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Understanding Modern Warfare has established itself as a leading text in professional military education and undergraduate teaching. This third edition has been revised throughout to reflect dramatic changes during the past decade. Introducing three brand new chapters, this updated volume provides in-depth analysis of the most pertinent issues of the 2020s and beyond, including cyber warfare, information activities, hybrid and grey zone warfare, multi-domain operations and recent conflicts in Ukraine, Gaza, and Syria. It also includes a range of features to maximise its value as a learning tool: a structure designed to guide students through key strategic principles; key questions and annotated reading guides for deeper understanding; text boxes highlighting critical thinkers and operational concepts; and a glossary explaining key terms. Providing debate driven analysis that encourages students to develop a balanced perspective, Understanding Modern Warfare remains essential reading both for officers and for students of international relations more broadly.
Objectives/Goals: Research suggests that veterans identifying as Black, Hispanic/Latinx and multiracial may be at higher risk for developing posttraumatic stress disorder (PTSD). The aim of the current study was to compare PTSD treatment outcomes across racial/ethnic veteran groups. Methods/Study Population: Data from 862 veterans who participated in a 2-week cognitive processing therapy (CPT)-based intensive PTSD treatment program were evaluated. Veterans were on average 45.2 years old and 53.8% identified as male. Overall, 64.4% identified as White, Non-Hispanic/ Latino; 17.9% identified as Black, Indigenous, and People of Color (BIPOC), Non-Hispanic/Latino; and 17.7% identified as Hispanic/Latino. PTSD (PCL-5) and depression (PHQ-9) were collected at intake, completion, and at 3-month follow up. A Bayes factor approach was used to examine whether PTSD, and depression outcomes would be noninferior for BIPOC and Hispanic/Latino groups compared to White, Non-Hispanic veterans over time. Results/Anticipated Results: PTSD severity decreased for the White, BIPOC, and Hispanic/Latino groups from baseline to 3-month follow-up. The likelihood that BIPOC and Hispanic/Latino groups would have comparable PTSD outcomes was 1.81e+06 to 208.56 times greater than the likelihood that these groups would have worse outcomes than the White, Non-Hispanic veterans. Depression severity values on the PHQ-9 decreased for the White, BIPOC, and Hispanic/Latino groups from baseline to 3-month follow-up. The likelihood that BIPOC and Hispanic/Latino groups would have comparable depression outcomes at treatment completion approached infinity. At 3-month follow-up, likelihood was 1.42e+11 and 3.09e+05, respectively. Discussion/Significance of Impact: Results indicated that White, BIPOC, and Hispanic/ Latino groups experienced similarly large PTSD and depression symptom reductions. This study adds to the growing body of literature examining differences in clinical outcomes across racial/ ethnic groups for PTSD.
Do fixed-prize charitable lotteries generate more net revenue than do revenue-dependent lotteries? I present the results of an experiment designed to test a theoretical prediction of the relationship between the prize structure of a lottery funding a public good and individuals’ participation in the lottery. I find that a fixed-prize lottery configuration induces significantly greater participation and a significantly higher level of public good funding than does a revenue-dependent lottery.
Auctions that require advance production increase seller costs because inventories must be held. This cost does not exist in production-to-demand markets for which production follows trading, and sales exactly match quantities produced. Data from laboratory computerized double auction markets show that advance-production prices are significantly higher and quantities traded are significantly lower than they are in production-to-demand auctions. Price convergence patterns show advance-production sellers moving toward 9% higher prices and 22% greater earnings.
Vaccines have revolutionised the field of medicine, eradicating and controlling many diseases. Recent pandemic vaccine successes have highlighted the accelerated pace of vaccine development and deployment. Leveraging this momentum, attention has shifted to cancer vaccines and personalised cancer vaccines, aimed at targeting individual tumour-specific abnormalities. The UK, now regarded for its vaccine capabilities, is an ideal nation for pioneering cancer vaccine trials. This article convened experts to share insights and approaches to navigate the challenges of cancer vaccine development with personalised or precision cancer vaccines, as well as fixed vaccines. Emphasising partnership and proactive strategies, this article outlines the ambition to harness national and local system capabilities in the UK; to work in collaboration with potential pharmaceutic partners; and to seize the opportunity to deliver the pace for rapid advances in cancer vaccine technology.
