: To determine whether the number of discharge medications is predictive of thirty-day readmission using a retrospective cohort study design performed at Barnes-Jewish Hospital from January 15, 2013 to May 9, 2013. The primary outcome assessed was thirty-day hospital readmission. We also assessed potential predictors of thirty-day readmission to include the number of discharge medications. Results: The final cohort had 5507 patients of which 1147 (20.8 %) were readmitted within thirty days of their hospital discharge date. The number of discharge medications was significantly greater for patients having a thirty-day readmission compared to those without a thirty-day readmission (7.2 ± 4.1 medications [7.0 medications (4.0 medications, 10.0 medications)] versus 6.0 ± 3.9 medications [6.0 medications (3.0 medications, 9.0 medications)]; P < 0.001). There was a statistically significant association between increasing numbers of discharge medications and the prevalence of thirty-day hospital readmission (P < 0.001). Multiple logistic regression identified more than six discharge medications to be independently associated with thirty-day readmission (OR, 1.26; 95 % CI, 1.17-1.36; P = 0.003). Other independent predictors of thirty-day readmission were: more than one emergency department visit in the previous six months, a minimum hemoglobin value less than or equal to 9 g/dL, presence of congestive heart failure, peripheral vascular disease, cirrhosis, and metastatic cancer. A risk score for thirty-day readmission derived from the logistic regression model had good predictive accuracy (AUROC = 0.661 [95 % CI, 0.643-0.679]). Conclusions: The number of discharge medications is associated with the prevalence of thirty-day hospital readmission. A risk score, that includes the number of discharge medications, accurately predicts patients at risk for thirty-day readmission. Our findings suggest that relatively simple and accessible parameters can identify patients at high risk for hospital readmission potentially distinguishing such individuals for interventions to minimize readmissions. [ABSTRACT FROM AUTHOR]

The article reports that Colchicine is a substrate of both CYP 3A4 and P-glycoprotein (Pgp). Inhibitors or competing substrates of either CYP 3A4 or P-gp increase the risk of colchicine toxicity. These include calcium channel blockers, azole antifungals, protease inhibitors, certain macrolide antimicrobials, tacrolimus, tamoxifen, cyclosporine, and amiodarone.

Buruli ulcer, the third most common mycobacterial disease worldwide, rarely affects travelers and is uncommon in the United States. We report a travel-associated case imported from Australia and review 3 previous cases diagnosed and treated in the United States. The differential diagnoses for unusual chronic cutaneous ulcers and those nonresponsive to conventional therapy should include Mycobacterium ulcerans infection. [ABSTRACT FROM AUTHOR]

