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To slow down the transmission of coronavirus disease 2019 (COVID-19), it is important to identify specific symptoms for effective screening. While anosmia/hyposmia and dysgeusia/ageusia have been identified as highly prevalent symptoms, there are wide geographic variations, necessitating the regional evaluation of the prevalence of the symptoms.
Methods
A cross-sectional study was performed to evaluate the self-reported symptoms among adults (over 18 years old) who underwent COVID-19 tests at an ambulatory assessment centre. We identified 1,345 patients (102 positive and 1,243 negative) who visited the assessment centre between March 16 and April 15, 2020. We randomly sampled negative patients in a 1:3 ratio. The primary outcome was the prevalence of self-reported anosmia/hyposmia and dysgeusia/ageusia. Logistic regression was performed to evaluate the association between COVID-19 positivity and loss of smell and taste.
Results
Fifty-six of 102 (50%) positive patients and 72 of 306 (23.5%) negative patients completed the survey. Anosmia/hyposmia and dysgeusia/ageusia were more prevalent among COVID-19 positive patients (41.1% v. 4.2%, p < 0.001 for smell and 46.4% v. 5.6%, p < 0.001 for taste). Anosmia/hyposmia and dysgeusia/ageusia were independently highly associated with COVID-19 positivity (adjusted odds ratios 14.4 and 11.4 for smell and taste, respectively).
Conclusion
In this Canadian study, smell and taste loss may be key symptoms of COVID-19. This evidence can be helpful in the clinical diagnosis of COVID-19, particularly settings of limited testing capacity.
Background: In patients with acute hip fracture, a fascia iliaca compartment block (FICB) has been shown to provide effective non-opioid analgesia, reduce the incidence of pneumonia, and potentially decrease the rate of delirium [1]. However, this procedure was infrequently used in the St. Michael's Hospital (SMH) emergency department (ED). Aim Statement: Our aim was to increase the proportion of patients with hip fracture receiving FICB in the ED to 50% in six months. Measures & Design: We completed two Plan-Do-Study-Act (PDSA) cycles, measuring rates of FICB before and after each cycle. The first was a departmental rounds presentation with information about the process and benefits of FICB, addressing barriers identified by surveying the group. The second cycle included a bundle of interventions comprising of an “instruction card” with the steps required to do the procedure, access to a video tutorial, and a list of experienced physicians willing to help less experienced providers perform FICB. Evaluation/Results: In the three months prior to the project, the rate of FICB in the ED was 12.5% (3/24). For the three months after the first PDSA cycle, the rate increased to 22.2% (8/36). Then, the second cycle was performed. In the following two months the rate further increased to 36.8% (7/19). Discussion/Impact: Despite the clear increase in FICB rate, these changes were not statistically significant (p = 0.063). Our methodology was shown to be safe and effective, and our model can be applied to other ED groups looking to increase their rates of FICB.
We observed the 2 July 2019 total solar eclipse with a variety of imaging and spectroscopic instruments recording from three sites in mainland Chile: on the centerline at La Higuera, from the Cerro Tololo Inter-American Observatory, and from La Serena, as well as from a chartered flight at peak totality in mid-Pacific. Our spectroscopy monitored Fe X, Fe XIV, and Ar X lines, and we imaged Ar X with a Lyot filter adjusted from its original H-alpha bandpass. Our composite imaging has been compared with predictions based on modeling using magnetic-field measurements from the pre-eclipse month. Our time-differenced sites will be used to measure motions in coronal streamers.
Sexual dimorphism is common in many extant animals, but it is difficult to demonstrate in fossil species. Working with material from the Late Cretaceous of the U.S. Coastal Plain, we herein analyze sexual dimorphism in ostracodes from the superfamily Cytheroidea, a group whose extant members have males that are relatively more elongate than females. We digitized outlines of more than 6000 individual ostracode valves or carapaces, extracted size (area) and shape (length-to-height ratio) information, and used finite mixture models to assess hypotheses of sexual dimorphism. Male and female clusters can be discerned in nearly all populations with sufficient data, resulting in estimates of size and shape dimorphism for 142 populations across 106 species; an additional nine samples are interpreted to consist only of females. Dimorphism patterns varied across taxa, especially for body size: males range from 30% larger to 20% smaller than females. Magnitudes of sexual dimorphism are generally stable within species across time and space; we can demonstrate substantial evolutionary changes in dimorphism in only one species, Haplocytheridea renfroensis. Several lines of evidence indicate that patterns of sexual dimorphism in these ostracodes reflect male investment in reproduction, suggesting that this study system has the potential to capture variation in sexual selection through the fossil record.
