We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
To evaluate the utility of selective reactive whole-genome sequencing (WGS) in aiding healthcare-associated cluster investigations.
Design:
Mixed-methods quality-improvement study.
Setting:
Thes study was conducted across 8 acute-care facilities in an integrated health system.
Methods:
We analyzed healthcare-associated coronavirus disease 2019 (COVID-19) clusters between May 2020 and July 2022 for which facility infection prevention and control (IPC) teams selectively requested reactive WGS to aid the epidemiologic investigation. WGS was performed with real-time results provided to IPC teams, including genetic relatedness of sequenced isolates. We conducted structured interviews with IPC teams on the informativeness of WGS for transmission investigation and prevention.
Results:
In total, 8 IPC teams requested WGS to aid the investigation of 17 COVID-19 clusters comprising 226 cases and 116 (51%) sequenced isolates. Of these, 16 (94%) clusters had at least 1 WGS-defined transmission event. IPC teams hypothesized transmission pathways in 14 (82%) of 17 clusters and used data visualizations to characterize these pathways in 11 clusters (65%). The teams reported that in 15 clusters (88%), WGS identified a transmission pathway; the WGS-defined pathway was not one that was predicted by epidemiologic investigation in 7 clusters (41%). WGS changed the understanding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in 8 clusters (47%) and altered infection prevention interventions in 8 clusters (47%).
Conclusions:
Selectively utilizing reactive WGS helped identify cryptic SARS-CoV-2 transmission pathways and frequently changed the understanding and response to SARS-CoV-2 outbreaks. Until WGS is widely adopted, a selective reactive WGS approach may be highly impactful in response to healthcare-associated cluster investigations.
The Community Research Advisory Council (C-RAC) of the Johns Hopkins Institute for Clinical and Translational Research was established in 2009 to provide community-engaged research consultation services. In 2016–2017, C-RAC members and researchers were surveyed on their consultation experiences. Survey results and a 2019 stakeholder meeting proceeding helped redesign the consultation services. Transitioning to virtual consultations during COVID-19, the redesigning involved increasing visibility, providing consultation materials in advance, expanding member training, and effective communications. An increase in consultations from 28 (2009–2017) to 114 (2020–2022) was observed. Implementing stakeholder-researcher inputs is critical to holistic and sustained community-engaged research.
The prolonged COVID-19 pandemic has created unique and complex challenges in operational and capacity planning for pediatric emergency departments, as initial low pediatric patient volumes gave way to unpredictable patient surges during Delta and Omicron variants. Compounded by widespread hospital supply chain issues, staffing shortages due to infection and attrition, and a concurrent pediatric mental health crisis, the surges have pushed pediatric emergency department leaders to re-examine traditionally defined clinical processes, and adopt innovative operational strategies. This study describes the strategic surge response and lessons learned by 3 major freestanding academic pediatric emergency departments in the western United States to help inform current and future pediatric pandemic preparedness.
The mitotic-inhibiting herbicide pronamide controls susceptible annual bluegrass (Poa annua L.) pre- and postemergence, but in some resistant populations, postemergence activity is compromised, hypothetically due to a target-site mutation, lack of root uptake, or an unknown resistance mechanism. Three suspected pronamide-resistant (LH-R, SC-R, and SL-R) and two pronamide-susceptible (BS-S and HH-S) populations were collected from Mississippi golf courses. Dose–response experiments were conducted to confirm and quantify pronamide resistance, as well as resistance to flazasulfuron and simazine. Target sites known to confer resistance to mitotic-inhibiting herbicides were sequenced, as were target sites for herbicides inhibiting acetolactate synthase (ALS) and photosystem II (PSII). Pronamide absorption and translocation were investigated following foliar and soil applications. Dose–response experiments confirmed pronamide resistance of LH-R, SC-R, and SL-R populations, as well as instances of multiple resistance to ALS- and PSII-inhibiting herbicides. Sequencing of the α-tubulin gene confirmed the presence of a mutation that substituted isoleucine for threonine at position 239 (Thr-239-Ile) in LH-R, SC-R, SL-R, and BS-S populations. Foliar application experiments failed to identify differences in pronamide absorption and translocation between the five populations, regardless of harvest time. All populations had limited basipetal translocation—only 3% to 13% of the absorbed pronamide—across harvest times. Soil application experiments revealed that pronamide translocation was similar between SC-R, SL-R, and both susceptible populations across harvest times. The LH-R population translocated less soil-applied pronamide than susceptible populations at 24, 72, and 168 h after treatment, suggesting that reduced acropetal translocation may contribute to pronamide resistance. This study reports three new pronamide-resistant populations, two of which are resistant to two modes of action (MOAs), and one of which is resistant to three MOAs. Results suggest that both target site– and translocation-based mechanisms may be associated with pronamide resistance. Further research is needed to confirm the link between pronamide resistance and the Thr-239-Ile mutation of the α-tubulin gene.