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Objective The purpose of this study was to determine the cost benefit to routinely using QFT-G versus the standard TST for screening U.S. and foreign born populations at a public health department clinic with a low prevalence of tuberculosis. Design and Sample A comparative cost analysis of the monetization between QFT-G and TST was conducted: Data from the health department's Chest Clinic patients seen in 2007 were used to model cost predictions. Measures The net costs of screening, x-rays, the standard 9 months of latent tuberculosis infection treatment, laboratory, and administration for U.S. born patients and foreign born patients were investigated. Results There are no apparent cost savings for U.S. born individuals, but due to the higher specificity of QFT-G for foreign born BCG-vaccinated individuals, there are unnecessary expenditures associated with the higher number of false positives incurred when using TST compared with QFT-G on 1,000 foreign born individuals (69%, 18%). Conclusion QFT-G is cost-effective and should be used at local health department clinics that want to achieve savings in screening and treating those suspected of having TB infection, especially for high-risk populations such as foreign born individuals. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to determine the cost benefit to routinely using QFT-G versus the standard TST for screening U.S. and foreign born populations at a public health department clinic with a low prevalence of tuberculosis. Design and Sample A comparative cost analysis of the monetization between QFT-G and TST was conducted: Data from the health department's Chest Clinic patients seen in 2007 were used to model cost predictions. Measures The net costs of screening, x-rays, the standard 9 months of latent tuberculosis infection treatment, laboratory, and administration for U.S. born patients and foreign born patients were investigated. Results There are no apparent cost savings for U.S. born individuals, but due to the higher specificity of QFT-G for foreign born BCG-vaccinated individuals, there are unnecessary expenditures associated with the higher number of false positives incurred when using TST compared with QFT-G on 1,000 foreign born individuals (69%, 18%). Conclusion QFT-G is cost-effective and should be used at local health department clinics that want to achieve savings in screening and treating those suspected of having TB infection, especially for high-risk populations such as foreign born individuals. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the carriage of a portable gas analyser during prolonged treadmill exercise at a variety of speeds. Ten male participants completed six trials at different speeds (4, 8 and 12 km h− 1) for 40 min whilst wearing the analyser (P) or where the analyser was externally supported (L). Throughout each trial, respiratory gases, heart rate (HR), perceptions of effort and energy expenditure (EE) were measured. Significantly higher EE occurred during P12 (p = 0.01) than during L12 (855.3 ± 104.3; CI = 780.7–930.0 and 801.5 ± 82.2 kcal; CI = 742.7–860.3 kcal, respectively), but not at the other speeds; despite this, perceptions of effort and HR responses were unaffected. This additional EE is likely caused by alterations to posture which increase oxygen demand. The use of such systems is unlikely to affect low-intensity tasks, but researchers should use caution when interpreting data, particularly when exercise duration exceeds 30 min and laboratory-based analysers should be used where possible. Practitioner Summary:There is extensive use of portable gas analysers in many settings. This study suggests that there is no additional effect on energy expenditure until running speeds of 8 km h− 1are exceeded. Future work should consider the effects of gas analyser carriage in a wider variety of populations, environments and terrain. [ABSTRACT FROM AUTHOR]

Purpose – As wireless penetration continues to increase worldwide, competitors in the mobile telecommunication industry are changing their strategies from a growth model to a value-added one. The companies that can attract and retain customers in this highly competitive and increasingly saturated market stand poised to make considerable gains, and thus customer retention is an important field of study in this maturing market. Using the Canadian mobile phone market as an example, this work aims to study the major motivators of customer retention and their interrelationships, and assess the value that customers perceive with regard to the related advertising. Design/methodology/approach – Based on a literature review and expert validation, the motivators of customer retention are divided into three dimensions and eight criteria. A systematic hybrid multiple criteria decision-making (MCDM) method that combines the decision making trial and evaluation laboratory (DEMATEL) technique and the analytic network process (ANP) is used to examine the customer retention framework and to evaluate the promotional strategies used by various market players. Findings – The interdependence relation shows that phone service quality, customer service quality, and phone plan quality are three major motivators in terms of causality with regard to brand image, customer service quality, and complaint management, while phone service quality has become a hygiene factor with regard to customer satisfaction and retention. The findings from an assessment of the promotional strategies used by the major players in the Canadian mobile telecoms industry suggest that well-financed foreign entrants pose a risk to the major domestic carriers, and that successful promotional strategies will require strong leverage of their existing price and quality advantages. Originality/value – This work adopted a hybrid MCDM approach to examine a major strategic issue in mobile telecoms, – i.e. customer retention – and demonstrated the strengths of using this method to investigate rapidly changing markets. The relative importance of the motivators of satisfaction and retention is investigated, and a strategy for customer retention in the mobile telecoms industry is provided to managers. [ABSTRACT FROM AUTHOR]

Paragonimiasis is an infection caused by lung flukes of the genus Paragonimus. In Asia, P. westermani infections are relatively common because of dietary practices. However, in North America, cases of paragonimiasis, which are caused by P. kellicotti flukes, are rare. Only 7 autochthonous cases of paragonimiasis were reported during 1968-2008. In 2009, we reported 3 new case-patients with paragonimiasis who had been seen at our medical center over an 18-month period. Six additional case-patients were identified in St. Louis, Missouri, USA, and treated at Washington University-affiliated health centers in 2009-2010. We report detailed descriptions of these case-patients, which includes unusual clinical manifestations. We also describe public health interventions that were undertaken to inform the general public and physicians about the disease and its mode of transmission. [ABSTRACT FROM AUTHOR]