To assess the impact of Matrix-Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF) mass spectrometry for rapid pathogen identification directly from early-positive blood cultures coupled with an antimicrobial stewardship program (ASP) in two community hospitals. Process measures and outcomes prior and after implementation of MALDI-TOF/ASP were evaluated.
DESIGN
Multicenter retrospective study.
SETTING
Two community hospitals in a system setting, Houston Methodist (HM) Sugar Land Hospital (235 beds) or HM Willowbrook Hospital (241 beds).
PATIENTS
Patients ≥18 years of age with culture-proven Gram-negative bacteremia.
INTERVENTION
Blood cultures from both hospitals were sent to and processed at our central microbiology laboratory. Clinical pharmacists at respective hospitals were notified of pathogen ID and susceptibility results.
RESULTS
We evaluated 572 patients for possible inclusion. After pre-defined exclusion criteria, 151 patients were included in the pre-intervention group and 242 were included in the intervention group. After MALDI-TOF/ASP implementation, the mean identification time after culture positivity was significantly reduced from 32 hours (±16 hours) to 6.5 hours (±5.4 hours) (P<.001); mean time to susceptibility results was significantly reduced from 48 (±22) hours to 23 (±14) hours (P<.001); and time to therapy adjustment was significantly reduced from 75 (±59) hours to 30 (±30) hours (P<.001). Mean hospital costs per patient were $3,411 less in the intervention group compared with the pre-intervention group ($18,645 vs $15,234; P=.04).
CONCLUSION
This study is the first to analyze the impact of MALDI-TOF coupled with an ASP in a community hospital setting. Time to results significantly differed with the use of MALDI-TOF, and time to appropriate therapy was significantly improved with the addition of ASP.
Infect. Control Hosp. Epidemiol. 2016;37(4):425–432
Children with conduct problems (CP) are a heterogeneous group. Those with high levels of callous–unemotional traits (CP/HCU) appear emotionally under-reactive at behavioural and neural levels whereas those with low levels of CU traits (CP/LCU) appear emotionally over-reactive, compared with typically developing (TD) controls. Investigating the degree to which these patterns of emotional reactivity are malleable may have important translational implications. Instructing participants with CP/HCU to focus on the eyes of fearful faces (i.e. the most salient feature) can ameliorate their fear-recognition deficits, but it is unknown whether this is mediated by amygdala response. It is also unknown whether focusing on fearful eyes is associated with increased amygdala reactivity in CP/LCU.
Method
Functional magnetic resonance imaging (fMRI) was used to measure neural responses to fearful and calm faces in children with CP/HCU, CP/LCU and TD controls (n = 17 per group). On half of trials participants looked for a blue dot anywhere within target faces; on the other half, participants were directed to focus on the eye region.
Results
Reaction time (RT) data showed that CP/LCU were selectively slowed in the fear/eyes condition. For the same condition, CP/LCU also showed increased amygdala and subgenual anterior cingulate cortex (sgACC)/orbitofrontal cortex (OFC) responses compared with TD controls. RT and amygdala response to fear/eyes were correlated in CP/LCU only. No effects of focusing on the eye region were observed in CP/HCU.
Conclusions
These data extend the evidence base suggesting that CU traits index meaningful heterogeneity in conduct problems. Focusing on regulating reactive emotional responses may be a fruitful strategy for children with CP/LCU.
Leprosy is a chronic disease predominantly affecting skin and nerves, which may result in deformity, disability and social stigma, creating problems for patients and their families. Africa is the third most affected region world-wide after Asia and South America (WHO, 2009). In 2009, eight African countries still reported more than one new leprosy case per 10 000 population.
