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Abstract Background Actigraphy is often used to measure sleep in pediatric populations, despite little confirmatory evidence of the accuracy of existing sleep/wake algorithms. The aim of this study was to determine the performance of 11 sleep algorithms in relation to overnight polysomnography in children and adolescents. Methods One hundred thirty-seven participants aged 8–16 years wore two Actigraph wGT3X-BT (wrist, waist) and three Axivity AX3 (wrist, back, thigh) accelerometers over 24-h. Gold standard measures of sleep were obtained using polysomnography (PSG; Embletta MPRPG, ST + Proxy and TX Proxy) in the home environment, overnight. Epoch by epoch comparisons of the Sadeh (two algorithms), Cole-Kripke (three algorithms), Tudor-Locke (four algorithms), Count-Scaled (CS), and HDCZA algorithms were undertaken. Mean differences from PSG values were calculated for various sleep outcomes. Results Overall, sensitivities were high (mean ± SD: 91.8%, ± 5.6%) and specificities moderate (63.8% ± 13.8%), with the HDCZA algorithm performing the best overall in terms of specificity (87.5% ± 1.3%) and accuracy (86.4% ± 0.9%). Sleep outcome measures were more accurately measured by devices worn at the wrist than the hip, thigh or lower back, with the exception of sleep efficiency where the reverse was true. The CS algorithm provided consistently accurate measures of sleep onset: the mean (95%CI) difference at the wrist with Axivity was 2 min (-6; -14,) and the offset was 10 min (5, -19). Several algorithms provided accurate measures of sleep quantity at the wrist, showing differences with PSG of just 1–18 min a night for sleep period time and 5–22 min for total sleep time. Accuracy was generally higher for sleep efficiency than for frequency of night wakings or wake after sleep onset. The CS algorithm was more accurate at assessing sleep period time, with narrower 95% limits of agreement compared to the HDCZA (CS:-165 to 172 min; HDCZA: -212 to 250 min). Conclusion Although the performance of existing count-based sleep algorithms varies markedly, wrist-worn devices provide more accurate measures of most sleep measures compared to other sites. Overall, the HDZCA algorithm showed the greatest accuracy, although the most appropriate algorithm depends on the sleep measure of focus.

Intro: Campylobacter is the most common bacterial cause of foodborne gastroenteritis in Australia, however outbreaks caused by the pathogen are relatively uncommon. On 4 March 2022, the Victorian Department of Health was notified of a gastrointestinal illness in 20 guests following attendance at a wedding reception on 12 February 2022. Four individuals were notified with laboratory confirmed campylobacteriosis, and an investigation was undertaken to determine the full extent of the outbreak and prevent further illness. Methods: A nested case-control study was conducted to determine the likely source of infection. Cases were defined as attendees of the wedding reception, with onset of diarrhoea and/or abdominal pain 1-10 days after attending the function. Controls were randomly selected from the remaining non-ill guests. Cases and controls were interviewed using a standardised menu-based questionnaire, and odds ratios (ORs) calculated of consumed foods. Food preparation processes were documented, and food samples collected. Findings: A total of 29 wedding guests met the case definition, with onset of illness between 2-5 days and major symptoms including diarrhoea (90%), abdominal pain (100%), headache (79%), and fever (62%). Two cases were hospitalised, one with ongoing neurological sequelae. Illness was found to be significantly associated with consumption of a duck breast brioche canape containing duck liver parfait following univariate analysis and stratification by other implicated foods (OR=2.85, 95% CI [1.03-7.86]). Cases aged 10-29 years were 13.2 times more likely to have eaten duck than controls in that age group. Discussion: The investigation found the duck canape was the likely vehicle of infection in this outbreak. Consistent with the literature on Campylobacter transmission, it is likely that inadequate cooking of the duck liver for the parfait was the contributing factor that led to illness. Conclusion: This outbreak investigation highlights the risks posed by poultry dishes if undercooked, and that education of food handlers remains a priority.

Objectives:. Non-mortality septic shock outcomes (e.g., Sequential Organ Failure Assessment score) are important clinical endpoints in pivotal sepsis trials. However, comparisons of observed longitudinal non-mortality outcomes between study groups can be biased if death is unequal between study groups or is associated with an intervention (i.e., informative censoring). We compared the effects of vasopressin versus norepinephrine on the Sequential Organ Failure Assessment score in the Vasopressin and Septic Shock Trial to illustrate the use of joint modeling to help minimize potential bias from informative censoring. Design:. Secondary analysis of the Vasopressin and Septic Shock Trial data. Setting:. Twenty-seven ICUs in Canada, Australia, and United States. Subjects:. Seven hundred sixty-three participants with septic shock who received blinded vasopressin (n = 389) or norepinephrine infusions (n = 374). Measurements and Main Results:. Sequential Organ Failure Assessment scores were calculated daily until discharge, death, or day 28 after randomization. Mortality was numerically higher in the norepinephrine arm (28 d mortality of 39% vs 35%; p = 0.25), and there was a positive association between higher Sequential Organ Failure Assessment scores and patient mortality, characteristics that suggest a potential for bias from informative censoring of Sequential Organ Failure Assessment scores by death. The best-fitting joint longitudinal (i.e., linear mixed-effects model) and survival (i.e., Cox proportional hazards model for the time-to-death) model showed that norepinephrine was associated with a more rapid improvement in the total Sequential Organ Failure Assessment score through day 4, and then the daily Sequential Organ Failure Assessment scores converged and overlapped for the remainder of the study period. Conclusions:. Short-term reversal of organ dysfunction occurred more rapidly with norepinephrine compared with vasopressin, although differences between study arms did not persist after day 4. Joint models are an accessible methodology that could be used in critical care trials to assess the effects of interventions on the longitudinal progression of key outcomes (e.g., organ dysfunction, biomarkers, or quality of life) that may be informatively truncated by death or other censoring events.

