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A 47-year-old male was upset with his girlfriend and poured gasoline on her house and set it on fire. While admiring his work he sat back and lit a cigarette. At this point he went up in flames. He presents to the emergency room with a 75% total body surface area (TBSA) burn. He is awake and talking. He has facial burns, singed nasal hair, and increased secretions. He is telling you that he will be fine, and doesn’t need a breathing tube. Pulse ox reads 99%. What are your specific concerns? What is your plan for airway management? What is your plan for fluid therapy?
Double-cropping winter rye cover crops (CC) with soybean in the North Central US could help with the global effort to sustainably intensify agriculture. Studies addressing the management of these systems are limited. Therefore, a field study was conducted from 2017 to 2019 in Central Iowa, US to evaluate winter rye CC biomass production, aboveground N accumulation, estimated economics, estimated within-field energy balance and estimated greenhouse gas (GHG) emissions under three N application rates (0, 60, 120 kg N ha−1) and three planting methods (pre- and post-harvest broadcast and post-harvest drilling). Averaged over N rates, all planting methods resulted in >5.0 Mg ha−1 year−1 rye aboveground biomass dry matter. Averaged over the 2-year study and compared with unfertilized treatments, applying 60 kg N ha−1 produced 1.1 Mg ha−1 more aboveground biomass (6.1 vs 5.0 Mg ha−1), accumulated 30 kg ha−1 more N in aboveground biomass (88 vs 58 kg N ha−1), and led to 20 GJ ha−1 more net energy. Biomass production was not significantly higher with 120 kg N ha−1 compared with the 60 kg N ha−1 rate. Even when accounting for an estimated 0.75 Mg ha−1 of above ground rye biomass left in the field after harvesting, more N was removed than applied at the 60 kg N ha−1 rate. The minimum rye prices over the 2-year study needed for double-cropping winter rye CC to be profitable (breakeven prices) averaged $117 and $104 Mg−1 for the 0 and 60 kg N ha−1 rates, which factors in estimated soybean yield reductions in 2019 compared with local averages but not off-site transportation. GHG emissions were estimated to increase approximately threefold between the unfertilized and 60 kg N ha−1 rates without considering bioenergy offsets. While environmental tradeoffs need further study, results suggest harvesting fertilized rye CC biomass before planting soybean is a promising practice for the North Central US to maximize total crop and net energy production.
With the projected surge in global dementia cases and no curative treatment available, research is increasingly focusing on lifestyle factors as preventive measures. Social and cognitive leisure activities are promising targets, but it is unclear which types of activities are more beneficial. This study investigated the individual and joint contribution of cognitive and social leisure activities to dementia risk and whether they modify the risks associated with other potentially modifiable and non-modifiable risk factors.
Methods
We used data from the English Longitudinal Study of Ageing (ELSA) from 7917 participants, followed up from 2008/2009 (Wave 4) until 2018/2019 (Wave 9) for incident dementia. Self-reported baseline cognitive activities (e.g. ‘reading the newspaper’), the number of social memberships (e.g. being a member of a social club) and social participation (e.g. ‘going to the cinema’) were clustered into high and low based on a median split. Subsequently, their individual and joint contribution to dementia risk, as well as their interaction with other dementia risk factors, were assessed with Cox regression models, adjusting for age, sex, level of education, wealth and a composite score of 11 lifestyle-related dementia risk factors.
Results
After a median follow-up period of 9.8 years, the dementia incidence rate was 54.5 cases per 10.000 person-years (95% CI 49.0–60.8). Adjusting for demographic and other lifestyle-related risk factors, higher engagement in cognitive activities (HR = 0.58; 95% CI 0.40–0.84), a greater number of social memberships (HR = 0.65; 95% CI 0.51–0.84) and more social participation (HR = 0.71; 95% CI 0.54–0.95) were associated with lower dementia risk. In a joint model, only engagement in cognitive activities (HR = 0.60; 95% CI 0.40–0.91) and social memberships (HR = 0.75; 95% CI 0.56–0.99) independently explained dementia risk. We did not find any interaction with other modifiable and non-modifiable risk factors.
Conclusions
Engagement in cognitive and social leisure activities may be beneficial for overall dementia risk, independent of each other and other risk factors. Both types of activities may be potential targets for dementia prevention measures and health advice initiatives.