In many countries leprosy work is being integrated into general health services, so all medical professionals need to be aware of the symptoms and signs of leprosy. Since new patients may have nerve function impairment at diagnosis, every health professional should know how to assess and manage nerve impairment caused by leprosy (Rijk et al., 1994).
The organism
Leprosy is caused by Mycobacterium leprae, an acid-fast intracellular organism not yet cultivated in vitro. The organism was first identified in the nodules of lepromatous leprosy patients by Hansen in 1873. M. leprae parasitizes skin macrophages and peripheral nerve Schwann cells.
M. leprae can be grown in the mouse footpad, but growth is slow. The nine-banded armadillo is susceptible to M. leprae infection, and develops disease with widespread bacterial multiplication. The armadillo and mouse models of M. leprae infection have been useful for producing M. leprae for biological studies and studying drug sensitivity patterns.
Radiocarbon is a useful tool for studying carbon dynamics in soil aggregates. The objective of the current study was to determine the mean residence time (MRT) of soil organic carbon (SOC) in macroaggregates and microaggregates under contrasting land uses. Contrasting land uses investigated at Alfisol (equivalent to Dermosol in Australian Soil Classification) sites were native pasture (NP), crop-pasture rotation (CP), and Eucalypt woodland (WL), whereas in Oxisol (Ferrosol in Australian Soil Classification) sites, land uses comprised improved pasture (IP), cropping (CR), and forest (FR). Soil aggregates were separated into macroaggregates (250–2000 μm) and microaggregates (53–250 μm) by wet-sieving, and their 14C signatures were determined by accelerator mass spectrometry (AMS). The 14C activity in both macro- and microaggregates was >100 pMC, indicating the presence of post-bomb carbon in the soil. The mean residence time (MRT) of SOC in macro- and microaggregates (MRTagg) was on average 68 yr longer in the Oxisol compared with that in the Alfisol. The MRTagg in microaggregates was 10 yr longer than that of macroaggregates in the Alfisol. However, the MRTagg in microaggregates was 50 yr shorter compared to macroaggregates in the Oxisol.
The MRT of macro- and microaggregates can be separated into active, slow, and stable SOC pools. Among the 3 SOC pools, the MRT of the stable pool is of higher significance in terms of SOC stabilization in soil aggregates because of its longer MRT. However, isolation and direct MRT estimation of the stable SOC pool is difficult. The MRT of active and slow SOC pools associated with macro- and microaggregates was measured using a SOC mineralization experiment to estimate the MRT of the stable SOC pool under contrasting land uses by applying a mass balance criterion. The MRT of active (MRTA) and slow (MRTS) SOC pools in macro- and microaggregates varied between 1–50 days and 13–38 yr, respectively. The estimated MRT of the stable pool carbon (MRTP) in microaggregates was 897 yr longer compared to that of macroaggregates in the Alfisol. However, in the Oxisol, MRTP in microaggregates was 568 yr shorter than that of macroaggregates. Among the land uses, WL in Alfisol and CR in Oxisol had longer MRTagg and MRTP compared to other land uses.
Examination of crop contents of three species of grasshoppers in outbreak densities on desert grassland of eastern Arizona revealed that all three were ingesting a mixed diet of plants. Crops of nymphal and adult Aulocara elliotti (Thomas) contained an average of 67 and 93% dry weight of grass, respectively, placing this species in both the mixed graminivorous and the graminivorous categories. The preferred host plant of A. elliotti was Bouteloua gracilis (H.B.K.) Lag. but it was not an essential item, as a large population developed in a site where this grass was virtually lacking but other perennial grasses were present. Crops of nymphs and adults of both Melanoplus sanguinipes (Fabricius) and M. cuneatus Scudder contained chiefly forbs (88–100% of dry weight). The principal host plants were Erodium cicutarium (L.) L’Hér., Lupinus brevicaulis Wats., Microsteris gracilis (Hook.) Greene, and Plantago purshii Roem. & Schult. Both species of Melanoplus fit into the forbivorous category and evidence indicated they were in competition with each other for food. All three grasshopper species showed preferences for particular plant species and as a consequence had significantly different frequencies of plant taxa in their crop contents from what were present in the field.