Background: Mortality due to opioid use continues to increase; effective strategies to improve access to treatment for opioid use disorder (OUD) are needed. While OUD medications exist, they are used infrequently and often not available in residential addiction treatment settings. CMS provides expanded opportunities for Medicaid reimbursement of treatment in residential facilities and requires states that request Medicaid SUD Waivers to provide a full continuum of care including medication treatment. The objective of this study was to assess how states facilitate access to OUD medications in residential settings and whether Medicaid requirements play a role. Methods: Using a legal mapping framework, across the 50 states and DC, we abstracted data from state regulations in 2019 - 2020 and Medicaid Section 1115(a) demonstration applications. We examined the temporal relationship between state regulations regarding medication-assisted treatment for OUD in residential settings and Section 1115(a) demonstrations. Results: We identified variation in regulations regarding medication treatment for OUD in residential settings and possible spillover effects of the CMS requirements for Medicaid SUD Waivers. In 18 states with relevant regulations, regulatory approaches include identifying opioid medication treatment as a right, requiring access to OUD medication treatment, and establishing other requirements. 25 of 30 states with approved Section 1115(a) demonstrations included explicit requirements for OUD medication treatment access. Four states updated OUD medication treatment regulations for residential treatment settings within a year of applying for a Section 1115(a) demonstration. Conclusions: State regulations and Medicaid program requirements are policy levers to facilitate OUD medication treatment access.

ObjectiveThe primary aim of the study was to determine levels of literacy in both oral health and orthodontics in an adult population. The secondary study aim was to investigate differences in literacy between males and females.MethodsParticipants included individuals 18 years or older seeking dental treatment at the East Carolina University (ECU) School of Dental Medicine. To determine levels of oral health literacy (OHL) and orthodontic literacy (OrthoL), validated instruments were administered, including the Rapid Estimate of Adult Literacy in Medicine and Dentistry, the Oral Health Literacy Instrument and its separate scales, and a questionnaire on orthodontic literacy. Summary statistics were computed, and statistical significance was set at 0.05.ResultsOne hundred seventy-two individuals participated in the study and had a mean age of 55.03 (range:18-88). Greater than 70% of the sampled population exhibited inadequate or marginal oral health knowledge. Additionally, greater than 70% of the sample possessed no more than an 8th grade reading level, with regard to basic medical and dental terms. Higher education was weakly associated with higher OrthoL and OHL. Higher age was also weakly associated with lower OrthoL and OHL. Males on average exhibited significantly higher OHL (p < .05) but there were no OrthoL differences between males and females. Dental visit frequency was not associated with OrthoL or OHL.ConclusionLow levels of OrthoL and OHL were observed in the study. While males demonstrated a higher level of OHL than females, neither age nor the occurrence of dental appointments significantly influenced levels of literacy.

Few studies assess the relationship between food and water access, despite global concerns about people's inability to maintain access to both food and water. We conducted a mixed-methods comparative case study in northern Nicaragua, with smallholders from two neighboring communities that differed in water availability and institutional strength, using a feminist political ecology framework and food and water security definitions that focus on access, availability, use, and stability. We adopted a participatory approach that included: a sex-disaggregated survey in 2016; interviews, participant observation, and community-based water quality testing from 2014 to 2019; and analysis of a severe drought that occurred from 2014 to 2017. Our results suggest that uneven power relations, biophysical conditions, gender, and institutions shape food and water access, and indicate that households across both communities average 2 months of drinking water insecurity during the dry season followed by an average of 2.5 months of food insecurity early in the growing season. The average duration of lean food months was similar across communities and sex, but water insecurity lasted longer in the community that had weaker local institutions and less surface water availability. Ethnographic research helped to document uneven and gendered experiences of water access and to illustrate how they were also shaped by conflicts over water for irrigation vs. domestic uses and cross-scalar limitations in water and land governance. Although we found that gender and institutions were not strong predictors of several food and water insecurity indicators on their own, both factors influenced the terms of access, conflict, and cooperative governance needed to secure resources and well-being. Our study highlights the need for theory, methods, and field research that integrate the analysis of food and water security, and it contributes to developing a feminist political ecology approach that unifies this analysis with a focus on gender.