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Patients with Opioid Use Disorder (OUD) are prone to Multidrug-Resistant Organism (MDRO) colonization and infections, thus at risk for worse outcomes during critical illness. Understanding the prevalence and predictors of MDRO infections is essential to optimize interventions and treatments.
Design:
Retrospective cohort study.
Methods:
The study evaluated the prevalence of MDRO isolation among adults with OUD admitted to an intensive care unit (ICU) between January 1, 2018, and July 31, 2023. It included adults admitted to an ICU with bacterial infections and positive cultures obtained within 48 hours of admission. Demographics, clinical traits, and MDRO isolation rates were analyzed using descriptive statistics, univariate methods, and Least Absolute Shrinkage and Selection Operator (LASSO) regression.
Results:
MDRO isolation occurred in 178 of 790 patients (22.5%), with methicillin-resistant Staphylococcus aureus as the most frequently isolated organism. LASSO regression identified housing insecurity (OR: 1.79, 95% CI 1.09–2.93, P = .022), no receipt of medications for OUD treatment (OR: 1.56, 95% CI 1.06–2.29, P = .023), positive hepatitis C virus (HCV) status (OR: 2.19, 95% CI 1.19–4.03, P = .012), and intravenous antibiotic use in the prior 90 days (OR: 1.04 per 24 h, 95% CI 1.01–1.07, P = .007) as significant predictors of MDRO isolation.
Conclusions:
The study highlights a high prevalence of MDRO isolation in critically ill OUD patients admitted for infection-related issues with positive cultures obtained within 48 hours of admission, influenced by factors like housing insecurity, no receipt of medications for OUD treatment, HCV status, and prior antibiotic use.
Clinical outcomes of repetitive transcranial magnetic stimulation (rTMS) for treatment of treatment-resistant depression (TRD) vary widely and there is no mood rating scale that is standard for assessing rTMS outcome. It remains unclear whether TMS is as efficacious in older adults with late-life depression (LLD) compared to younger adults with major depressive disorder (MDD). This study examined the effect of age on outcomes of rTMS treatment of adults with TRD. Self-report and observer mood ratings were measured weekly in 687 subjects ages 16–100 years undergoing rTMS treatment using the Inventory of Depressive Symptomatology 30-item Self-Report (IDS-SR), Patient Health Questionnaire 9-item (PHQ), Profile of Mood States 30-item, and Hamilton Depression Rating Scale 17-item (HDRS). All rating scales detected significant improvement with treatment; response and remission rates varied by scale but not by age (response/remission ≥ 60: 38%–57%/25%–33%; <60: 32%–49%/18%–25%). Proportional hazards models showed early improvement predicted later improvement across ages, though early improvements in PHQ and HDRS were more predictive of remission in those < 60 years (relative to those ≥ 60) and greater baseline IDS burden was more predictive of non-remission in those ≥ 60 years (relative to those < 60). These results indicate there is no significant effect of age on treatment outcomes in rTMS for TRD, though rating instruments may differ in assessment of symptom burden between younger and older adults during treatment.
The neural mechanisms contributing to the social problems of pediatric brain tumor survivors (PBTS) are unknown. Face processing is important to social communication, social behavior, and peer acceptance. Research with other populations with social difficulties, namely autism spectrum disorder, suggests atypical brain activation in areas important for face processing. This case-controlled functional magnetic resonance imaging (fMRI) study compared brain activation during face processing in PBTS and typically developing (TD) youth.
Methods:
Participants included 36 age-, gender-, and IQ-matched youth (N = 18 per group). PBTS were at least 5 years from diagnosis and 2 years from the completion of tumor therapy. fMRI data were acquired during a face identity task and a control condition. Groups were compared on activation magnitude within the fusiform gyrus for the faces condition compared to the control condition. Correlational analyses evaluated associations between neuroimaging metrics and indices of social behavior for PBTS participants.
Results:
Both groups demonstrated face-specific activation within the social brain for the faces condition compared to the control condition. PBTS showed significantly decreased activation for faces in the medial portions of the fusiform gyrus bilaterally compared to TD youth, ps ≤ .004. Higher peak activity in the left fusiform gyrus was associated with better socialization (r = .53, p < .05).