Irrigation has been used for thousands of years to maximize the performance, efficiency and profitability of crops and it is a science that is constantly evolving. This potential for improved crop yields has never been more important as population levels and demand for food continue to grow. Recognising the need for a coherent and accessible review of international irrigation research, this book examines the factors influencing water productivity in individual crops. It focuses on nine key plantation/industrial crops on which millions of people in the tropics and subtropics depend for their livelihoods (banana, cocoa, coconut, coffee, oil palm, rubber, sisal, sugar cane and tea). Linking crop physiology, agronomy and irrigation practices, this is a valuable resource for planners, irrigation engineers, agronomists and producers concerned with the international need to improve water productivity in agriculture in the face of increased pressure on water resources.
The rubber tree of commerce (Hevea brasiliensis Muell. Arg.) is indigenous to the Amazon rainforest, within 5° N and 5° S latitude of the equator. Its properties were well known to the Indians of South and Central America long before the arrival of the Europeans in the sixteenth century. It is cultivated for its latex, which is used in the production of natural rubber, 60% of which is utilised in the manufacture of tyres (Figure 7.1). Latex is a cellular fluid consisting of a suspension of rubber hydrocarbon particles, represented by the formula (C5H8)n, in an aqueous medium. The nineteenth century saw the vulcanisation of rubber (heating with sulphur allows rubber to retain its physical properties unchanged over the temperature range 0–100 °C), the development of specialist machinery and techniques for manufacturing rubber goods, the rise of commercial trade in rubber, and the first efforts to cultivate rubber when the demand for raw rubber began to exceed the supply from wild trees in Brazil (Varghese and Abraham, 2005). In 1876 seeds were gathered from the rainforest and taken to Kew Gardens in London. Subsequently, seedlings were sent from London to Sri Lanka and afterwards onward to Singapore where they formed the basis of the rubber-producing industry that developed throughout the twentieth century, particularly in South-east Asia (Purseglove, 1968).
The total annual production of natural rubber in 2008 was about 10.6 million t from 8.9 million ha. The principal producers are Thailand (3.0 million t, 1.8 million ha), Indonesia (2.8 million t, 2.9 million ha), Malaysia (1.2 million t, 1.25 million ha), India (0.82 million t, 0.45 million ha) and Vietnam (0.61 million t, 0.63 million ha). The largest producer in West Africa is the Côte d'Ivoire (0.18 million t), and in South America it is Brazil (0.11 million t). In 2008, South-east Asia produced 94% of the world's crop (FAO, 2010b; IRSG, 2010).
The centre of origin of the oil palm (Elaeis guineensis Jacq.) is the tropical rainforest of West Africa where its natural habitat is believed to be in swamps and along river banks. The main economic product is palm oil obtained from the mesocarp in the fruit. Palm kernel oil, which has a different fatty acid composition, is produced in smaller quantities. Kernel cake, produced after the kernel oil has been extracted, is used in animal feeds. Oil palm is the highest yielding oil crop (t ha−1) in the world. Traditionally, palm oil was used in soap, margarine and cooking fat, but is now largely used in food products. It has also become the source of more diverse materials (Corley and Tinker, 2003). When grown as a smallholder crop, the oil palm contributes much more than oil to the communities living in the areas where it is cultivated. For, example, the sap can provide raw material for sugar and alcoholic beverages. The palms are also a source of building materials, and some of the tissues are important sources of fibre.
The oil palm has long been important to village economies throughout its area of distribution in the forests of West Africa, where semi-wild palm groves became established around homesteads (Nouy et al., 1999). The export of palm oil and kernels from Africa grew rapidly in the late nineteenth century, while the first large-scale plantations in Malaysia and Indonesia were established in the early years of the twentieth century. These were followed in the 1920s by plantations in the Congo and later in other parts of West Africa (Corley, 1976a). It is now grown between latitudes 19° N (Dominican Republic) and 15° S (Brazil). In 2009, the two largest palm oil producers by far were Indonesia (85 million t fresh fruit bunches from 5 million ha) and Malaysia (83 million t from 3.9 million ha). This represents a substantial proportion of the estimated total global area of 14.7 million ha. In terms of fruit production these two countries produce 81% of the world total with fruit bunch yields averaging 17–21 t ha−1 (containing 3.4–4.2 t ha−1 of mesocarp oil) (FAO, 2011a).
