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Most people who develop dementia will never be diagnosed, and therefore lack access to treatment and care from specialists in the field. This new edition provides updated guidance on how behavioral symptom reflect the changes occurring in the brain, and how these can help generalist clinicians to accurately diagnose neurodegenerative diseases. This practical book is aimed at healthcare professionals working in neurology, psychiatry and neuropsychology wanting to enhance the skills and knowledge needed to successfully manage these diseases. Simple approaches to bedside mental status testing, differential diagnosis and treatment, and interpreting neuropsychological testing and neuroimaging findings are covered. Introductory chapters outline dementia epidemiology and dementia neuropathology whilst chapters new to this edition describe the improvements in diagnostic capabilities in recent years, including blood based and cerebrospinal biomarkers and emerging biologically based therapies. Chapters on sleep disorders, and chronic traumatic encephalopathy and traumatic brain injury have also been expanded.
Enlist E3® soybean is resistant to 2,4-D, glyphosate, and glufosinate, allowing postemergence applications of these herbicides sequentially or as tank mixes. The objectives of this experiment were to evaluate the effect of postemergence herbicide application timing and sequence with or without a preemergence application of micro-encapsulated acetochlor on waterhemp and common lambsquarters control, soybean yield, and economic returns. Field experiments were conducted in Rosemount and Franklin, Minnesota, in 2021 and 2022. Site, herbicide application timing, and sequence influenced weed control, yield, and profitability. In Rosemount, preemergence followed by (fb) two-pass postemergence programs, including 2,4-D + glyphosate applied at mid-postemergence with or without S-metolachlor, resulted in ≥95% waterhemp control at 28 d after late postemergence application. In Franklin, where weed density was lower, two-pass postemergence programs, regardless of preemergence application that included at least one application of 2,4-D + glyphosate (with or without S-metolachlor), provided ≥97% control of waterhemp and common lambsquarters at 28 d after late postemergence. The level of control was comparable to that of a preemergence herbicide fb a mid-postemergence application of 2,4-D + glyphosate + S-metolachlor at that site. In Rosemount, including acetochlor as the preemergence herbicide in the preemergence fb postemergence programs improved soybean yield by 32% and partial returns by US$384.50 ha−1 compared to postemergence herbicides–only programs. In contrast, the preemergence application did not affect yield or profitability in Franklin. The highest soybean yield (2,925.7 kg ha−1) in Rosemount resulted after glufosinate was applied early postemergence fb 2,4-D + glyphosate applied mid-postemergence. This yield was comparable to that of glufosinate applied early postemergence fb 2,4-D + glyphosate + S-metolachlor applied mid-postemergence and the two-pass glufosinate (early postemergence fb mid-postemergence) program, highlighting the importance of early season weed control. In Franklin, 2,4-D + glyphosate + S-metolachlor (applied mid-postemergence) fb glufosinate (applied late postemergence) provided a yield that was similar to the aforementioned programs at that site.
Multicenter clinical trials are essential for evaluating interventions but often face significant challenges in study design, site coordination, participant recruitment, and regulatory compliance. To address these issues, the National Institutes of Health’s National Center for Advancing Translational Sciences established the Trial Innovation Network (TIN). The TIN offers a scientific consultation process, providing access to clinical trial and disease experts who provide input and recommendations throughout the trial’s duration, at no cost to investigators. This approach aims to improve trial design, accelerate implementation, foster interdisciplinary teamwork, and spur innovations that enhance multicenter trial quality and efficiency. The TIN leverages resources of the Clinical and Translational Science Awards (CTSA) program, complementing local capabilities at the investigator’s institution. The Initial Consultation process focuses on the study’s scientific premise, design, site development, recruitment and retention strategies, funding feasibility, and other support areas. As of 6/1/2024, the TIN has provided 431 Initial Consultations to increase efficiency and accelerate trial implementation by delivering customized support and tailored recommendations. Across a range of clinical trials, the TIN has developed standardized, streamlined, and adaptable processes. We describe these processes, provide operational metrics, and include a set of lessons learned for consideration by other trial support and innovation networks.
To identify institution-specific risk factors for extended-spectrum beta-lactamase (ESBL) bloodstream infections (BSI) to develop and validate a risk assessment scoring tool that can be utilized for hospitalized patients.