Historical changes from shifting land use, the natural meandering of waterways, and the aftereffects of erosion complicate modern environments and obfuscate precontact landscapes. Although archaeologists can create stratified sampling models or employ systematic surveys, traditional field methodologies are often not suitable for site discovery, thereby limiting knowledge of ancient cultural landscapes. Many water systems in southern Louisiana, and in many parts of the world, have been covered or concealed in backswamps by natural geomorphological processes, development, or environmental degradation. Investigation standards that do not account for these changes will not be effective at identifying archaeological sites in such transformed landscapes. Discoveries made during ongoing archaeological research in Iberville Parish, Louisiana, provide examples of what can be missed and offer solutions through changes in archaeological field methods. This article advocates for a mixed-methodology approach, drawing from historical research and shallow geophysics to look at landforms and landscape changes. Strictly following state survey guidelines can muddle the archaeological record, particularly in places subject to significant landscape change from historical land-use alteration. By applying these approaches, we offer a way to reconstruct ancient landscapes and landforms that are culturally significant but often missed given the nature of modern environmental conditions.
This study examined associations between pregnancy and infant birth outcomes with child telomere length at age 17 years; and investigated if there are sex differences between pregnancy complications and telomere length. We utilised the population-based prospective Raine cohort study in Western Australia, Australia. 2900 pregnant women were recruited at 16–20 weeks’ gestation (Gen 1), and their children (Gen 2) were followed up over several years. Generalised linear models were used to examine relationships between pregnancy or birth outcomes (gestational diabetes, pre-eclampsia, preterm birth, low birth weight, macrosomia), and as a composite, with telomere length, measured via a DNA sample from blood at 17 years of age. Analyses were adjusted for a range of confounders. Among the 1202 included children, there were no differences in child telomere length for any of the individual maternal or birth weight pregnancy outcomes nor were there any significant interactions between each of the complications (individual or composite) and the sex of the child. However, females born from any of the 5 adverse outcomes had shorter telomeres (estimated mean (SE) = -0.159 (0.061), p = 0.010) than females born in the absence of these complications. Specifically, females born from a pre-eclamptic pregnancy had shorter telomeres than females not born from a pre-eclamptic pregnancy (estimated mean (SE) = -0.166 (0.072), p = 0.022). No relationships were observed in males. Further longitudinal studies are needed to understand mediating factors that are important in predicting offspring telomere length and the necessity to investigate females and males independently.
Patients tested for Clostridioides difficile infection (CDI) using a 2-step algorithm with a nucleic acid amplification test (NAAT) followed by toxin assay are not reported to the National Healthcare Safety Network as a laboratory-identified CDI event if they are NAAT positive (+)/toxin negative (−). We compared NAAT+/toxin− and NAAT+/toxin+ patients and identified factors associated with CDI treatment among NAAT+/toxin− patients.
Design:
Retrospective observational study.
Setting:
The study was conducted across 36 laboratories at 5 Emerging Infections Program sites.
Patients:
We defined a CDI case as a positive test detected by this 2-step algorithm during 2018–2020 in a patient aged ≥1 year with no positive test in the previous 8 weeks.
Methods:
We used multivariable logistic regression to compare CDI-related complications and recurrence between NAAT+/toxin− and NAAT+/toxin+ cases. We used a mixed-effects logistic model to identify factors associated with treatment in NAAT+/toxin− cases.
Results:
Of 1,801 cases, 1,252 were NAAT+/toxin−, and 549 were NAAT+/toxin+. CDI treatment was given to 866 (71.5%) of 1,212 NAAT+/toxin− cases versus 510 (95.9%) of 532 NAAT+/toxin+ cases (P < .0001). NAAT+/toxin− status was protective for recurrence (adjusted odds ratio [aOR], 0.65; 95% CI, 0.55–0.77) but not CDI-related complications (aOR, 1.05; 95% CI, 0.87–1.28). Among NAAT+/toxin− cases, white blood cell count ≥15,000/µL (aOR, 1.87; 95% CI, 1.28–2.74), ≥3 unformed stools for ≥1 day (aOR, 1.90; 95% CI, 1.40–2.59), and diagnosis by a laboratory that provided no or neutral interpretive comments (aOR, 3.23; 95% CI, 2.23–4.68) were predictors of CDI treatment.
Conclusion:
Use of this 2-step algorithm likely results in underreporting of some NAAT+/toxin− cases with clinically relevant CDI. Disease severity and laboratory interpretive comments influence treatment decisions for NAAT+/toxin− cases.
The Li+ ion is used frequently as an environmentally acceptable surrogate for sorbing radionuclides in field tracer tests, and experiments using Li are an important part of assessing the potential transport of radionuclides in saturated alluvium south of Yucca Mountain, Nevada, the site of a proposed nuclear waste repository. Equilibrium partition constants (Li+ Kds) were measured using batch studies incorporating a wide range of Li+ concentrations and two different grain-size fractions of alluvium samples from multiple depth intervals in two wells. Cation exchange capacity, surface area, bulk mineralogy from quantitative X-ray powder diffraction, and trace Mn- and Fe-oxyhydroxide mineralogy from extractive studies were evaluated as predictors for linearized Li+ Kd values (K1in) in the alluvium. Many of the predictor variables are correlated with each other and this was considered in the analysis. Linearized Kd values were consistently higher for fine particle-size fractions than for coarse fractions. Single and multivariate linear regression analyses indicated that the clinoptilolite + smectite content, taken together as a combined variable, was the best predictor for Li+ sorption in the alluvium, although clinoptilolite content was clearly a better predictor when the two variables were considered separately in simple linear regressions. Even so, Li+ Klin predictions based on clinoptilolite and smectite abundance were accurate only to within about ±100%. This uncertainty suggests that there is either a high inherent variability in Li+ Klin values or that additional alluvium characteristics not measured or evaluated here may play an important role in simple Li+ cation exchange in the alluvium.
