Lindehaas1591

m heat acclimation; TCORE Core temperature; TDHA Twice-daily heat acclimation; TS Thermal sensation; TSKIN Skin temperature; V̇O2max Maximal oxygen uptake; WGBT Wet bulb globe temperature. © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.Remediation of struggling learners is a challenge faced by all educators. In recognition of this reality, and in light of contemporary challenges facing infectious diseases (ID) fellowship program directors, the Infectious Diseases Society of America Training Program Directors' Committee focused the 2018 National Fellowship Program Directors' Meeting at IDWeek on "Remediation of the Struggling Fellow." Small group discussions addressed 7 core topics, including feedback and evaluations, performance management and remediation, knowledge deficits, fellow well-being, efficiency and time management, teaching skills, and career development. This manuscript synthesizes those discussions around a competency-based framework to provide program directors and other educators with a roadmap for addressing common contemporary remediation challenges. © The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.Background Rapid diagnostic tests (RDTs) have been developed with the aim of providing accurate results in a timely manner. Despite this, studies report that provider uptake remains low. Methods We conducted a retrospective analysis of ambulatory, urgent care, and emergency department (ED) encounters at an urban safety net hospital with a primary diagnosis of an upper or lower respiratory tract infection (eg, bronchitis, pharyngitis, acute sinusitis) from January 1, 2016, to December 31, 2018. We collected RDT type and results, antibiotics prescribed, demographic and clinical patient information, and provider demographics. Results RDT use was low; a test was performed at 29.5% of the 33 494 visits. The RDT most often ordered was the rapid Group A Streptococcus (GAS) test (n = 7352), predominantly for visits with a discharge diagnosis of pharyngitis (n = 5818). Though antibiotic prescription was more likely if the test was positive (relative risk [RR], 1.68; 95% confidence interval [CI], 1.58-1.8), 92.46% of streptococcal pharyngitis cases with a negative test were prescribed an antibiotic. The Comprehensive Respiratory Panel (CRP) was ordered in 2498 visits; influenza was the most commonly detected pathogen. Physicians in the ED were most likely to order a CRP. Antibiotic prescription was lower if the CRP was not ordered compared with a negative CRP result (RR, 0.77; 95% CI, 0.7-0.84). There was no difference in prescribing by CRP result (negative vs positive). Conclusions RDTs are used infrequently in the outpatient setting, and impact on prescribing was inconsistent. Further work is needed to determine barriers to RDT use and to address potential solutions. © The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.Background User- and time-stamped data from hospital electronic health records (EHRs) present opportunities to evaluate how healthcare worker (HCW)-mediated contact networks impact transmission of multidrug-resistant pathogens, such as vancomycin-resistant enterococci (VRE). Methods This is a retrospective analysis of incident acquisitions of VRE between July 1, 2016 and June 30, 2018. Clinical and demographic patient data were extracted from the hospital EHR system, including all recorded HCW contacts with patients. Contacts by an HCW with 2 different patients within 1 hour was considered a "connection". Incident VRE acquisition was determined by positive clinical or surveillance cultures collected ≥72 hours after a negative surveillance culture. Results There were 2952 hospitalizations by 2364 patients who had ≥2 VRE surveillance swabs, 112 (4.7%) patients of which had incident nosocomial acquisitions. Patients had a median of 24 (interquartile range [IQR], 18-33) recorded HCW contacts per day, 9 (IQR, 5-16) of which, or approximately 40%, were connections that occurred  less then 1 hour after another patient contact. Patients that acquired VRE had a higher average number of daily connections to VRE-positive patients (3.1 [standard deviation SD, 2.4] versus 2.0 [SD, 2.1]). Controlling for other risk factors, connection to a VRE-positive patient was associated with increased odds of acquiring VRE (odds ratio, 1.64; 95% confidence interval, 1.39-1.92). Conclusions We demonstrated that EHR data can be used to quantify the impact of HCW-mediated patient connections on transmission of VRE in the hospital. Defining incident acquisition risk of multidrug-resistant organisms through HCWs connections from EHR data in real-time may aid implementation and evaluation of interventions to contain their spread. © The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.Background The prevalence of adolescent athletes who specialize in sports has increased in recent years. Substantial literature on youth sports has linked early sport specialization to negative consequences, such as burnout and injury. However, empirical evidence directly comparing burnout rates in sport specialization versus sport sampling is very limited. Purpose To conduct a systematic review and meta-analysis to evaluate psychological burnout in adolescent athletes who sport specialize compared with adolescent athletes who sport sample. Study Design Systematic review; Level of evidence, 4. Methods A systematic review was performed through use of the PubMed, SportDiscus, PsychInfo, and CINAHL databases (between inception and May 2019) according to PRISMA-IPD (Preferred Reporting Items for Systematic Reviews and Meta-Analyses of individual participant data) guidelines. Results from the 3 measures