Design:
Single-center, retrospective, case-control study.
Setting:
Tertiary teaching hospital.
Patients:
Hospitalized adult and pediatric patients with E. coli or Klebsiella spp. BSI were stratified based on ESBL production between August 2019 to July 2021. Exclusion criteria included patients < 28 days old, a positive blood culture resulting prior to admission/after discharge or a polymicrobial and/or carbapenem-resistant BSI.
Methods:
Multivariable logistic regression assessed predictors of ESBL in a derivation cohort. Predictors were applied to a novel validation BSI cohort using area under the receiver-operator characteristics curve (ROC AUC) to assess the reliability of identifying patients likely to harbor ESBL at the time of organism identification.
Results:
A total of 238 patients in the derivation cohort met inclusion criteria stratified as ESBL (n = 68) or non-ESBL (n = 170). Multivariable logistic regression demonstrated diabetes, 30-day history of invasive procedure or antibiotic use, and/or history of ESBL as independent predictors of ESBL. After creation of an ESBL risk assessment tool, the results were applied to a validation cohort of 170 patients. This model displayed good calibration and discrimination with a strong predictive power (Hosmer-Lemeshow χ2= 4.66, p = 0.19; ROC AUC = 0.88, 95% CI = 0.7909 – 0.974).
Conclusions:
A validated ESBL risk assessment tool reliably identified hospitalized patients likely to harbor ESBL E. coli or Klebsiella spp. BSI upon organism identification.
Palmer amaranth, a competitive weed in cotton and soybeans, poses challenges due to its rapid growth, high fertility, and herbicide resistance. Effective management strategies targeting sex ratios could reduce seed production by female plants. Protoporphyrinogen oxidase (PPO-) inhibiting herbicides play a role in the evolving resistance of Amaranthus spp. in the US Midwest. These herbicides may also affect the male-to-female ratio of Palmer amaranth. A 2-yr field experiment (2015 and 2016) was conducted in a soybean field in Collinsville, IL, evaluating various preemergence and postemergence PPO-inhibiting herbicide treatments. Untreated Palmer amaranth populations exhibited a bias toward females. Preemergence application of sulfentrazone and flumioxazin effectively reduced Palmer amaranth density (1.66 plants m–2) throughout the season, whereas postemergence applications of fomesafen and lactofen provided limited control (27 and 31 plants m–2, respectively). Early-season mortality was high (96%) among Palmer amaranth seedlings, especially with pyroxasulfone + fluthiacet-methyl treatment. Fomesafen increased female biomass (28.8%) while reducing male biomass compared to the nontreated control. In 2015, pyroxasulfone + fluthiacet-methyl and acetochlor altered the male-to-female sex ratio compared to the nontreated control, with pyroxasulfone + fluthiacet-methyl reducing the proportion of females (–0.11 M/F) and acetochlor slightly increasing the proportion of males (0.03 M/F), though not different from a 1:1 ratio. In 2016, pendimethalin and flumioxazin (71 g ai ha–1) resulted in a strong female-biased sex ratio, with an almost exclusively female population. In both years, the nontreated control plots (–0.58 and –0.55 M/F) maintained a naturally female-biased sex ratio, deviating significantly from a 1:1 ratio. These findings suggest that specific herbicide treatments can alter the sex ratio. Understanding sex determination in Palmer amaranth holds promise for developing more effective control strategies in the future.
Evaluate prescribing practices and risk factors for treatment failure in obese patients treated for purulent cellulitis with oral antibiotics in the outpatient setting.
Design:
Retrospective, multicenter, observational cohort.
Setting:
Emergency departments, primary care, and urgent care sites throughout Michigan.
Patients:
Adult patients with a body mass index of ≥ 30 kg/m2 who received ≥ 5 days of oral antibiotics for purulent cellulitis were included. Key exclusion criteria were chronic infections, antibiotic treatment within the past 30 days, and suspected polymicrobial infections.
Methods:
Obese patients receiving oral antibiotics for purulent cellulitis between February 1, 2020, and August 31, 2023, were assessed. The primary objective was to describe outpatient prescribing trends. Secondary objectives included comparing patient risk factors for treatment failure and safety outcomes between patients experiencing treatment success and those experiencing treatment failure.