To assess influenza symptoms, adherence to mask use recommendations, absenteesm and presenteeism in acute care healthcare workers (HCWs) during influenza epidemics.
Methods:
The TransFLUas influenza transmission study in acute healthcare prospectively followed HCWs prospectively over 2 consecutive influenza seasons. Symptom diaries asking for respiratory symptoms and adherence with mask use recommendations were recorded on a daily basis, and study participants provided midturbinate nasal swabs for influenza testing.
Results:
In total, 152 HCWs (65.8% nurses and 13.2% physicians) were included: 89.1% of study participants reported at least 1 influenza symptom during their study season and 77.8% suffered from respiratory symptoms. Also, 28.3% of HCW missed at least 1 working day during the study period: 82.6% of these days were missed because of symptoms of influenza illness. Of all participating HCWs, 67.9% worked with symptoms of influenza infection on 8.8% of study days. On 0.3% of study days, symptomatic HCWs were shedding influenza virus while at work. Among HCWs with respiratory symptoms, 74.1% adhered to the policy to wear a mask at work on 59.1% of days with respiratory symptoms.
Conclusions:
Respiratory disease is frequent among HCWs and imposes a significant economic burden on hospitals due to the number of working days lost. Presenteesm with respiratory illness, including influenza, is also frequent and poses a risk for patients and staff.
Compare quetiapine+antidepressant (AD) with lithium+AD, and quetiapine monotherapy with lithium+AD in open, rater-blinded treatment.
Methods
Patients with treatment resistant depression (Thase et al 1997 stage 1 and 2) with severity of MADRS ≥25 received: quetiapine XR 300mg/day plus AD (SSRIs or venlafaxine) (n=229), lithium (monitored to between 0.6 to 1.0 meq/l) plus AD (n=221) or quetiapine XR alone (300mg/day) (n=225) for 6 weeks. Primary efficacy measure was change from baseline in MADRS total score. The pre-specified non-inferiority limit was 3 points on the MADRS.
Results
Fewer patients discontinued on quetiapine+AD (15.2%) than lithium+AD (20.5%) and quetiapine monotherapy (21.5%). Quetiapine+AD and quetiapine monotherapy, were not inferior to lithium+AD in the primary (per protocol) analysis with a mean difference (97.5%CI) on the MADRS of -2.32 (-4.6 to -0.05) favouring add-on quetiapine and -0.97 (-3.24 to 1.31) favouring quetiapine monotherapy. This mandated superiority testing on the modified ITT population showing no significant difference at endpoint.
In a post hoc analysis discounting multiplicity, quetiapine+AD was significantly more effective than lithium+AD on the MADRS change from baseline, p=0.046. The advantage was observed at day 4 (p=0.007) and persisted throughout. Efficacy was supported by CGI-I (p=0.07). Quetiapine+AD showed a numerically greater advantage over lithium+AD in those with two failed treatments (Stage 2) rather than one (Stage 1).
Conclusions
Quetiapine+AD and quetiapine monotherapy, were non-inferior to lithium+AD in treatment resistant depression. There was an early significant and persistent efficacy advantage on MADRS for quetiapine augmentation compared with lithium augmentation of SSRI or venlafaxine treatment.
To examine the influence of gender on burden experience and depression among informal caregivers of frail older people.
Methods
The study was part of a large survey in private households in Germany headed by TNS Infratest Social Research. Based on a probability sample of the German population (n = 52,916), we contacted all people who were 60 years of age and older and who screened positively for at least one deficit in a range of activities of daily living as well as for cognitive impairment. Characteristics of the frail person and the care situation were assessed and - if an informal caregiver was available - burden measures and the CES-Depression Scale were applied.
Results
The care of the frail old people (n = 306, attrition: 39%; mean age: 80.2 years; female: 68.6%) was provided mostly by family caregivers (n = 262; mean age: 61 years; female: 73%). Both the burden experience and the depressive symptoms were higher among the female than among the male caregivers. Multiple linear regression analyses confirmed that caregiver's gender was one of the strongest predictors of burden experience as well as of depression. Structural equation modeling suggested that burden mediates depression; it further proposed that there should be separate models for female and male caregivers.
Conclusion
The results provide a basis for the development of strategies to reduce or even prevent serious distress and psychiatric disorders among informal caregivers. Furthermore, they point to the need for gender-specific interventions in this field.
