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This study from a South Indian tertiary care hospital found a 41% peri-rectal Carbapenem-resistant Enterobacterales colonization prevalence at intensive care unit admission, with New Delhi metallo-β-lactamase as the predominant carbapenemase. It underscores the need for contextually appropriate, cost-effective infection prevention strategies to mitigate the spread of resistant organisms in Indian healthcare settings.
Physical health checks in primary care for people with severe mental illness ((SMI) defined as schizophrenia, bipolar disorders and non-organic psychosis) aim to reduce health inequalities. Patients who decline or are deemed unsuitable for screening are removed from the denominator used to calculate incentivisation, termed exception reporting.
Aims
To describe the prevalence of, and patient characteristics associated with, exception reporting in patients with SMI.
Method
We identified adult patients with SMI from the UK Clinical Practice Research Datalink (CPRD), registered with a general practice between 2004 and 2018. We calculated the annual prevalence of exception reporting and investigated patient characteristics associated with exception reporting, using logistic regression.
Results
Of 193 850 patients with SMI, 27.7% were exception reported from physical health checks at least once. Exception reporting owing to non-response or declining screening increased over the study period. Patients of Asian or Black ethnicity (Asian: odds ratio 0.72, 95% CI 0.65–0.80; Black: odds ratio 0.86, 95% CI 0.76–0.97; compared with White) and women (odds ratio 0.90, 95% CI 0.88–0.92) had a reduced odds of being exception reported, whereas patients diagnosed with ‘other psychoses’ (odds ratio 1.19, 95% CI 1.15–1.23; compared with bipolar disorder) had increased odds. Younger patients and those diagnosed with schizophrenia were more likely to be exception reported owing to informed dissent.
Conclusions
Exception reporting was common in people with SMI. Interventions are required to improve accessibility and uptake of physical health checks to improve physical health in people with SMI.
Impartiality as a property of government is central to many of the major constitutional concerns of liberal democracy. This essay tersely considers the nature and implications of impartiality in three main areas: the rule of law; the distinction between the right and the good; and freedom of speech. Because of constraints of space, each of the discussions in this paper is no more than a sketch of the complex matters that are at issue in debates over impartiality.
Objectives/Goals: The never in mitosis kinase (NEK) family regulates vital processes, namely cell cycle progression, but their potential as therapeutic targets in TNBC has not been fully explored. Our studies aim to develop a toolkit to investigate the functional roles of NEKs in pathologies including carcinogenesis. Methods/Study Population: To assess differential NEK expression in normal and tumor tissues and correlation of gene expression with patient survival, we used Gene Expression Profiling Interactive Analysis (GEPIA) and Kaplan–Meier Plotter (KMPlot) pan-cancer analysis, respectively. Basal NEK protein levels were determined by immunoblot across a panel of cell lines, including breast cancer, osteosarcoma, hepatocellular carcinoma, and non-cancerous cells, to identify appropriate systems for evaluation of NEK function. Doxycycline-inducible cell lines were generated by transduction with lentiviral stocks of NEK shRNA and overexpression constructs and antibiotic selection. Expression was analyzed by qPCR and immunoblot. Results/Anticipated Results: Expression of NEK2, 4, 5, 6, 8, and 11 was higher in breast tumors compared to normal tissue by GEPIA analysis. Further examination using KMPlot showed a correlation between elevated NEK6 expression and decreased overall survival in patients with aggressive cancers. As an initial proof-of-concept study, we analyzed NEK6 protein expression in breast cancer cells. Levels of NEK6 were elevated in TNBC cells (MDA-MB-231) compared to hormone receptor positive (HR+) breast cancer cells (MCF7). Using complementary approaches to investigate the functional role of NEK6 in breast cancer, we depleted NEK6 expression using shRNAs in TNBC cells and expressed NEK6 in HR+ cells Discussion/Significance of Impact: Because kinase dysregulation promotes oncogenesis and metastasis, targeting kinases is a key strategy in therapeutic development. A NEK-specific molecular toolkit allows researchers to elucidate NEK functions and contributions to carcinogenesis, promoting advancement of novel therapies.
There is an “under-representation problem” in philosophy departments and journals. Empirical data suggest that while we have seen some improvements since the 1990s, the rate of change has slowed down. Some posit that philosophy has disciplinary norms making it uniquely resistant to change. We present results from an empirical case study of a philosophy department that achieved and maintained male-female gender parity among its faculty as early as 2014. Our analysis extends beyond matters of gender parity because that is only one, albeit important, dimension of inclusion. We build from the study to reflect on strategies that may catalyze change.
Previous studies have linked social behaviors to COVID-19 risk in the general population. The impact of these behaviors among healthcare personnel, who face higher workplace exposure risks and possess greater prevention awareness, remains less explored.