Results:
Two hundred patients were included (Treatment success, n = 100; Treatment failure, n = 100). Patients received 11 antibiotic regimens with 26 dosing variations; 45.5% were inappropriately dosed. Sixty-seven percent of patients received MRSA-active therapy. Treatment failure was similar between those appropriately dosed (46.4%) versus under-dosed (54.4%) (P = 0.256), those receiving 5–7 days of therapy (47.1%) versus 10–14 days (54.4%) (P = 0.311), and those receiving MRSA-active therapy (52.2%) versus no MRSA therapy (45.5%) (P = 0.367). Patients treated with clindamycin were more likely to experience treatment failure (73.7% vs 47.5%, P = 0.030).
Conclusions:
Nearly half of antimicrobial regimens prescribed for outpatient treatment of cellulitis in patients with obesity were suboptimally prescribed. Opportunities exist to optimize agent selection, dosing, and duration of therapy in this population.
Scholarly work in American politics has yet to confront one of the nation’s starkest inequalities: lethal violence. The risk falls disproportionately on Black Americans, but much like poverty and inequality, lethal violence is a broadly American problem that African Americans are disproportionately likely to experience. The lack of attention to life-threatening violence has limited our understanding of race, criminal justice, and the nature of the American state. We draw on work in American political development and racial politics to extend a racialized state failure framework for understanding the United States as a high-violence society. Life-threatening violence declined dramatically in the nineteenth century in countries where state building involved the integrated consolidation of centralized violence monopolization and universal male suffrage. Such efforts faltered in the US, however, and violence thrived. We argue that this racialized state failure is the result of two reinforcing features of American politics: anti-transformative racial orders and institutional fragmentation. Fragmentation has long provided opportunities for anti-transformative racial orders to limit national intervention in violence control and enfranchisement, even during critical junctures when institutions are less determinate, and actions by decision makers are more likely to generate change. We illustrate the disruption of state building by racial orders, which minimized the state’s capacity to delegitimize violent self-help during two critical junctures in the US: Reconstruction and the crime wave of the mid- to late twentieth century. The resulting institutional configuration, which we refer to as forced localism, reinforces the jurisdictional authority of highly constrained state and local institutions in violence attenuation. The consequence is exceptionally high rates of serious violence and a harsh and exclusionary criminal justice system, with Black Americans exceptionally vulnerable to both.
Given the US population concentration near coastal areas and increased flooding due to climate change, public health professionals must recognize the psychological burden resulting from exposure to natural hazards.
Methods
We performed a systematic search of databases to identify articles with a clearly defined comparison group consisting of either pre-exposure measurements in a disaster-exposed population or disaster-unexposed controls, and assessment of mental health, including but not limited to, depression, post-traumatic stress (PTS), and anxiety.
Results
Twenty-five studies, with a combined total of n =616 657 people were included in a systematic review, and 11 studies with a total of 2012 people were included in a meta-analysis of 3 mental health outcomes. Meta-analytic findings included a positive association between disaster exposure and PTS (n = 5, g = 0.44, 95% CI 0.04, 0.85), as well as depression (n = 9, g = 0.28, 95% CI 0.04, 0.53), and no meaningful effect size in studies assessing anxiety (n = 6, g = 0.05 95% CI −0.30, 0.19).
Conclusions
Hurricanes and flooding were consistently associated with increased depression and PTS in studies with comparison groups representing individuals unaffected by hazards.
The global population and status of Snowy Owls Bubo scandiacus are particularly challenging to assess because individuals are irruptive and nomadic, and the breeding range is restricted to the remote circumpolar Arctic tundra. The International Union for Conservation of Nature (IUCN) uplisted the Snowy Owl to “Vulnerable” in 2017 because the suggested population estimates appeared considerably lower than historical estimates, and it recommended actions to clarify the population size, structure, and trends. Here we present a broad review and status assessment, an effort led by the International Snowy Owl Working Group (ISOWG) and researchers from around the world, to estimate population trends and the current global status of the Snowy Owl. We use long-term breeding data, genetic studies, satellite-GPS tracking, and survival estimates to assess current population trends at several monitoring sites in the Arctic and we review the ecology and threats throughout the Snowy Owl range. An assessment of the available data suggests that current estimates of a worldwide population of 14,000–28,000 breeding adults are plausible. Our assessment of population trends at five long-term monitoring sites suggests that breeding populations of Snowy Owls in the Arctic have decreased by more than 30% over the past three generations and the species should continue to be categorised as Vulnerable under the IUCN Red List Criterion A2. We offer research recommendations to improve our understanding of Snowy Owl biology and future population assessments in a changing world.