Healthcare workers (HCWs) are at risk of acquiring and transmitting respiratory viruses while working in healthcare settings.
Objectives:
To investigate the incidence of and factors associated with HCWs working during an acute respiratory illness (ARI).
Methods:
HCWs from 9 Canadian hospitals were prospectively enrolled in active surveillance for ARI during the 2010–2011 to 2013–2014 influenza seasons. Daily illness diaries during ARI episodes collected information on symptoms and work attendance.
Results:
At least 1 ARI episode was reported by 50.4% of participants each study season. Overall, 94.6% of ill individuals reported working at least 1 day while symptomatic, resulting in an estimated 1.9 days of working while symptomatic and 0.5 days of absence during an ARI per participant season. In multivariable analysis, the adjusted relative risk of working while symptomatic was higher for physicians and lower for nurses relative to other HCWs. Participants were more likely to work if symptoms were less severe and on the illness onset date compared to subsequent days. The most cited reason for working while symptomatic was that symptoms were mild and the HCW felt well enough to work (67%). Participants were more likely to state that they could not afford to stay home if they did not have paid sick leave and were younger.
Conclusions:
HCWs worked during most episodes of ARI, most often because their symptoms were mild. Further data are needed to understand how best to balance the costs and risks of absenteeism versus those associated with working while ill.
Immune system markers may predict affective disorder treatment response, but whether an overall immune system marker predicts bipolar disorder treatment effect is unclear.
Methods:
Bipolar CHOICE (N = 482) and LiTMUS (N = 283) were similar comparative effectiveness trials treating patients with bipolar disorder for 24 weeks with four different treatment arms (standard-dose lithium, quetiapine, moderate-dose lithium plus optimised personalised treatment (OPT) and OPT without lithium). We performed secondary mixed effects linear regression analyses adjusted for age, gender, smoking and body mass index to investigate relationships between pre-treatment white blood cell (WBC) levels and clinical global impression scale (CGI) response.
Results:
Compared to participants with WBC counts of 4.5–10 × 109/l, participants with WBC < 4.5 or WBC ≥ 10 showed similar improvement within each specific treatment arm and in gender-stratified analyses.
Conclusions:
An overall immune system marker did not predict differential treatment response to four different treatment approaches for bipolar disorder all lasting 24 weeks.
Lentic freshwater habitats are important centres of biodiversity within the infrequent ice-free oases across Antarctica. Given imminent climate changes, it is crucial to catalogue these habitats in order to provide baseline data for future monitoring and biological surveys. The lacustrine systems of Clearwater Mesa, a previously unexplored part of James Ross Island, north-eastern Antarctic Peninsula, are described here. We conducted basic geomorphological and limnological surveys over three Antarctic summers (2009–16) to characterize landscape evolution, infer the origin of lake basins and assess the variability in their water chemistry. Stable shallow lakes, formed in depressions between lava tumuli following the last deglaciation, were found to dominate the volcanic mesa, although several peripheral lakes in ice-proximal settings appear to have formed recently as a result of post-Neoglacial ice recession. We found large heterogeneity in conductivity (~10–7000 μS cm−1), despite the lithologically uniform substrate. This variability was shown to be related to lake type, basin type (open vs closed), meltwater source and proximity to the coast. Inter-annual differences were attributed to changes in sea spray influx and snow accumulation driven by variable weather conditions. Overall, the ion composition of lakes suggested that sea spray was the dominant source of ions, followed by the weathering of bedrock.
On an 11 m firn/ice core from Kongsvegen, Svalbard, we have used dielectric profiling (DEP) to measure electrical properties, and digital photography to measure a core optical stratigraphy (COS) profile. We also used a neutron-scattering probe (NP) to measure a density profile in the borehole from which the core was extracted. The NP- and DEP-derived density profiles were similar, showing large-scale (>30 cm) variation in the gravimetric densities of each core section. Fine-scale features (<10 cm) are well characterized by the COS record and are seen at a slightly lower resolution in both the DEP and NP records, which show increasing smoothing. A combination of the density accuracy of NP and the spatial resolution of COS provides a useful method of evaluating the shallow-density profile of a glacier, improving paleoclimate interpretation, mass-balance measurement and interpretation of radar returns.