Although exposure therapy (ET) is an effective treatment for anxiety disorders and obsessive-compulsive disorder, many clinicians report not utilizing it. The present study targeted common utilization barriers by evaluating an intensive ET training experience in a relatively inexperienced sample of pre-professionals. Thirty-two individuals at the undergraduate or college graduate level without formal clinical experience participated as camp counsellors in a 5day exposure-based therapeutic summer camp for youth with anxiety disorders and/or obsessive-compulsive disorder. Participants were trained in ET through a progressive cascading model and answered questionnaires before and after camp. Repeated measure MANOVA revealed significantly increased feelings of self-efficacy conducting exposures, and significantly decreased feelings of disgust sensitivity and contamination-related disgust from pre-camp to post-camp. A subset of individuals providing data 1 month after the camp maintained a significant gain in ET self-efficacy. Regression analyses revealed that contamination-related disgust, but not disgust sensitivity, significantly predicted post-camp ET self-efficacy. These findings suggest that individuals early into their post-secondary education can learn ET, and the progressive cascading model holds promise in its utility across experience levels and warrants further investigation. Disgust may also play a role in feelings of competency conducting ET. Implications on dissemination and implementation efforts are also discussed.
Key learning aims
(1) How can training of CBT techniques such as exposure occur prior to graduate education?
(2) Can self-efficacy in conducting exposures meaningfully increase in an experiential training of pre-professionals?
(3) How does an individual’s tolerance of disgust impact feelings of competence conducting exposures?
Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.
Aims
To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
Method
Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.
Results
Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.
Conclusions
AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.
A novel paediatric disease, multi-system inflammatory syndrome in children, has emerged during the 2019 coronavirus disease pandemic.
Objectives:
To describe the short-term evolution of cardiac complications and associated risk factors in patients with multi-system inflammatory syndrome in children.
Methods:
Retrospective single-centre study of confirmed multi-system inflammatory syndrome in children treated from 29 March, 2020 to 1 September, 2020. Cardiac complications during the acute phase were defined as decreased systolic function, coronary artery abnormalities, pericardial effusion, or mitral and/or tricuspid valve regurgitation. Patients with or without cardiac complications were compared with chi-square, Fisher’s exact, and Wilcoxon rank sum.
Results:
Thirty-nine children with median (interquartile range) age 7.8 (3.6–12.7) years were included. Nineteen (49%) patients developed cardiac complications including systolic dysfunction (33%), valvular regurgitation (31%), coronary artery abnormalities (18%), and pericardial effusion (5%). At the time of the most recent follow-up, at a median (interquartile range) of 49 (26–61) days, cardiac complications resolved in 16/19 (84%) patients. Two patients had persistent mild systolic dysfunction and one patient had persistent coronary artery abnormality. Children with cardiac complications were more likely to have higher N-terminal B-type natriuretic peptide (p = 0.01), higher white blood cell count (p = 0.01), higher neutrophil count (p = 0.02), severe lymphopenia (p = 0.05), use of milrinone (p = 0.03), and intensive care requirement (p = 0.04).
Conclusion:
Patients with multi-system inflammatory syndrome in children had a high rate of cardiac complications in the acute phase, with associated inflammatory markers. Although cardiac complications resolved in 84% of patients, further long-term studies are needed to assess if the cardiac abnormalities (transient or persistent) are associated with major cardiac events.
An inflammation-induced imbalance in the kynurenine pathway (KP) has been reported in major depressive disorder but the utility of these metabolites as predictive or therapeutic biomarkers of behavioral activation (BA) therapy is unknown.