Daily sodium intake in England is ∼3.3 g/day(1), with government and scientific advice to reduce intake for cardiovascular health purposes having varying success(2). Eccrine sweat is produced during exercise or exposure to warm environments to maintain body temperature through evaporative cooling. Sweat is primarily water, but also contains appreciable amounts of electrolytes, particularly sodium, meaning sweat sodium losses could reduce daily sodium balance without the need for dietary manipulation. However, the effects of sweat sodium losses on 24-h sodium balance are unclear.
Fourteen active participants (10 males, 4 females; 23±2 years, 45±9 mL/kg/min) completed a preliminary trial and two 24-h randomised, counterbalanced experimental trials. Participants arrived fasted for baseline (0-h) measures (blood/urine samples, blood pressure, nude body mass) followed by breakfast and low-intensity intermittent cycling in the heat (∼36⁰C, ∼50% humidity) to turnover ∼2.5% body mass in sweat (EX), or the same duration of room temperature seated rest (REST). Further blood samples were collected post-EX/REST (1.5-3 h post-baseline). During EX, sweat was collected from 5 sites and water consumed to fully replace sweat losses. During REST, participants drank 100 mL/h. Food intake was individually standardised over the 24-h, with bottled water available ad-libitum. Participants collected all urine produced over the 24-h and returned the following morning to repeat baseline measures fasted (24-h). Sodium balance was estimated over the 24-h using sweat/urine losses and dietary intake. Data were analysed using 2-way ANOVA followed by Shapiro-Wilk and paired t-tests/Wilcoxon signed-rank tests. Data are mean (standard deviation).
Dietary sodium intake was 2.3 (0.3) g and participants lost 2.8 (0.3) % body mass in sweat (containing 2.5 (0.9) g sodium). Sodium balance was lower for EX (-2.0 (1.6) g vs -1.0 (1.6) g; P = 0.022), despite lower 24-h urine sodium losses in EX (1.8 (1.2) g vs 3.3 (1.7) g; P = 0.001). PostEX/REST blood sodium concentration was lower in EX (137.6 (2.3) mmol/L vs 139.9 (1.0) mmol/L; P = 0.002) but did not differ at 0-h (P = 0.906) or 24-h (P = 0.118). There was no difference in plasma volume change (P = 0.423), urine specific gravity (P = 0.495), systolic (P = 0.324) or diastolic (P = 0.274) blood pressure between trials over the 24-h. Body mass change over 24-h was not different between trials (REST +0.25 (1.10) %; EX +0.40 (0.68) %; P = 0.663).
Sweat loss through low-intensity exercise resulted in a lower sodium balance compared to rest. Although urine sodium output reduced with EX, it was not sufficient to offset exercise-induced sodium losses. Despite this, body mass, plasma volume and blood sodium concentration were not different between trials, suggesting sodium may have been lost from non-osmotic sodium stores. This suggests sweat sodium losses could be used to reduce sodium balance, although longer studies are required to confirm this thesis.
Paediatric patients with heart failure requiring ventricular assist devices are at heightened risk of neurologic injury and psychosocial adjustment challenges, resulting in a need for neurodevelopmental and psychosocial support following device placement. Through a descriptive survey developed in collaboration by the Advanced Cardiac Therapies Improving Outcomes Network and the Cardiac Neurodevelopmental Outcome Collaborative, the present study aimed to characterise current neurodevelopmental and psychosocial care practices for paediatric patients with ventricular assist devices.
Method:
Members of both learning networks developed a 25-item electronic survey assessing neurodevelopmental and psychosocial care practices specific to paediatric ventricular assist device patients. The survey was sent to Advanced Cardiac Therapies Improving Outcomes Network site primary investigators and co-primary investigators via email.