Winter balance is an important metric for assessing the change on glaciers and ice caps, yet measuring it using ground-based techniques can be challenging. We use the European Space Agency prototype Airborne SAR/Interferometric Radar Altimeter System (ASIRAS) to extract snow depths from the received altimeter waveforms over Austfonna ice cap, Svalbard. Additionally, we attempt to distinguish the long-term firn area from other glacier facies. We validate our results using snow depth and glacier facies characterizations determined from ground-based radar profiles, snow pits and a multi-look satellite synthetic aperture radar image. We show that the depth of the winter snowpack can be extracted from the altimeter data over most of the accumulation zone, comprising wet snow zone and a superimposed ice zone. The method struggles at lower elevations where internal reflections within the winter snowpack are strong and the winter snow depth is less than ~1 m. We use the abruptness of the reflection from the last summer surface (LSS) to attempt to distinguish glacier facies. While there is a general correlation between LSS abruptness and glacier facies, we do not find a relationship that warrants a distinct classification based on ASIRAS waveforms alone.
Hoop structures bedded with crop residues are becoming increasingly popular for swine production in the northcentral United States. Compost made from bedding materials and swine manure can be used as a soil amendment. A 3-yr field experiment was conducted in Boone, IA, to determine how composted swine manure affected selected soil characteristics and nutrient uptake, growth, and seed production of corn and three weed species (giant foxtail, velvetleaf, and common waterhemp) grown in mixture with corn. Two soil management systems, designed to provide equivalent amounts of N to corn, were compared: one that received composted manure and an average of 118 kg N ha−1 as synthetic fertilizer and another that received no composted manure and an average of 143 kg N ha−1 as synthetic fertilizer. Soil organic matter, P, K, and early-season NO3-N levels were greater in the (+) compost system. The N concentration of velvetleaf shoots, the P concentration of giant foxtail and common waterhemp shoots, and the K concentration of shoots of all three weed species also were greater in the (+) compost system. Compost application consistently increased common waterhemp height, common waterhemp biomass, and velvetleaf height, but increased velvetleaf biomass in only 1 yr and had no effect on giant foxtail height or biomass. Measurements of weed seed production, conducted in the final year of the study, showed that compost increased velvetleaf and common waterhemp seed production but had no effect on giant foxtail seed production. Compost consistently increased corn height and leaf K concentration but generally had no effect on corn yield. Results of this study indicate that large differences can exist among crop and weed species in their response to soil amendments. Depending on the weed species present, use of composted swine manure may increase requirements for weed management in corn production systems.
Cultural practices used for crop production influence the composition of the weed seed bank in the soil. This paper reports the results of a 5-yr experiment to characterize the weed seed bank conducted on a farmer-managed field in central Iowa. The number of weed seeds in the soil and their vertical distribution were examined each October. At the initial sampling in October 1994, the field had been in hay production and about 80% of the weed seeds were common waterhemp and foxtail species. The cropping sequence over the next 3 yr was corn/soybean/corn using a ridge tillage system. Over this period, the density of common waterhemp seeds declined each year. The density of foxtail seeds declined by almost 90% during the first year of corn and did not change during the following years of soybean and corn production. Prior to moldboard plowing of the hay sward in 1994, weed seeds were concentrated in the upper 10 cm of soil. Moldboard plowing resulted in a more uniform distribution of the weed seeds over the upper 20 cm of soil, and the distribution across depths remained relatively constant during the 3 yr of corn and soybean production. During the final year of the experiment, the field was rotated to oat and reseeded with hay species. The number of common waterhemp and foxtail seeds in the soil greatly increased following oat/hay production and seeds were concentrated in the upper 10 cm of the soil profile. Results indicated that the processes affecting the weed seed bank in production fields are complex and will vary greatly based on the production practices used and the timing of their application.
The degree to which prehispanic societies in the northern upland Southwest were hierarchical or egalitarian is still debated and seems likely to have changed through time. This paper examines the plausibility of village-spanning polities in the northern Southwest by simulating the coevolution of hierarchy and warfare using extensions to the Village Ecodynamics Project's agent-based model. We additionally compile empirical data on the population size distribution of habitations and ritual spaces (kivas) and the social groups that used them in three large regions of the Pueblo Southwest and analyze these through time. All lines of evidence refute an “autonomous village” model during the Pueblo II period (A.D. 890–1145); rather, they support the existence of village-spanning polities during the Pueblo II and probably into the Pueblo III period (A.D. 1145–1285) in some areas. One or more polities connecting the northern Southwest, with tribute flowing to an apex in Chaco Canyon, appears plausible during Pueblo II for the areas we examine. During Pueblo III, more local organizations likely held sway until depopulation in the late thirteenth century.