Methods
Serum samples were provided by 56 depressed individuals before BA therapy and 29 of these individuals also provided samples after 10 weeks of therapy to measure cytokines and KP metabolites. The PROMIS Depression Scale (PROMIS-D) and the Sheehan Disability Scale were administered weekly and the Beck depression inventory was administered pre- and post-therapy. Data were analyzed with linear mixed-effect, general linear, and logistic regression models. The primary outcome for the biomarker analyses was the ratio of kynurenic acid to quinolinic acid (KynA/QA).
Results
BA decreased depression and disability scores (p's < 0.001, Cohen's d's > 0.5). KynA/QA significantly increased at post-therapy relative to baseline (p < 0.001, d = 2.2), an effect driven by a decrease in QA post-therapy (p < 0.001, uncorrected, d = 3.39). A trend towards a decrease in the ratio of kynurenine to tryptophan (KYN/TRP) was also observed (p = 0.054, uncorrected, d = 0.78). Neither the change in KynA/QA, nor baseline KynA/QA were associated with response to BA therapy.
Conclusion
The current findings together with previous research show that electronconvulsive therapy, escitalopram, and ketamine decrease concentrations of the neurotoxin, QA, raise the possibility that a common therapeutic mechanism underlies diverse forms of anti-depressant treatment but future controlled studies are needed to test this hypothesis.
Motivated by the results of recent experiments (Kühnen et al., Flow Turbul. Combust., vol. 100, 2018, pp. 919–943), we consider the problem of designing a baffle (an obstacle to the flow) to relaminarise turbulence in pipe flows. Modelling the baffle as a spatial distribution of linear drag ${\boldsymbol {F}}(\boldsymbol {x},t)=-\chi (\boldsymbol {x})\boldsymbol {u}_{tot}(\boldsymbol {x},t)$ within the flow ($\boldsymbol {u}_{tot}$ is the total velocity field and $\chi \ge 0$ a scalar field), two different optimisation problems are considered to design $\chi$ at a Reynolds number $Re=3000$. In the first, the smallest baffle defined in terms of a $L_1$ norm of $\chi$ is sought which minimises the viscous dissipation rate of the flow. In the second, a baffle which minimises the total energy consumption of the flow is treated. Both problems indicate that the baffle should be axisymmetric and radially localised near the pipe wall, but struggle to predict the optimal streamwise extent. A manual search finds an optimal baffle one radius long which is then used to study how the amplitude for relaminarisation varies with $Re$ up to $15\,000$. Large stress reduction is found at the pipe wall, but at the expense of an increased pressure drop across the baffle. Estimates are then made of the break-even point downstream of the baffle where the stress reduction at the wall due to the relaminarised flow compensates for the extra drag produced by the baffle.
Recent experimental observations (Kühnen et al., Nat. Phys., vol. 14, 2018b, pp. 386–390) have shown that flattening a turbulent streamwise velocity profile in pipe flow destabilises the turbulence so that the flow relaminarises. We show that a similar phenomenon exists for laminar pipe flow profiles in the sense that the nonlinear stability of the laminar state is enhanced as the profile becomes more flattened. The flattening of the laminar base profile is produced by an artificial localised body force designed to mimic an obstacle used in the experiments of Kühnen et al. (Flow Turbul. Combust., vol. 100, 2018a, pp. 919–943) and the nonlinear stability measured by the size of the energy of the initial perturbations needed to trigger transition. Significant drag reduction is also observed for the turbulent flow when triggered by sufficiently large disturbances. In order to make the nonlinear stability computations more efficient, we examine how indicative the minimal seed – the disturbance of smallest energy for transition – is in measuring transition thresholds. We first show that the minimal seed is relatively robust to base profile changes and spectral filtering. We then compare the (unforced) transition behaviour of the minimal seed with several forms of randomised initial conditions in the range of Reynolds numbers $Re=2400$–$10\,000$ and find that the energy of the minimal seed after the Orr and oblique phases of its evolution is close to that of a critical localised random disturbance. In this sense, the minimal seed at the end of the oblique phase can be regarded as a good proxy for typical disturbances (here taken to be the localised random ones) and is thus used as initial condition in the simulations with the body force. The enhanced nonlinear stability and drag reduction predicted in the present study are an encouraging first step in modelling the experiments of Kühnen et al. and should motivate future developments to fully exploit the benefits of this promising direction for flow control.