Results:
Of the 63 eligible sites contacted, responses were received from 24 unique North and South American cardiology centres. Access to neurodevelopmental providers, referral practices, and family neurodevelopmental education varied across sites. Inpatient neurodevelopmental care consults were available at many centres, as were inpatient family support services. Over half of heart centres had outpatient neurodevelopmental testing and individual psychotherapy services available to patients with ventricular assist devices, though few centres had outpatient group psychotherapy (12.5%) or parent support groups (16.7%) available. Barriers to inpatient and outpatient neurodevelopmental care included limited access to neurodevelopmental providers and parent/provider focus on the child’s medical status.
Conclusions:
Paediatric patients with ventricular assist devices often have access to neurodevelopmental providers in the inpatient setting, though supports vary by centre. Strengthening family neurodevelopmental education, referral processes, and family-centred psychosocial services may improve current neurodevelopmental/psychosocial care for paediatric ventricular assist device patients.
Black and Latino individuals are underrepresented in COVID-19 treatment and vaccine clinical trials, calling for an examination of factors that may predict willingness to participate in trials.
Methods:
We administered the Common Survey 2.0 developed by the Community Engagement Alliance (CEAL) Against COVID-19 Disparities to 600 Black and Latino adults in Baltimore City, Prince George’s County, Maryland, Montgomery County, Maryland, and Washington, DC, between October and December 2021. We examined the relationship between awareness of clinical trials, social determinants of health challenges, trust in COVID-19 clinical trial information sources, and willingness to participate in COVID-19 treatment and vaccine trials using multinomial regression analysis.
Results:
Approximately half of Black and Latino respondents were unwilling to participate in COVID-19 treatment or vaccine clinical trials. Results showed that increased trust in COVID-19 clinical trial information sources and trial awareness were associated with greater willingness to participate in COVID-19 treatment and vaccine trials among Black and Latino individuals. For Latino respondents, having recently experienced more challenges related to social determinants of health was associated with a decreased likelihood of willingness to participate in COVID-19 vaccine trials.
Conclusions:
The willingness of Black and Latino adults to participate in COVID-19 treatment and vaccine clinical trials is influenced by trial awareness and trust in trial information sources. Ensuring the inclusion of these communities in clinical trials will require approaches that build greater awareness and trust.
The One Health High-Level Expert Panel’s definition of One Health includes optimizing the health of people, animals (wild and domestic) and ecosystems. For many One Health practitioners, wildlife that can spread zoonoses are the focus, particularly if they can come in contact with people. However, ecosystem health is often best-indicated by less-encountered species, for instance, amphibians and reptiles. This review highlights how these taxa can benefit human health and well-being, including cultural significance, as well as their impact on plant, animal and environmental health. We highlight current challenges to the health of these species and the need to include them in the One Health Joint Action Plan. We conclude with a call to action for inclusion of amphibians and reptiles in a One Health approach.
Tiafenacil is a new nonselective protoporphyrinogen IX oxidase (PPO)–inhibiting herbicide with both grass and broadleaf activity labeled for preplant application to corn, cotton, soybean, and wheat. Early-season corn emergence and growth often coincides in the mid-South with preplant herbicide application in cotton and soybean, thereby increasing opportunity for off-target herbicide movement from adjacent fields. Field studies were conducted in 2022 to identify the impacts of reduced rates of tiafenacil (12.5% to 0.4% of the lowest labeled application rate of 24.64 g ai ha–1) applied to two- or four-leaf corn. Corn injury 1 wk after treatment (WAT) for the two- and four-leaf growth stages ranged from 31% to 6% and 37% to 9%, respectively, whereas at 2 WAT these respective ranges were 21.7% to 4% and 22.5% to 7.2%. By 4 WAT, visible injury following the two- and four-leaf exposure timing was no greater than 8% in all instances except the highest tiafenacil rate applied at the four-leaf growth stage (13%). Tiafenacil had no negative season-long impact, as the early-season injury observed was not manifested in a reduction in corn height 2 WAT or yield. Application of tiafenacil directly adjacent to corn in early vegetative stages of growth should be avoided. In cases where off-target movement does occur, however, affected corn should be expected to fully recover with no impact on growth and yield, assuming adequate growing conditions and agronomic/pest management practices are provided.