Conclusions:
This study offers initial evidence of atypical activation in a key face processing area in PBTS. Such atypical activation may underlie some of the social difficulties of PBTS. Social cognitive neuroscience methodologies may elucidate the neurobiological bases for PBTS social behavior.
In many ways the study of resolved stellar populations is the bestmethod for exploring properties of stellar populations. However, the method requires measurements to be obtained for individual stars, and this rapidly becomes challenging as the distance to extragalactic systems increases. The depths of resolved stellar samples in galaxies are primarily limited by the levels of stellarfluxes and effects of crowding. Currently most resolved stellar population studies are constrained to galaxies within a distance of about 20 Mpc. Fortunately, the short-lived massive stars, whose numbers trace SFRs, are luminous and thus among the most readily observed, especially when they are not obscured by interstellar dust. The number of stars above a fiducial luminosity in a set of spectroscopic band-passesare counted and corrected for incomplete sampling. The distribution of these stars is then compared to expectations of stellar population models to derive estimates for the observed mass in the form of stars detected in the data. Further modeling provides an interpretation in terms of stellar masses within age bins. In this chapter we provide a brief overview of the history and some of the techniques used to derive star-formation rates (SFRs) and the associated star-formation histories of galaxies through observations
We describe 14 yr of public data from the Parkes Pulsar Timing Array (PPTA), an ongoing project that is producing precise measurements of pulse times of arrival from 26 millisecond pulsars using the 64-m Parkes radio telescope with a cadence of approximately 3 weeks in three observing bands. A comprehensive description of the pulsar observing systems employed at the telescope since 2004 is provided, including the calibration methodology and an analysis of the stability of system components. We attempt to provide full accounting of the reduction from the raw measured Stokes parameters to pulse times of arrival to aid third parties in reproducing our results. This conversion is encapsulated in a processing pipeline designed to track provenance. Our data products include pulse times of arrival for each of the pulsars along with an initial set of pulsar parameters and noise models. The calibrated pulse profiles and timing template profiles are also available. These data represent almost 21 000 h of recorded data spanning over 14 yr. After accounting for processes that induce time-correlated noise, 22 of the pulsars have weighted root-mean-square timing residuals of $<\!\!1\,\mu\text{s}$ in at least one radio band. The data should allow end users to quickly undertake their own gravitational wave analyses, for example, without having to understand the intricacies of pulsar polarisation calibration or attain a mastery of radio frequency interference mitigation as is required when analysing raw data files.
In January 2017, Washington, DC, hosted the 58th United States presidential inauguration. The DC Department of Health leveraged multiple health surveillance approaches, including syndromic surveillance (human and animal) and medical aid station–based patient tracking, to detect disease and injury associated with this mass gathering.
Methods:
Patient data were collected from a regional syndromic surveillance system, medical aid stations, and an internet-based emergency department reporting system.Animal health data were collected from DC veterinary facilities.
Results:
Of 174 703 chief complaints from human syndromic data, there were 6 inauguration-related alerts. Inauguration attendees who visited aid stations (n = 162) and emergency departments (n = 180) most commonly reported feeling faint/dizzy (n = 29; 17.9%) and pain/cramps (n = 34;18.9%).In animals, of 533 clinical signs reported, most were gastrointestinal (n = 237; 44.5%) and occurred in canines (n = 374; 70.2%).Ten animals that presented dead on arrival were investigated; no significant threats were identified.
Conclusion:
Use of multiple surveillance systems allowed for near-real-time detection and monitoring of disease and injury syndromes in humans and domestic animals potentially associated with inaugural events and in local health care systems.
This article examines key barriers to business sustainability discussed at a multidisciplinary conference held at the Harvard Business School in 2018. Drawing on perspectives from both the historical and business literatures, speakers debated the historical success of and future opportunities for voluntary business actions to advance sustainability. Roadblocks include misaligned incentives, missing institutions, inertia of economic systems, and the concept of sustainability itself. Overcoming these roadblocks will require systematic interventions and alternative normative concepts.