Design:
We conducted a Prospective cohort study from December 2021 to May 2022, using monthly surveys. Exposures included (1) a composite of nine common social activities in the past month and (2) similarity of social behavior compared to pre-pandemic. Outcomes included self-reported SARS-CoV-2 infection (primary)and testing for SARS-CoV-2 (secondary). Mixed-effect logistic regression assessed the association between social behavior and outcomes, adjusting for baseline and time-dependent covariates. To account for missed surveys, we employed inverse probability-of-censoring weighting with a propensity score approach.
Setting:
An academic healthcare system.
Participants:
Healthcare personnel.
Results:
Of 1,302 healthcare personnel who completed ≥2 surveys, 244 reported ≥1 positive test during the study, resulting in a cumulative incidence of 19%. More social activities in the past month and social behavior similar to pre-pandemic levels were associated with increased likelihood of SARS-CoV-2 infection (recent social activity composite: OR = 1.11, 95% CI 1.02–1.21; pre-pandemic social similarity: OR = 1.14, 95% CI 1.07–1.21). Neither was significantly associated with testing for SARS-CoV-2.
Conclusions:
Healthcare personnel social behavior outside work was associated with a higher risk for COVID-19. To protect the hospital workforce, risk mitigation strategies for healthcare personnel should focus on both the community and workplace.
In a short span, this Element will delineate the general nature of legal and moral rights and the general nature of the holding of rights, and it will also sketch the justificatory foundations of rights. Hence, the Element will treat of some major topics within legal, political, and moral philosophy as it combines analytical theses and ethical theses in a complex pattern.
Non-native plants negatively impact ecosystems via a variety of mechanisms, including in forested riparian areas. Japanese knotweed [Polygonum cuspidatum Siebold & Zucc.] and its hybrids (referred to as Polygonum spp. hereafter) are widely spread throughout North America and can impact flora and fauna of riparian habitats. Thus, information improving our ability to understand and predict the potential spread and colonization of Polygonum spp. is valuable. One dispersal mechanism is hydrochory (i.e., dispersal by water), including the downstream dispersal of viable stems that can facilitate rapid invasion within a watershed. We used passive integrated transponder (PIT) telemetry in experimental releases of Polygonum spp. stems to track the downstream transport of Polygonum spp. in a small (second-order) stream in northern New Hampshire, USA, in the summers of 2021 and 2022. A total of 180 (90 each year) Polygonum spp. stems were released at three sites within the stream reach, with 185 (∼98%) being recaptured at least once, with a total of 686 recaptures. Individual relocated stems moved a maximum distance of 30 to 875 m downstream in 2021 and 13 to 1,233 m in 2022 during regular flows; however, a high-streamflow event in July 2021 flushed out all remaining stems downstream of the study area. Generalized additive mixed models (GAMMs) identified site-specific differences in stem movement rates and a general reduction in movement rates with increased duration of time elapsed since post-release. In general, Polygonum spp. stems moved farther downstream in sites with lower channel sinuosity, although other fine-scale habitat factors (e.g., water depth, habitat type, and presence of wood and debris jams) likely contribute to the ability for Polygonum spp. to further disperse or otherwise be retained within the channel. Thus, stream morphology and stream flow are likely to affect where Polygonum spp. stems will be retained and potentially reestablish. Predictive tools identifying areas of higher probability of hydrochory-based dispersal could help to focus removal efforts when employed or to identify riparian habitats at highest risk for spread.
England's primary care service for psychological therapy (Improving Access to Psychological Therapies [IAPT]) treats anxiety and depression, with a target recovery rate of 50%. Identifying the characteristics of patients who achieve recovery may assist in optimizing future treatment. This naturalistic cohort study investigated pre-therapy characteristics as predictors of recovery and improvement after IAPT therapy.
Methods
In a cohort of patients attending an IAPT service in South London, we recruited 263 participants and conducted a baseline interview to gather extensive pre-therapy characteristics. Bayesian prediction models and variable selection were used to identify baseline variables prognostic of good clinical outcomes. Recovery (primary outcome) was defined using (IAPT) service-defined score thresholds for both depression (Patient Health Questionnaire [PHQ-9]) and anxiety (Generalized Anxiety Disorder [GAD-7]). Depression and anxiety outcomes were also evaluated as standalone (PHQ-9/GAD-7) scores after therapy. Prediction model performance metrics were estimated using cross-validation.
Results
Predictor variables explained 26% (recovery), 37% (depression), and 31% (anxiety) of the variance in outcomes, respectively. Variables prognostic of recovery were lower pre-treatment depression severity and not meeting criteria for obsessive compulsive disorder. Post-therapy depression and anxiety severity scores were predicted by lower symptom severity and higher ratings of health-related quality of life (EuroQol questionnaire [EQ5D]) at baseline.