of the Athlete Burnout Questionnaire and athlete specialization status were recorded and analyzed. An athlete war levels of burnout in all 3 aspects (reduced sense of accomplishment, sport devaluation, and exhaustion) compared with sport sampling. © The Author(s) 2020.Background Controversy exits regarding performing a tenotomy versus a tenodesis of the long head of the biceps tendon (LHBT). Purpose To evaluate the complications after arthroscopic tenotomy of the LHBT and characterize the incidence of cosmetic deformity, cramping, subjective weakness, and continued anterior shoulder pain (ASP). Additionally, to identify patient-related factors that may predispose a patient to these complications. Study Design Case-control study; Level of evidence, 3. Methods Records of patients who underwent an arthroscopic LHBT tenotomy at an integrated health care system under the care of 55 surgeons were retrospectively reviewed. Exclusion criteria included LHBT tenodesis, arthroplasty, neoplastic, or fracture surgery; age younger than 18 years; incomplete documentation of physical examination; or incomplete operative reports. Characteristic data, concomitant procedures, LHBT morphology, and postoperative complications were recorded. Patients with and without postoperative complicationsic (Popeye) deformity. Patients who had active workers' compensation claims had 12.5 (95% CI, 2.4-63.4) times the odds of having continued postoperative ASP. Tenotomy on the dominant arm, BMI, and active smoking status demonstrated no statistically significant association with postoperative complications. Conclusion Patients experiencing complications after tenotomy were significantly younger and more likely to be male and to have a workers' compensation injury. LHBT tenotomy may best be indicated for elderly patients, female patients, and those without active workers' compensation claims. © The Author(s) 2020.Background Research into improving player safety of sport-related concussion (SRC) in American football has been an ongoing endeavor. In an attempt to better understand the incidence of SRCs in American football, research has focused on the characteristics of SRC during gameplay. Determining SRC specifics and assessing them quantitatively can help identify high-risk scenarios and predict exposure risk. Purpose To identify and assess the incidence of SRCs in a National Collegiate Athletic Association football team by comparing field location, player positions, collision partners, and player cues. Study Design Descriptive epidemiology study. Methods We used physician sideline reports of diagnosed concussions from a Division I football team from September 2010 to December 2018. Game videos were analyzed to identify the field location where the SRC occurred, collision partner, and player behavior postconcussion. The incidence of in-game SRCs by position was also assessed. We used the "words of estimative probabilcal observer to better identify them. © The Author(s) 2020.Cough, an important respiratory symptom, predominantly involves the brainstem and the urge-to-cough (UTC) is modulated by the cerebral cortex. Lewy body disease is associated with decreased cough reflex sensitivity and central respiratory chemosensitivity. Additionally, the insula, associated with the UTC, shows decreased activation and atrophy in dementia with Lewy bodies (DLB). We investigated the relationships between cognition and cough reflex and the UTC and compared the differences in responses of patients with DLB and other dementia subtypes. We conducted a cross-sectional study within a geriatric ward of a university hospital involving elderly patients diagnosed with Alzheimer's disease (AD), DLB, or non-dementia (controls). The cough reflex sensitivities were estimated based on the lowest concentrations of inhaled citric acid that could induce ≥2 coughs (C2) or ≥5 coughs (C5). Subjects were asked to rate the UTC based on the threshold concentrations (Cu) using the modified Borg scale. C2, C5 and Cu were negatively correlated with cognitive function in female participants but not in males (p less then 0.01). The cough reflex sensitivities expressed as C2 and C5 were significantly higher in the DLB group than in the AD and control groups (p less then 0.01 adjusted for gender). The UTC threshold expressed as Cu was also significantly higher in the DLB group, while the UTC log-log slope was less responsive in the DLB group than in the other groups. The cough reflex sensitivity and perceived UTC deteriorated in the DLB group more than in the other groups. This result might be valuable in treating patients with DLB. Copyright ©ERS 2020.Introduction Tuberculosis remains one of the top 10 major causes of global mortality, imposing social-economic and medical challenges in Malaysia. Refugees sheltered in Malaysia are a high-risk population but basic health checks upon their arrival, including tuberculosis screening, are not practised. This study aimed to identify the prevalence and risk factors of tuberculosis and latent tuberculosis infection (LTBI) among refugee children in Malaysia. Methods A cross-sectional study was performed in three refugee schools in the Klang Valley, Malaysia, using tuberculin skin tests or interferon-γ release assays. Participants who tested positive were sent for further examination with chest radiography to confirm the tuberculosis diagnosis. Results From April 2018 to April 2019, we screened 430 refugee children with a median age of 13.0 years. Most of the children were born in Myanmar (n=274, 63.7%) and Pakistan (n=60, 14.0%). No children were diagnosed with active tuberculosis but 55 of the children (12.8%) were diagnosed with LTBI.