Information regarding the prevalence and distribution of herbicide-resistant waterhemp [Amaranthus tuberculatus (Moq.) Sauer] in Minnesota is limited. Whole-plant bioassays were conducted in the greenhouse on 90 A. tuberculatus populations collected from 47 counties in Minnesota. Eight postemergence herbicides, 2,4-D, atrazine, dicamba, fomesafen, glufosinate, glyphosate, imazamox, and mesotrione, were applied at 1× and 3× the labeled doses. Based on their responses, populations were classified into highly resistant (≥40 % survival at 3× the labeled dose), moderately resistant (<40% survival at 3× the labeled dose but ≥40% survival at 1× the labeled dose), less sensitive (10% to 39% survival at 1× the labeled dose), and susceptible (<10% survival at 1× the labeled dose) categories. All 90 populations were resistant to imazamox, while 89% were resistant to glyphosate. Atrazine, fomesafen, and mesotrione resistance was observed in 47%, 31%, and 22% of all populations, respectively. Ten percent of the populations were resistant to 2,4-D, and 2 of 90 populations exhibited >40% survival following dicamba application at the labeled dose. No population was confirmed to be resistant to glufosinate. However, 22% of all populations were classified as less sensitive to glufosinate. Eighty-two populations were found to be multiple-herbicide resistant. Among these, 15 populations exhibited resistance to four different herbicide sites of action (SOAs); 7 and 4 populations were resistant to five and six SOAs, respectively. All six-way-resistant populations were from southwest Minnesota. Two populations, one from Lincoln County and the other from Lyon County, were resistant to 2,4-D, atrazine, dicamba, fomesafen, glyphosate, imazamox, and mesotrione, leaving only glufosinate as a postemergence control option for these populations in corn (Zea mays L.) and soybean [Glycine max (L.) Merr.]. Diversified management tactics, including nonchemical control measures along with herbicide applications from effective SOAs, should be implemented to slow down the evolution and spread of herbicide-resistant A. tuberculatus populations.
Immediate-use steam sterilization (IUSS) shortens the time of sterilization but may increase the risk of surgical site infection (SSI). Among 23,919 procedures with 416 (1.7%) procedures resulting in SSI, IUSS was associated with a 1.52 (95% CI, 1.10–2.11) times higher risk of SSI. IUSS should be minimized.
Despite thousands of individuals entering the illegal wildlife trade each year, assessments of pangolin populations are largely non-existent, even in areas with high exploitation and limited personnel and field equipment. Although pangolins have unique keratin-based scales, there is no universal scale-marking method for individuals despite some pangolin conservation programmes utilizing marking for reference and cataloguing. Each programme currently establishes and manages its own system, resulting in inconsistencies and limiting data sharing. To facilitate pangolin monitoring and research, we developed a standardized method for assigning individual identification numbers, which we call the Pangolin Universal Notching System. This system is neither resource nor training intensive, which could facilitate its adoption and implementation globally. Its application could help to address knowledge gaps in pangolin ageing, reproduction, survivorship, migration and local trafficking patterns, and could be used in combination with other tagging techniques for research on pangolin biology.
Tiafenacil is a new nonselective protoporphyrinogen IX oxidase–inhibiting herbicide with both grass and broadleaf activity labeled for preplant application to corn, cotton, soybean, and wheat. Early season rice emergence and growth often coincide in the mid-southern United States with applications of preplant herbicides to cotton and soybean, thereby increasing the opportunity for off-target herbicide movement from adjacent fields. Field studies were conducted to identify any deleterious effects of reduced rates of tiafenacil (12.5% to 0.4% of the lowest labeled application rate of 24.64 g ai ha−1) applied to 1- or 3-leaf rice. Visual injury 1 wk after treatment (WAT) for the 1- and 3-leaf growth stages ranged from 50% to 7% and 20% to 2%, respectively, whereas at 2 WAT these respective ranges were 13% to 2%, and no injury was observed. Tiafenacil applied at those rates had no negative season-long effect because observed early season injury was not manifested as a reduction in rice height 2 WAT or rough rice yield. Application of tiafenacil to crops directly adjacent to rice in its early vegetative stages of growth should be avoided because visual injury will occur. When off-target movement does occur, however, the affected rice should be expected to fully recover with no effect on growth or yield, assuming adequate growing conditions and agronomic/pest management are provided.