Importance Suicide is a leading cause of deaths in the U.S. Although the emergency department (ED) is an opportune setting for initiating suicide prevention efforts, ED-initiated suicide prevention interventions remain underdeveloped. Objective To determine if an ED-initiated intervention reduces subsequent suicidal behavior. Design This multicenter study was composed of three sequential phases: 1) Treatment as Usual (TAU) (August 2010–December 2011), 2) Universal Screening (Screening) (September 2011–December 2012, and 3) Universal Screening + Intervention (Intervention)(July 2012-November 2013. Setting Eight EDs in the United States Participants Adults with a recent suicidal attempt or ideation were enrolled. Intervention Universal Screening consisted of universal suicide risk screening. The Intervention phase consisted of universal screening plus an intervention which included secondary suicide risk screening by the ED physician, discharge resources, and post-ED telephone calls focused on reducing suicide risk. Main Outcomes The primary outcome was suicide attempts (non-fatal and fatal) over the 52-week follow-up. The proportion and total number of attempts were analyzed. Results 1,376 participants (56% female, median age 36 years) were recruited. 288 participants (21%) made at least one suicide attempt. There were 548 total suicide attempts among participants. There were no significant differences in risk reduction between the TAU and Screening phases (23% vs. 22%). However, when compared to the TAU Phase, subjects in the Intervention phase showed a 5 % absolute reduction in suicide attempt risk (23% vs. 18%) with a relative risk reduction of 20%. Participants in the Intervention Phase had 30% fewer total suicide attempts than participants in the TAU Phase. Negative binomial regression analysis indicated that the participants in the Intervention Phase had significantly fewer total suicide attempts than participants in the TAU Phase (IRR, 0.72, 95%CI 0.52–1.00, P=0.05), but no differences between the TAU and Screening phases (IRR, 1, 95%CI 0.71–1.41, P=0.99). Conclusions Among at-risk patients in the ED, a combination of brief interventions administered both during and after the ED visit decreased post-ED suicidal behavior.

Little is known about the relationship between specific composition of the airway microbiota and severity of bronchiolitis. We aimed to identify nasopharyngeal microbiota profiles and to link these profiles to acute severity in infants hospitalized for bronchiolitis. We conducted a multicenter prospective cohort study of 1005 infants (age <1 year) hospitalized for bronchiolitis over three winters, 2011-2014. By applying a 16S rRNA gene sequence and clustering approach to the nasopharyngeal aspirates collected within 24 hours of hospitalization, we determined nasopharyngeal microbiota profiles and their association with bronchiolitis severity. The primary outcome was intensive care use – i.e., admission to an intensive care unit or use of mechanical ventilation. We identified four distinct nasopharyngeal microbiota profiles – three profiles were dominated by either Haemophilus, Moraxella, or Streptococcus, while the fourth profile had the highest bacterial richness. The rate of intensive care use was highest in infants with a Haemophilus-dominant profile and lowest in those with a Moraxella-dominant profile (20.2% vs 12.3%; unadjusted OR, 1.81; 95%CI, 1.07-3.11; P=0.03). After adjusting for 11 patient-level confounders, the rate remained significantly higher in infants with a Haemophilus-dominant profile (OR, 1.98; 95%CI, 1.08-3.62; P=0.03). These findings were externally validated in a separate cohort of 307 children hospitalized for bronchiolitis.

OBJECTIVE We evaluated vitamin D insufficiency in a nationally representative sample of women and assessed the role of vitamin supplementation. STUDY DESIGN We conducted secondary analysis of 928 pregnant and 5173 nonpregnant women aged 13–44 years from the National Health and Nutrition Examination Survey 2001–2006. RESULTS The mean 25-hydroxyvitamin D (25[OH]D) level was 65 nmol/L for pregnant women and 59 nmol/L for nonpregnant women. The prevalence of 25(OH)D <75 nmol/L was 69% and 78%, respectively. Pregnant women in the first trimester had similar 25(OH)D levels as nonpregnant women (55 vs 59 nmol/L), despite a higher proportion taking vitamin D supplementation (61% vs 32%). However, first-trimester women had lower 25(OH)D levels than third-trimester women (80 nmol/L), likely from shorter duration of supplement use. CONCLUSION Adolescent and adult women of childbearing age have a high prevalence of vitamin D insufficiency. Current prenatal multivitamins (400 IU vitamin D) helped to raise serum 25(OH)D levels, but higher doses and longer duration may be required.