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Summary Background Procalcitonin (PCT) has previously been proposed as useful marker to rule out bloodstream‐infection (BSI). The objective of this study was to evaluate the sensitivity of different PCT cut‐offs for prediction of BSI in patients with community (CA)‐ and hospital‐acquired (HA)‐BSI. Methods A total of 898 patients fulfilling systemic‐inflammatory‐response‐syndrome (SIRS) criteria were enrolled in this prospective cohort study at the Medical University of Graz, Austria. Of those 666 patients had positive blood cultures (282 CA‐BSI, 384 HA‐BSI, enrolled between January 2011 and December 2012) and 232 negative blood cultures (enrolled between January 2011 and July 2011 at the emergency department). Blood samples for determination of laboratory infection markers (e.g. PCT) were collected simultaneously with blood cultures. Results Procalcitonin was significantly (p < 0.001) higher in SIRS patients with bacteremia/fungemia than in those without. Receiver operating characteristic curve analysis revealed an area under the curve (AUC) value of 0.675 for PCT (95% CI 0.636–0.714) for differentiating patients with BSI from those without. AUC for IL‐6 was 0.558 (95% CI 0.515–0.600). However, even at the lowest cut‐off evaluated (i.e. 0.1 ng/ml) PCT failed to predict BSI in 7% (n = 46) of patients. In the group of patients with SIRS and negative blood culture 79% (n = 185) had PCT levels > 0.1. Conclusion Procalcitonin was significantly higher in patients with BSI than in those without and superior to IL‐6 and CRP. The clinical importance of this is questionable, because a suitable PCT threshold for excluding BSI was not established. An approach where blood cultures are guided by PCT only can therefore not be recommended. Linked Comment: www.youtube.com/IJCPeditorial

Background The COVID-19 pandemic and subsequent restrictions increased the psychological distress of the population while the use of on-site mental health care decreased. The provision of online mental health care was therefore scaled up in many European countries. The extent to which online care can deliver services to all people (horizontal equity) according to their needs (vertical equity) is unknown. This study assessed whether online advice-seeking was related to mental health needs and whether different population subgroups were equally likely to seek advice. Methods A longitudinal, online survey was carried out in Belgium in April, June, and November 2020. 13,150 different individuals participated in at least one study wave. At the end of each wave, information on how to receive help was provided. Psychological distress was measured using the GHQ-12. We used logistic regression to compare the association between psychological distress and online advice-seeking across waves and sociodemographic groups. Results 29% of the respondents sought online advice in April, and one fifth in June and November. The frequency of advice-seeking was associated with higher psychological distress (OR = 1.24, 95% CI:1.22–1.26). Women, young people, respondents with higher education, and respondents with less social support were more likely to seek advice online. Conclusions Online mental health advice seems to achieve vertical equity. Sociodemographic variables were, however, better predictors of psychological distress than advice-seeking. More attention should be paid to older and less well educated men, who were less likely to seek advice. In the longer term, the responsiveness of online services needs to be assessed.

While loneliness in Jane Austen’s Emma is under-studied, those critics who do address it posit marriage as its cure. In contrast, this essay argues that, in Emma, marriage is not the solution, but rather part of the problem of loneliness. The novel begins with the painful after-effects of a wedding for those left behind and it consistently shows how the institution of marriage displaces other bonds. Emma’s resistance to marriage (frequently interpreted as her domineering nature in need of correction) is her attempt to maintain the bonds at Hartfield. This essay, taking a cognitive approach, reads Emma sympathetically by taking seriously the loss and loneliness she has endured, thus reframing her alleged flaws, and credits her with the attempt to imagine belonging outside of the conventional marriage plot.