Manganoan ilvaite forms as an early retrograde metamorphic phase from calcic rhodonite in the polymetamorphosed Pb-Zn sulphide/manganese silicate rocks at Broken Hill and from grossular-andradite in a skarn at Ban Ban. Ilvaite exists as a probable metastable phase into which Mn is apparently strongly partitioned. The manganoan ilvaites analysed contain up to 13·5 % MnO substituting for FeO and this substitution shifts the 020 peak.
The discovery of the first electromagnetic counterpart to a gravitational wave signal has generated follow-up observations by over 50 facilities world-wide, ushering in the new era of multi-messenger astronomy. In this paper, we present follow-up observations of the gravitational wave event GW170817 and its electromagnetic counterpart SSS17a/DLT17ck (IAU label AT2017gfo) by 14 Australian telescopes and partner observatories as part of Australian-based and Australian-led research programs. We report early- to late-time multi-wavelength observations, including optical imaging and spectroscopy, mid-infrared imaging, radio imaging, and searches for fast radio bursts. Our optical spectra reveal that the transient source emission cooled from approximately 6 400 K to 2 100 K over a 7-d period and produced no significant optical emission lines. The spectral profiles, cooling rate, and photometric light curves are consistent with the expected outburst and subsequent processes of a binary neutron star merger. Star formation in the host galaxy probably ceased at least a Gyr ago, although there is evidence for a galaxy merger. Binary pulsars with short (100 Myr) decay times are therefore unlikely progenitors, but pulsars like PSR B1534+12 with its 2.7 Gyr coalescence time could produce such a merger. The displacement (~2.2 kpc) of the binary star system from the centre of the main galaxy is not unusual for stars in the host galaxy or stars originating in the merging galaxy, and therefore any constraints on the kick velocity imparted to the progenitor are poor.
We have observed the oxygen-rich SNR 1E 0102.2-7219 with the integral field spectrograph WiFeS at Siding Spring Observatory and discovered sulfur-rich ejecta for the first time. Follow-up deep DDT observations with MUSE on the VLT (8100 s on source) reaching down to a noise level of ~5 × 10−20ergs−1cm−2Å−1spaxel−1 have led to the additional discovery of fast-moving hydrogen as well as argon-rich and chlorine-rich material. The detection of fast-moving hydrogen knots challenges the interpretation that the progenitor of 1E 0102 was a compact core of a Wolf-Rayet star that had shed its entire envelope. In addition to the detection of hydrogen and the products of oxygen-burning, this unprecedented sharp (0.2″ spaxel size at ~0.7″ seeing) and deep MUSE view of an oxygen-rich SNR in the Magellanic Clouds reveals further exciting discoveries, including [Fe xiv]λ5303 and [Fe xi]λ7892 emission, which we associate with the forward shock. We present this exciting data set and discuss some of its implications for the explosion mechanism and nucleosynthesis of the associated supernova.
Recent work at FLK North (FLK N) has unearthed a new archaeological assemblage recovered with precise control of its stratigraphic position. In the present work, the technological study of the new lithic sample is described. The results show the co-occurrence in the same site of different technological behaviors. At FLK N, hominins were involved in both percussion/battering activities and through freehand and bipolar knapping, in core reduction. However, the reconstruction of the operational sequences shows that core reduction was probably a marginal behavior, while percussion/battering activities occurred more regularly throughout the sequence. If hominins were not involved in regular carcass processing, as recent taphonomic studies suggest, then hominins' sporadic and low-impact visits to the site over a long period of time must have been driven by other activities probably linked to the exploitation of alternative resources. Plant processing could have been a plausible explanation for hominin presence at FLK N.
FLK North is one of the densest concentrations of fossils found in Olduvai Gorge. A recent taphonomic re-evaluation of the collection excavated by Leakey at the site suggests that it was a palimpsest in which most of the animals were accumulated and modified by carnivores. The lithic tools therefore seem to have an independent depositional history from most of the fauna. The present study, based on new excavations, expands the evidence supporting this interpretation and demonstrates a thicker deposit than was reported by Leakey, including new archaeological levels. It also shows that in the few instances where hominins butchered carcasses, meat, not marrow, was their main target. This argues against passive scavenging hypotheses, which emphasize the dietary role of marrow, and instead underscores the importance of meat in the diet of early Pleistocene hominins.