Since the initial publication of A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals in 2008, the prevention of healthcare-associated infections (HAIs) has continued to be a national priority. Progress in healthcare epidemiology, infection prevention, antimicrobial stewardship, and implementation science research has led to improvements in our understanding of effective strategies for HAI prevention. Despite these advances, HAIs continue to affect ∼1 of every 31 hospitalized patients,1 leading to substantial morbidity, mortality, and excess healthcare expenditures,1 and persistent gaps remain between what is recommended and what is practiced.
The widespread impact of the coronavirus disease 2019 (COVID-19) pandemic on HAI outcomes2 in acute-care hospitals has further highlighted the essential role of infection prevention programs and the critical importance of prioritizing efforts that can be sustained even in the face of resource requirements from COVID-19 and future infectious diseases crises.3
The Compendium: 2022 Updates document provides acute-care hospitals with up-to-date, practical expert guidance to assist in prioritizing and implementing HAI prevention efforts. It is the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Disease Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Pediatric Infectious Disease Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), the Surgical Infection Society (SIS), and others.
The intent of this document is to highlight practical recommendations in a concise format designed to assist acute-care hospitals in implementing and prioritizing their surgical-site infection (SSI) prevention efforts. This document updates the Strategies to Prevent Surgical Site Infections in Acute Care Hospitals published in 2014.1 This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
The aim of this preliminary study was to identify key behavioural indicators of pain in cats. The behaviour of cats before and after ovariohysterectomy was analysed using a detailed behavioural ethogram. A comparison of behaviours between cats given pre-operative analgesia only and cats given both pre- and post-operative analgesia indicated that both groups demonstrated changed behaviour following surgery, compared to a control group of cats which underwent anaesthesia but not surgery. However, some specific postures, such as ‘half-tucked-up’ and ‘crouching’, were identified that occurred with greater frequency in the cats receiving pre-operative analgesia only, as compared to those receiving additional post-operative analgesia. This indicates that there are some key behaviours that may be useful in determining pain in cats. Routine administration of pre- but not post-operative analgesia may be ineffective for adequately alleviating pain in cats.
This study explores the use of Free Choice Profiling (FCP) methodology for the qualitative behaviour assessment of emotional expression in the domestic dog (Canis familiaris). Qualitative behaviour assessment is based upon the integration of many pieces of information that in conventional quantitative approaches are recorded separately or not at all. Observers are asked to focus on an animal's interaction with its surrounding environment, and to describe the animal's expressive demeanor, or ‘body language’. A specific characteristic of FCP methodology is that it allows observers the freedom to devise their own descriptive terms, and then to use these personal terms to quantitatively score observed subjects. Application of FCP to qualitative behaviour assessment in animals was originally tested for pigs, and more recently for dairy cows, horses, and ponies. The goal of this study was to apply FCP to the domestic dog, and to investigate the inter-observer reliability of assessments of emotional expression in 10 individual Beagles by a group of 18 untrained observers. The data was analysed using Generalised Procrustes Analysis (GPA), a multivariate statistical technique associated with FCP. The observers achieved highly-significant agreement in their assessments of the dogs’ expressions, thereby establishing the applicability of this methodology for the first time in the domestic dog.
The purpose of this investigation was to expand upon the limited existing research examining the test–retest reliability, cross-sectional validity and longitudinal validity of a sample of bioelectrical impedance analysis (BIA) devices as compared with a laboratory four-compartment (4C) model. Seventy-three healthy participants aged 19–50 years were assessed by each of fifteen BIA devices, with resulting body fat percentage estimates compared with a 4C model utilising air displacement plethysmography, dual-energy X-ray absorptiometry and bioimpedance spectroscopy. A subset of thirty-seven participants returned for a second visit 12–16 weeks later and were included in an analysis of longitudinal validity. The sample of devices included fourteen consumer-grade and one research-grade model in a variety of configurations: hand-to-hand, foot-to-foot and bilateral hand-to-foot (octapolar). BIA devices demonstrated high reliability, with precision error ranging from 0·0 to 0·49 %. Cross-sectional validity varied, with constant error relative to the 4C model ranging from −3·5 (sd 4·1) % to 11·7 (sd 4·7) %, standard error of the estimate values of 3·1–7·5 % and Lin’s concordance correlation coefficients (CCC) of 0·48–0·94. For longitudinal validity, constant error ranged from −0·4 (sd 2·1) % to 1·3 (sd 2·7) %, with standard error of the estimate values of 1·7–2·6 % and Lin’s CCC of 0·37–0·78. While performance varied widely across the sample investigated, select models of BIA devices (particularly octapolar and select foot-to-foot devices) may hold potential utility for the tracking of body composition over time, particularly in contexts in which the purchase or use of a research-grade device is infeasible.