My first job was with the Tea Research Institute of East Africa. This institute served the tea industries in three neighbouring countries, Kenya, Tanzania and Uganda, each with diverse ecological conditions. The results of the research, which was largely funded by the industry, had to be interpreted and applied to areas distant from the location of the field experiments, and then communicated to smallholders as well as large estates in appropriate ways. There was little opportunity to undertake basic research as the industry wanted answers to immediate practical questions, but if the results were to have generic value answers to fundamental questions were also needed.
My second job was in the UK with Wye College (University of London) where the task was to support the introduction of maize, a ‘new crop’, into British agriculture. This might seem very different from the job in East Africa, but the challenge was the same. To undertake and report research of immediate value to enterprising farmers concerned about profitability, yet supported by good science. It also meant working with a multidisciplinary team of agronomists, engineers and economists.
There are few easily identifiable or accessible sources where the results of international irrigation research have been brought together and interpreted in coherent and useful ways for individual crops. This is in part due to the diversity of sources, and also to the difficulty of reconciling the results of research conducted in contrasting situations, often with insufficient supporting information, to allow the results to be extrapolated to new situations with confidence (Carr, 2000a).
A scientific understanding of the role that water plays in the growth and development of crops is essential, but this knowledge needs to be interpreted and presented as practical advice in a language that can assist planners, irrigation engineers, irrigation agronomists and producers to allocate and use water, whether rainfall or irrigation, effectively and profitably. Communication between the professions attempting to improve irrigation water management for the benefit of the commercial producer and the wider community can always be improved. Field experiments must be designed and managed to quantify with precision the (marketable) yield responses of crops to water. Adequate supporting measurements need to be taken to enable the results to be interpreted and applied with confidence to other locations, or at other times, where the climate, weather and/or soils may be different. Site specific, single discipline, empirical studies should normally be avoided. But, to minimise duplication of effort, existing information on the water relations and irrigation need of individual crops first needs to be collated and interpreted in practically useful ways. This is especially true for plantation crops having international commercial importance (Carr, 2000a).
Tea (Camellia sinensis L.) is believed to have originated within the fan-shaped area extending from the Assam/Burma border in the west to China in the east (c. 26° N), and south from this line through Burma and Thailand to Vietnam (c. 14° N) (Kingdom-Ward, 1950; Mair and Hoh, 2009). This is an area of monsoon climates with a warm, wet summer and a cool, dry (or less wet) winter. From the main centres of cultivation in South-east Asia tea has been introduced into many other areas of the world and is now grown in conditions that range from Mediterranean-type climates to the hot, humid tropics, from Georgia in the north (42° N) to Argentina (27° S) and New Zealand (37° S) in the south, and from sea level to 2700 m altitude (Carr, 1972). By far the largest producer of tea is China (estimated planted area by 2008 = 1.4 million ha; annual production of processed tea = 1.3 million t) followed by India (474 000 ha; 800 000 t) and then Kenya (158 000 ha; 345 000 t) and Sri Lanka (222 000 ha; 319 000 t) (FAO, 2010b).
In this chapter, the contribution of research into the water relations and irrigation requirements of tea over the last 40 years to commercial crop management, and to our understanding of the physiology of the crop, is summarised and reviewed. The focus is on work done in eastern Africa where the Tea Research Foundation of Kenya (TRFK; 0° 22c′ S; alt. 2200 m), the Tea Research Institute of Tanzania (TRIT, 8° 32′ S; alt. 1840 m), and the Tea Research Foundation of Central Africa (TRFCA, 16° 05′ S; alt. 630 m), based in Malawi, have all undertaken fundamental research on these topics. Prior to 1978, the Tea Research Institute of East Africa (TRIEA) served three countries – Kenya, Tanzania and Uganda. Some of the major private tea companies also undertake their own research.