Conclusion
Almost a third of the variance in clinical outcomes was explained by pre-treatment symptom severity scores. These constructs benefit from being rapidly accessible in healthcare services. If replicated in external samples, the early identification of patients who are less likely to recover may facilitate earlier triage to alternative interventions.
Unconsolidated soils typically develop a physical surface crust after wetting and drying. We reproduced this process in the laboratory by wetting with fog and simulated rain on fallow agricultural soils from 26 locations, representing 15 soil types from Pinal County, Arizona. Through correlative analyses, we found that carbonate content was a strong predictor of physical crust strength with fog (p < 0.0001, R2 = 0.48) and rain (p = 0.004, R2 = 0.30). Clay content increased crust strength (p = 0.04) but was not a useful predictor. Our results extend the current understanding of the soil crusting process by highlighting the preeminence of carbonate cementation in desert agricultural soils. Consequently, we identify carbonate as a pragmatic tool for estimating crust strength, a surrogate measure of a soil’s potential to produce fugitive dust, which can help prioritize interventions to curb airborne dust in arid lands.
Debate surrounds the early peopling of the Arabian Peninsula. The first evidence of the Levallois lithic technology in the Huqf area of south-eastern Arabia now extends the Middle Palaeolithic record of hominin activity into central Oman and helps to diversify the picture of Arabian prehistory.
With Palmer amaranth and waterhemp evolving resistance to nine and six different sites of action (SOAs) globally, soybean producers continue to search for new options to control these problematic weeds. Bayer CropScience has announced its intentions to launch a Convintro™ brand of herbicides, one being a three-way premixture for preemergence use in soybean. The premixture will contain diflufenican (WSSA Group 12), metribuzin (WSSA Group 5), and flufenacet (WSSA Group 15), adding a new SOA for soybean producers throughout the United States. With the anticipated launch of the premixture, research is needed to evaluate the length of residual control provided by the new herbicide. Research trials were conducted in Fayetteville and Keiser, AR, and Morrice, MI, in 2022 and 2023. A 0.17:0.35:0.48 ratio of a diflufenican:metribuzin:flufenacet (DFF)-containing premixture was applied alone and in combination with additional metribuzin and dicamba. Also, metribuzin, acetochlor, a S-metolachlor:metribuzin premixture, and a flumioxazin:pyroxasulfone:metribuzin premixture were applied preemergence. The DFF-containing premixture was more effective in reducing Palmer amaranth/waterhemp emergence than acetochlor in four of six trials at 28 d after treatment (DAT). Palmer amaranth and waterhemp densities in plots treated with the DFF-containing premixture exhibited similar results to plots treated with the S-metolachlor:metribuzin premixture and the flumioxazin:pyroxasulfone:metribuzin premixture at 28 DAT. By 56 DAT, Palmer amaranth and waterhemp densities were comparable or superior in plots with the DFF-containing premixture than in those treated with acetochlor and metribuzin, and the S-metolachlor:metribuzin premixture at five of six sites. The addition of dicamba or metribuzin to the DFF-containing premixture did not reduce Palmer amaranth or waterhemp density compared to the DFF-containing premixture at 28 or 56 DAT. Overall, the DFF-containing premixture generally provided greater or comparable control over several standard herbicides, providing growers a new product for preemergence control of Amaranthus species in soybean fields.
In response to the COVID-19 pandemic, we rapidly implemented a plasma coordination center, within two months, to support transfusion for two outpatient randomized controlled trials. The center design was based on an investigational drug services model and a Food and Drug Administration-compliant database to manage blood product inventory and trial safety.
Methods:
A core investigational team adapted a cloud-based platform to randomize patient assignments and track inventory distribution of control plasma and high-titer COVID-19 convalescent plasma of different blood groups from 29 donor collection centers directly to blood banks serving 26 transfusion sites.
Results:
We performed 1,351 transfusions in 16 months. The transparency of the digital inventory at each site was critical to facilitate qualification, randomization, and overnight shipments of blood group-compatible plasma for transfusions into trial participants. While inventory challenges were heightened with COVID-19 convalescent plasma, the cloud-based system, and the flexible approach of the plasma coordination center staff across the blood bank network enabled decentralized procurement and distribution of investigational products to maintain inventory thresholds and overcome local supply chain restraints at the sites.
Conclusion:
The rapid creation of a plasma coordination center for outpatient transfusions is infrequent in the academic setting. Distributing more than 3,100 plasma units to blood banks charged with managing investigational inventory across the U.S. in a decentralized manner posed operational and regulatory challenges while providing opportunities for the plasma coordination center to contribute to research of global importance. This program can serve as a template in subsequent public health emergencies.