We read with interest the recent editorial, “The Hennepin Ketamine Study,” by Dr. Samuel Stratton commenting on the research ethics, methodology, and the current public controversy surrounding this study.1 As researchers and investigators of this study, we strongly agree that prospective clinical research in the prehospital environment is necessary to advance the science of Emergency Medical Services (EMS) and emergency medicine. We also agree that accomplishing this is challenging as the prehospital environment often encounters patient populations who cannot provide meaningful informed consent due to their emergent conditions. To ensure that fellow emergency medicine researchers understand the facts of our work so they may plan future studies, and to address some of the questions and concerns in Dr. Stratton’s editorial, the lay press, and in social media,2 we would like to call attention to some inaccuracies in Dr. Stratton’s editorial, and to the lay media stories on which it appears to be based.
Ho JD, Cole JB, Klein LR, Olives TD, Driver BE, Moore JC, Nystrom PC, Arens AM, Simpson NS, Hick JL, Chavez RA, Lynch WL, Miner JR. The Hennepin Ketamine Study investigators’ reply. Prehosp Disaster Med. 2019;34(2):111–113
The first textbook to present world history via social history, drawing on social science methods and research. This interdisciplinary, comprehensive and comparative textbook is authored by distinguished scholars and experienced teachers, and offers expert scholarship on global history that is ideal for undergraduate students. Volume 1 takes us from the origin of hominids to ancient civilizations, the rise of empires, and the Middle Ages. The book pays particular attention to the ways in which ordinary people lived through the great changes of their times, and how everyday experience connects to great political events and the commercial exchanges of an interconnected world. With 65 maps, 45 illustrations, timelines, boxes, and primary source extracts, the book moves students easily from particular historical incidents to broader perspectives, enabling them to use historical material and social science methodologies to analyze the events of the past, present and future.
The first textbook to present world history via social history, drawing on social science methods and research. This interdisciplinary, comprehensive, and comparative textbook is authored by distinguished scholars and experienced teachers, and offers expert scholarship on global history that is ideal for undergraduate students. Volume 2 takes us from the early modern period to speculation about the world in 2050, visiting diverse civilizations, nation-states, ecologies, and people along the journey through time and place. The book pays particular attention to the ways in which ordinary people lived through the great changes of their times, and how everyday experience connects to great political events and the commercial exchanges of an interconnected world. With 75 maps, 65 illustrations, timelines, boxes, and primary source extracts, the book enables students to use historical material and social science methodologies to analyze the events of the past, present, and future.
Reforestation in the Inland Northwest, including northeastern Oregon, USA, is often limited by a dry climate and soil moisture availability during the summer months. Reduction of competing vegetative cover in forest plantations is a common method for retaining available soil moisture. Several spring and summer site preparation (applied prior to planting) herbicide treatments were evaluated to determine their efficacy in reducing competing cover, thus retaining soil moisture, on three sites in northeastern Oregon. Results varied by site, year, and season of application. In general, sulfometuron (0.14 kg ai ha–1 alone and in various mixtures), imazapyr (0.42 ae kg ha–1), and hexazinone (1.68 kg ai ha–1) resulted in 3 to 17% cover of forbs and grasses in the first-year when applied in spring. Sulfometuron+glyphosate (2.2 kg ha–1) consistently reduced grasses and forbs for the first year when applied in summer, but forbs recovered in the second year on two of three sites. Aminopyralid (0.12 kg ae ha–1)+sulfometuron applied in summer also led to comparable control of forb cover. In the second year after treatment, forb cover in treated plots was similar to levels in nontreated plots, and some species of forbs had increased relative to nontreated plots. Imazapyr (0.21 and 0.42 kg ha–1) at either rate, spring or summer 2007, or at lower rate (0.14 kg ha–1) with glyphosate in summer, provided the best control of shrubs, of which snowberry was the dominant species. Total vegetative cover was similar across all treatments seven and eight years after application, and differences in vegetation were related to site rather than treatment. In the first year after treatment, rates of soil moisture depletion in the 0- to 23-cm depth were correlated with vegetative cover, particularly late season soil moisture, suggesting increased water availability for tree seedling growth.