The herbicides that inhibit 4-hydroxyphenylpyruvate dioxygenase (HPPD) are primarily used for weed control in corn, barley, oat, rice, sorghum, sugarcane, and wheat production fields in the United States. The objectives of this review were to summarize 1) the history of HPPD-inhibitor herbicides and their use in the United States; 2) HPPD-inhibitor resistant weeds, their mechanism of resistance, and management; 3) interaction of HPPD-inhibitor herbicides with other herbicides; and 4) the future of HPPD-inhibitor-resistant crops. As of 2022, three broadleaf weeds (Palmer amaranth, waterhemp, and wild radish) have evolved resistance to the HPPD inhibitor. The predominance of metabolic resistance to HPPD inhibitor was found in aforementioned three weed species. Management of HPPD-inhibitor-resistant weeds can be accomplished using alternate herbicides such as glyphosate, glufosinate, 2,4-D, or dicamba; however, metabolic resistance poses a serious challenge, because the weeds may be cross-resistant to other herbicide sites of action, leading to limited herbicide options. An HPPD-inhibitor herbicide is commonly applied with a photosystem II (PS II) inhibitor to increase efficacy and weed control spectrum. The synergism with an HPPD inhibitor arises from depletion of plastoquinones, which allows increased binding of a PS II inhibitor to the D1 protein. New HPPD inhibitors from the azole carboxamides class are in development and expected to be available in the near future. HPPD-inhibitor-resistant crops have been developed through overexpression of a resistant bacterial HPPD enzyme in plants and the overexpression of transgenes for HPPD and a microbial gene that enhances the production of the HPPD substrate. Isoxaflutole-resistant soybean is commercially available, and it is expected that soybean resistant to other HPPD inhibitor herbicides such as mesotrione, stacked with resistance to other herbicides, will be available in the near future.
Field studies were conducted in Alabama in 2016 and 2017 to determine the effect of postemergence applications of glufosinate alone and glufosinate applied with S-metolachlor, using two different nozzle types, on LibertyLink®, XtendFlex®, and WideStrike® cotton growth and yield. Two applications of glufosinate at 0.6 kg ha−1, and glufosinate with S-metolachlor at 1.39 kg ha−1 were applied to each cotton cultivar at the four-leaf and eight-leaf growth stages using a flatfan and Turbo TeeJet Induction® nozzle. Visual estimates of cotton injury were evaluated after each application, as well as yield. No differences in yield within each cotton cultivar were observed for either year. Visible injury was higher for WideStrike cotton than LibertyLink or XtendFlex cultivars. On average, glufosinate applied with S-metolachlor resulted in greater injury than glufosinate applied alone. In LibertyLink cotton, applications made with TTI nozzles resulted in greater injury than flatfan nozzles. However, cotton injury was transient and did not affect cotton yields. These data indicate that applications of glufosinate and glufosinate applied with S-metolachlor, at 0.6 kg ha−1 and 1.39 kg ha−1, respectively, with either a flatfan or TTI nozzle, can have no detrimental effect on cotton growth or yield.
Intraventricular lesions are challenging pathologies in neurosurgery. Walter Dandy had a major impact in advancing our understanding of the management of these lesions. Furthermore, the introduction of the microscope and microsurgical techniques have improved the surgical outcomes of these lesions. Several approaches have been described to address ventricular lesions, and can be classified anatomically as anterior, lateral, or posterior. The operative corridor for each of these approaches transgresses unaffected neural tissues. Therefore, tailoring the approach to individual patient lesion characteristics and anatomy is crucial to maximize exposure and minimize morbidity. The majority of open and endoscopic approaches to the third ventricle use the interhemispheric anterior transcallosal, frontal transsulcal, or frontal transcortical corridor to access the lateral ventricle. Once inside the lateral ventricle, the operative corridors to the third ventricle include working through the foramen of Monroe (transforaminal approach) for small lesions located in the anterior superior part of the third ventricle, or through the choroidal fissure (transchoroidal or subchoroidal) which provide access to lesions located in, or extending into, the middle or posterior parts of the roof of the third ventricle. In this chapter, we will discuss the transchoroidal, subchoroidal, and combined transchoroidal and subchoroidal approaches to the third ventricle.