Japanese hop (Humulus japonicus Siebold & Zucc.) is an emerging invasive plant that has been observed to invade and spread throughout wetlands. As an annual vine, H. japonicus can smother native vegetation, forming dense stands and reducing biodiversity. At a restored floodplain forest in Joslin, IL, formerly used as an experimental site to test the effectiveness of different reforestation methods, H. japonicus has invaded stands of the previously dominant invasive, reed canarygrass (Phalaris arundinacea L.). We conducted an observational field study to examine the spatiotemporal dynamics of H. japonicus invasion relative to gradients in canopy cover and species composition. Ten transects, with half the transect extending into and half extending beyond H. japonicus patches, were established in October 2022. Seven quadrats per transect were surveyed for vegetation cover and canopy cover in October 2022, June 2023, and October 2023. Transects were evenly split between forested and open areas based on the reforestation treatments. Humulus japonicus cover significantly increased from October 2022 to October 2023, resulting in a slight decrease and replacement of P. arundinacea across the site. Shade reduced H. japonicus cover, indicating its preference for sunlit conditions. Species richness was higher in forested transects compared with open ones, most likely due to the absence of both P. arundinacea and H. japonicus in shaded transects. Along transects, quadrats that had been invaded by H. japonicus differed in species composition from quadrats that had not been invaded in both October 2022 and October 2023. Humulus japonicus cover was much lower in June than October, suggesting that temporal niche partitioning may allow P. arundinacea to persist, and indicating that monitoring for H. japonicus should occur late in the growing season. Both invasive species are shade intolerant, suggesting that planting fast-growing trees should be an effective long-term solution for controlling invasion.
Partisan polarization on “culture war” issues has become a defining feature of contemporary American politics. This was not always the case; for the first two-thirds of the twentieth century, social issues such as abortion and LGBTQ rights played no role in politics. Where and when did the partisan divide begin? Did the initiative come from state or national parties? Was there a critical moment, or was position change incremental? We have constructed an original database of nearly 2,000 state party platforms from 1960 to 2018. These platforms allow us to trace position-taking on these issues and generate estimates of platform ideology. By the time national parties took positions, we show, they lagged state-level position-taking. Contrary to long-held assumptions, we show that state party system polarization did not occur around any critical moment but rather was incremental.
Bacterial resistance is known to diminish the effectiveness of antibiotics for treatment of urinary tract infections. Review of recent healthcare and antibiotic exposures, as well as prior culture results is recommended to aid in selection of empirical treatment. However, the optimal approach for assessing these data is unclear. We utilized data from the Veterans Health Administration to evaluate relationships between culture and treatment history and the subsequent probability of antibiotic-resistant bacteria identified in urine cultures to further guide clinicians in understanding these risk factors.
Methods:
Using the XGBoost algorithm, a retrospective cohort of outpatients with urine culture results and antibiotic prescriptions from 2017 to 2022 was used to develop models for predicting antibiotic resistance for three classes of antibiotics: cephalosporins, fluoroquinolones, and trimethoprim/sulfamethoxazole (TMP/SMX) obtained from urine cultures. Model performance was assessed using Area Under the Receiver Operating Characteristic curve (AUC) and Precision-Recall AUC (PRAUC)
Results:
There were 392,647 prior urine cultures identified in 214,656 patients. A history of bacterial resistance to the specific treatment was the most important predictor of subsequent resistance for positive cultures, followed by a history of specific antibiotic exposure. The models performed better than previously established risk factors alone, especially for fluoroquinolone resistance, with an AUC of .84 and PRAUC of .70. Notably, the models’ performance improved markedly (AUC = .90, PRAUC = .87) when applied to cultures from patients with a known history of resistance to any of the antibiotic classes.
Conclusion:
These predictive models demonstrate potential in guiding antibiotic prescription and improving infection management.
One commendable aspect of the ruminations by H.L.A Hart on legal positivism, which quite a few contemporary philosophers of law have not fully absorbed, is that he recognised the diversity of the points of contention that have pitted the devotees of positivism against the devotees of natural-law theories. Whereas some present-day philosophers of law are inclined to refer to “the separability thesis” of legal positivism – with the definite article “the” as a signal that there is one defining point of dispute between legal positivists and their opponents – Hart knew that there is no single such thesis. Natural-law theorists have in fact postulated numerous connections between law and morality which putatively clinch the character of law as an inherently moral phenomenon, and legal positivists have posed challenges to each of those connections or to the claim that any unchallenged connection serves to establish the inherently moral character of law.