Longitudinal studies have identified an increase in psychological distress across the general population during the COVID-19 pandemic. Nevertheless, the trajectories of mental health outcomes exhibit variations, suggesting potential associations with psychosocial individual factors. This paper identifies the factors of this individual trajectory of psychological distress during the COVID-19 pandemic. Five waves of a prospective cohort survey were conducted with a convenience sample of the general population in Belgium between March 2020 and November 2021 (n = 4,550). Psychological distress was measured using the GHQ-12. Individual covariates included socioeconomic factors (age, gender, level of education), psychological factors (loneliness, social support, and social activities), and factors related to the virus and the lockdown measures (exposure to COVID-19 and survey wave). Multilevel models were used for analysis. Women and young people experienced more pronounced fluctuations in their risk of psychological distress across study waves, experiencing both increases and decreases. We found that individual variance in psychological distress breaks down into two components, respectively 43% for psychosocial factors (time-invariant) and 57% for the survey waves (time-variant) variation. A significant share of the time-invariant difference in psychological distress over COVID-19 is associated with loneliness, social support, and social activities. Loneliness emerged as the most important interpersonal factor associated with psychological distress. The change in psychological distress was mainly associated with psychosocial factors rather than with pandemic-related dynamics (e.g. survey waves). These findings suggest that mitigation policies aiming at controlling the pandemic should focus more on addressing specific individual vulnerabilities rather than solely responding to the fluctuations within pandemic waves to decrease their detrimental impact on mental health.

General Consent in Jane Austen examines the \"early\" and \"late\" novels as well as the juvenilia in the light of three paradigms: \"The Other Heroine\" focuses on voices that challenge and compete with the central heroines, \"Cameo Appearances\" examines buried past narratives, and \"Investigating Crimes\" explores acts of violence. These three avenues into dialogic space destabilize conventional readings of Austen. The Bakhtinian model that structures this book is not one of linearity and balance but one of conflict, simultaneity, and multiplicity. While some novels fit into only one paradigm, others incorporate more than one; Mansfield Park receives the most attention. A bold and provocative study, General Consent in Jane Austen will be of interest not only to Austen scholars but to scholars of literary theory and dialogism.

Purpose Reliable and rapid diagnosis of influenza A H1N1 is essential to initiate the appropriate antiviral therapy and preventive measures. As PCR assays are time-consuming and rapid antigen tests have a limited sensitivity, official influenza case definitions are used in many clinical settings. These, however, are based exclusively on clinical criteria and have only a moderate potential to differentiate between influenza and other febrile diseases. Only limited data on the differences in clinical and laboratory parameters between influenza and non-influenza febrile diseases are available to date. Methods This was a retrospective case-negative control series that was conducted in Styria, southeast Austria. We analyzed the differences in clinical presentation and laboratory admission parameters between patients with PCR-confirmed H1N1 influenza infection ( n  = 199) and those with influenza-like disease and negative influenza PCR results (ILD group; n  = 252). Results In the multivariable analysis lower C-reactive protein (CRP) level, lower white blood cell (WBC) count, fever, wheezing, cough, and the absence of nausea or sudden onset remained significant predictors of H1N1 influenza in adult patients ( n  = 263). Lower CRP level, lower WBC count, and cough remained significant predictors in pediatric patients (<16 years; n  = 188). Conclusion Lower CRP level, lower WBC count, and cough were significant predictors of H1N1 in both the adult and pediatric patient group. These data may help to develop an improved case definition for suspected H1N1 infection which combines clinical findings and easily available laboratory parameters.

General Consent in Jane Austen examines the \"early\" and \"late\" novels as well as the juvenilia in the light of three paradigms: \"The Other Heroine\" focuses on voices that challenge and compete with the central heroines, \"Cameo Appearances\" examines buried past narratives, and \"Investigating Crimes\" explores acts of violence. These three avenues into dialogic space destabilize conventional readings of Austen. The Bakhtinian model that structures this book is not one of linearity and balance but one of conflict, simultaneity, and multiplicity. While some novels fit into only one paradigm, others incorporate more than one; Mansfield Park receives the most attention.