The WAIS (West Antarctic Ice Sheet) Divide deep ice core was recently completed to a total depth of 3405 m, ending 50 m above the bed. Investigation of the visual stratigraphy and grain characteristics indicates that the ice column at the drilling location is undisturbed by any large-scale overturning or discontinuity. The climate record developed from this core is therefore likely to be continuous and robust. Measured grain-growth rates, recrystallization characteristics, and grain-size response at climate transitions fit within current understanding. Significant impurity control on grain size is indicated from correlation analysis between impurity loading and grain size. Bubble-number densities and bubble sizes and shapes are presented through the full extent of the bubbly ice. Where bubble elongation is observed, the direction of elongation is preferentially parallel to the trace of the basal (0001) plane. Preferred crystallographic orientation of grains is present in the shallowest samples measured, and increases with depth, progressing to a vertical-girdle pattern that tightens to a vertical single-maximum fabric. This single-maximum fabric switches into multiple maxima as the grain size increases rapidly in the deepest, warmest ice. A strong dependence of the fabric on the impurity-mediated grain size is apparent in the deepest samples.
Postemergence treatments utilizing various combinations of fluazifop-P, paraquat, and 2,4-DB were compared to a preplant-incorporated (PPI) application of benefin followed by a ground-cracking application of alachlor and dinoseb plus naptalam and a postemergence application of 2,4-DB for weed control, peanut yield, and net economic return to land, overhead, and management. The greatest peanut yields (3-yr average of 4510 kg/ha) and net returns (3-yr average of $521/ha) were provided by a postemergence system that utilized one ground-cracking and one postemergence application of paraquat and one postemergence application of fluazifop-P and 2,4-DB. Seven postemergence systems provided equivalent or greater yield and net returns than the PPI and dinoseb plus naptalam system. Fresh weight reductions of Texas panicum, sicklepod, Florida beggarweed, and pitted morningglory from postemergence weed control systems were equivalent to reductions obtained from the PPI and dinoseb plus naptalam system. The addition of paraquat and 2,4-DB to the PPI and dinoseb plus naptalam system improved the 3-yr average peanut yield and net economic return by 510 kg/ha and $136/ha, respectively, compared to the same system without paraquat and 2,4-DB.
Absorption of foliar-applied 14C-imazaquin {2-[4,5-dihydro-4-methyl-4-(1-methylethyl)-5-oxo-1H-imidazol-2-yl]-3-quinolinecarboxylic acid} 72 h after treatment was higher than 90% for soybean [Glycine max (L.) Merr. ‘Braxton’], peanut (Arachis hypogaea L. ‘Florunner’), common cocklebur (Xanthium strumarium L. # XANST), sicklepod (Cassia obtusifolia L. # CASOB), and Florida beggarweed [Desmodium tortuosum (SW.) # DEDTO]. Both symplasmic and apoplasmic translocation of the herbicide were evident. Imazaquin half-life was 4.4 days in soybean, 5.3 days in peanut, 9.6 days in Florida beggarweed, 12.7 days in sicklepod, and 39.8 days in cocklebur. Tolerance of these species to foliar-applied imazaquin as determined in greenhouse studies with 21-day-old seedlings was as follows: soybean = peanut > Florida beggarweed > sicklepod > cocklebur. Tolerance was directly correlated to imazaquin halflife within the tissue of the respective species.
Tolerance of species to foliar applications of the ethyl ester of chlorimuron as determined in greenhouse studies with 21-day-old seedlings was: soybean = peanut > prickly sida > sicklepod > Florida beggarweed > common cocklebur. Absorption of foliar-applied 14C-chlorimuron 72 h after application was similar in soybean, peanut, sicklepod, common cocklebur, and prickly sida, but much less in Florida beggarweed. Slight symplasmic and apoplasmic translocation of the herbicide was evident in all species. Metabolism of chlorimuron 72 h after application was greatest in soybean and least in common cocklebur. Species tolerance to chlorimuron was directly correlated (r2 = 0.93) to the amount of unmetabolized chlorimuron (dpm/g dry wt) in the plant. Peanut exhibited increased tolerance to chlorimuron with age; this result was attributed to reduced absorption and translocation and more extensive metabolism of the absorbed herbicide by older plants.