The following history has been compiled and written by the authors. The historical facts are available from the Conference of Research Workers in Animal Diseases (CRWAD) archives, dating back to letters and summaries written by the founders, and by a few of the Secretary-Treasurers from the early decades through 2014. The Organization and Purpose: The CRWAD is a non-profit organization and has been since its origin. The sole purpose of CRWAD is to discuss and disseminate the most current research advances in animal diseases. Graduate students and industry and academic professionals present and discuss the most recent advances on subjects of interest to the CRWAD and of importance to the global livestock and companion animal industries. The oral and poster abstracts of new and unpublished data presented at the meeting sessions are published each year in the CRWAD Proceedings (formerly the CRWAD Abstracts). CRWAD publishes, copyrights, and distributes the Proceedings. The presentations are arranged into the following 10 sections, according to the primary topic of the presentation: Bacterial Pathogenesis, Biosafety and Biosecurity, Companion Animal Epidemiology, Ecology and Management of Foodborne Agents, Epidemiology and Animal Health Economics, Immunology, Pathobiology of Enteric and Foodborne Pathogens, Respiratory Diseases, Vector-Borne and Parasitic Diseases, and Viral Pathogenesis. Prospective members should be actively engaged in animal disease research or research administration. Meeting information and membership applications may be obtained by contacting the Executive Director or by visiting the CRWAD website. Annual abstracts are currently available on-line at the On-line Meeting Planner and Itinerary Builder, with access through the CRWAD website.
Edited by
Hartmut Berghoff, German Historical Institute, Washington DC,Jürgen Kocka, Wissenschaftszentrum Berlin für Sozialforschung,Dieter Ziegler, Ruhr-Universität, Bochum, Germany
Psychotic symptoms, also termed psychotic-like experiences (PLEs) in the absence of psychotic disorder, are common in adolescents and are associated with increased risk of schizophrenia-spectrum illness in adulthood. At the same time, schizophrenia is associated with deficits in social cognition, with deficits particularly documented in facial emotion recognition (FER). However, little is known about the relationship between PLEs and FER abilities, with only one previous prospective study examining the association between these abilities in childhood and reported PLEs in adolescence. The current study was a cross-sectional investigation of the association between PLEs and FER in a sample of Irish adolescents.
Method
The Adolescent Psychotic-Like Symptom Screener (APSS), a self-report measure of PLEs, and the Penn Emotion Recognition-40 Test (Penn ER-40), a measure of facial emotion recognition, were completed by 793 children aged 10–13 years.
Results
Children who reported PLEs performed significantly more poorly on FER (β=−0.03, p=0.035). Recognition of sad faces was the major driver of effects, with children performing particularly poorly when identifying this expression (β=−0.08, p=0.032).
Conclusions
The current findings show that PLEs are associated with poorer FER. Further work is needed to elucidate causal relationships with implications for the design of future interventions for those at risk of developing psychosis.
Initial clinical trials using Trichuris suis eggs (TSO) in autoimmune diseases such as inflammatory bowel disease, revealed a striking suppressive effect on the autoimmune response. Here, we analysed the effect of TSO therapy on the course of multiple sclerosis (MS), as a Th1/Th17-associated autoimmune disease. Different immunological parameters in four patients with secondary progressive MS were surveyed during a 6-month therapy with TSO, focusing on the modulation of T-cell Th1–Th2 balance as well as on the innate immune response. We are able to show a slight downregulation of the Th1-associated cytokine pattern, especially relevant in interleukin (IL)-2 (P < 0.05 after 2 months of therapy), with a temporary increase of Th2-associated cytokines such as IL-4. Furthermore, mild eosinophily and changes in CD4+ and CD8+T cells and natural killer (NK) CD56 bright cell numbers were observed. The findings observed in this group of patients suggest that TSO therapy has a moderate immunomodulatory impact in MS.