Field studies were conducted from 1985 to 1987 to evaluate postemergence herbicide systems with preemergence systems to control Texas panicum, Florida beggarweed, sicklepod, and pitted morningglory in peanuts. Adding paraquat at 0.14 kg ai/ha to postemergence herbicide systems reduced fresh weight of Florida beggarweed 92% (18% increase over the same systems without paraquat), sicklepod 95% (21% increase), and pitted morningglory 95% (11% increase). Herbicide systems containing paraquat improved peanut yields by 230 kg/ha and net returns by $52/ha over herbicide systems not containing paraquat. Fluazifop-P and sethoxydim systems reduced Texas panicum fresh weight (at least 96%) more than a preemergence system (92% reduction) that used benefin applied preplant incorporated and alachlor plus naptalam and dinoseb applied at cracking (GC) or a postemergence system that used alachlor and naptalam plus dinoseb GC and paraquat applied early postemergence (86% reduction). Systems containing fluazifop-P provided greater yields (4190 kg/ha) and net returns ($383/ha) than systems containing sethoxydim (4010 kg/ha, $305/ha) when averaged across all rates of application.
Imazethapyr was applied at 0.14 kg ae/ha to soybean, peanut, sicklepod. Florida beggarweed, and redroot pigweed as either a soil, foliar, or soil plus foliar application. Soybean and peanut were the most tolerant species; redroot pigweed was the most sensitive, with sicklepod and Florida beggarweed being intermediate. Foliar or foliar plus soil applications were more effective in reducing sicklepod and Florida beggarweed fresh weights than soil application alone. Foliar absorption of 14C-imazethapyr 72 h after treatment was greater than 90% for soybean, peanut, sicklepod, and redroot pigweed, but only 77% in Florida beggarweed. For the species evaluated, the amount translocated from the treated leaf ranged from 5 to 16% after 72 h. Within this same time period, an average of 90% of the root-absorbed imazethapyr had been translocated to the shoot in all species except peanut. The half-life of imazethapyr was 6.6, 6.5, 14.4, 24.0, and 32.1 days in soybean, peanut, Florida beggarweed, sicklepod, and redroot pigweed, respectively. Tolerance was most closely associated with imazethapyr half-life within these species.
Research was conducted from 2011 to 2014 to determine weed populationdynamics and frequency of glyphosate-resistant (GR) Palmer amaranth withherbicide programs consisting of glyphosate, dicamba, and residualherbicides in dicamba-tolerant cotton. Five treatments were maintained inthe same plots over the duration of the experiment: three sequential POSTapplications of glyphosate with or without pendimethalin plus diuron PRE;three sequential POST applications of glyphosate plus dicamba with andwithout the PRE herbicides; and a POST application of glyphosate plusdicamba plus acetochlor followed by one or two POST applications ofglyphosate plus dicamba without PRE herbicides. Additional treatmentsincluded alternating years with three sequential POST applications ofglyphosate only and glyphosate plus dicamba POST with and without PREherbicides. The greatest population of Palmer amaranth was observed whenglyphosate was the only POST herbicide throughout the experiment. Althoughdiuron plus pendimethalin PRE in a program with only glyphosate POSTimproved control during the first 2 yr, these herbicides were ineffective bythe final 2 yr on the basis of weed counts from soil cores. The lowestpopulation of Palmer amaranth was observed when glyphosate plus dicamba wereapplied regardless of PRE herbicides or inclusion of acetochlor POST.Frequency of GR Palmer amaranth was 8% or less when the experiment wasinitiated. Frequency of GR Palmer amaranth varied by herbicide programduring 2012 but was similar among all herbicide programs in 2013 and 2014.Similar frequency of GR Palmer amaranth across all treatments at the end ofthe experiment most likely resulted from pollen movement from Palmeramaranth treated with glyphosate only to any surviving female plantsregardless of PRE or POST treatment. These data suggest that GR Palmeramaranth can be controlled by dicamba and that dicamba is an effectivealternative mode of action to glyphosate in fields where GR Palmer amaranthexists.
We studied neuroinflammation in individuals with late-life, depression, as arisk factor for dementia, using [11C]PK11195 positron emissiontomography (PET). Five older participants with major depression and 13controls underwent PET and multimodal 3T magnetic resonance imaging (MRI),with blood taken to measure C-reactive protein (CRP). We found significantlyhigher CRP levels in those with late-life depression and raised [11C]PK11195 binding compared with controls in brain regionsassociated with depression, including subgenual anterior cingulate cortex,and significant hippocampal subfield atrophy in cornu ammonis 1 andsubiculum. Our findings suggest neuroinflammation requires furtherinvestigation in late-life depression, both as a possible aetiologicalfactor and a potential therapeutic target.