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To determine the usefulness of adjusting antibiotic use (AU) by prevalence of bacterial isolates as an alternative method for risk adjustment beyond hospital characteristics.
AU in days of therapy per 1,000 patient days and microbiologic data from 2015 and 2016 were collected from 26 hospitals. The prevalences of Pseudomonas aeruginosa, extended-spectrum β-lactamase (ESBL)–producing bacteria, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE) were calculated and compared to the average prevalence of all hospitals in the network. This proportion was used to calculate the adjusted AU (a-AU) for various categories of antimicrobials. For example, a-AU of antipseudomonal β-lactams (APBL) was the AU of APBL divided by (prevalence of P. aeruginosa at that hospital divided by the average prevalence of P. aeruginosa). Hospitals were categorized by bed size and ranked by AU and a-AU, and the rankings were compared.
Results:
Most hospitals in 2015 and 2016, respectively, moved ≥2 positions in the ranking using a-AU of APBL (15 of 24, 63%; 22 of 26, 85%), carbapenems (14 of 23, 61%; 22 of 25; 88%), anti-MRSA agents (13 of 23, 57%; 18 of 26, 69%), and anti-VRE agents (18 of 24, 75%; 15 of 26, 58%). Use of a-AU resulted in a shift in quartile of hospital ranking for 50% of APBL agents, 57% of carbapenems, 35% of anti-MRSA agents, and 75% of anti-VRE agents in 2015 and 50% of APBL agents, 28% of carbapenems, 50% of anti-MRSA agents, and 58% of anti-VRE agents in 2016.
Conclusions:
The a-AU considerably changes how hospitals compare among each other within a network. Adjusting AU by microbiological burden allows for a more balanced comparison among hospitals with variable baseline rates of resistant bacteria.
Evidence is mixed on e-cigarette's effectiveness as a tobacco cessation aid. Research suggests that e-cigarette users face greater barriers to quitting tobacco.
Aim
To examine the association between e-cigarette use and tobacco cessation outcomes among quitline callers.
Methods
We examined 2,204 callers who enrolled and completed 7-month follow-up surveys between April 2014 and January 2017. We examined the association between any e-cigarette use and tobacco cessation. We also evaluated these relationships by e-cigarette use patterns between enrollment and 7-month follow-up: sustained, adopted, discontinued, and non-use. We used multivariable logistic regression to control for caller characteristics, tobacco history, and program utilization.
Results
Overall, 18% of callers reported using e-cigarettes at enrollment, follow-up, or both. Compared to non-users, e-cigarette users were more likely to be younger, non-Hispanic, and report a mental health condition. The adjusted odds of tobacco cessation were not statistically different for callers who used e-cigarettes compared to those who did not (adjusted odds ratios = 1.02, 95% confidence interval 0.79–1.32). Results were similar when examining cessation by patterns of e-cigarette use.
Conclusions
E-cigarette use was not associated with tobacco cessation. This suggests that e-cigarette use may neither facilitate nor deter tobacco cessation among quitline callers. Future research should continue exploring how e-cigarette use affects quitting.
Canopy cover of false broomweed (Ericameria austrotexana M.C. Johnston) on the Rio Grande Plains of Texas was initially reduced by 96% by glyphosate [N-(phosphonomethyl)glycine] applied at 2.2 kg/ha in the spring. Acceptable control of this shrub with glyphosate lasted at least 4 yr. Glyphosate severely reduced basal cover of perennial grasses during the year of treatment, but grasses completely recovered within 2 yr after treatment. Standing forage crop increased by an average of 83%, compared to untreated areas, and livestock carrying capacity increased from 1 animal unit (AU)/13 ha to 1 AU/7 ha. Picloram (4-amino-3,5,6-trichloropicolinic acid), paraquat (1,1′-dimethyl-4,4′-bipyridinium ion), and paraquat plus atrazine [2-chloro-4-(ethylamino)-6-(isopropylamino)-s-triazine] applied in the spring were less effective than glyphosate. Canopy reductions of false broomweed 6 months after applications of 2.2 kg/ha of picloram, paraquat, or paraquat plus atrazine were equivalent to that from 1.1 kg/ha of glyphosate, and control with these herbicides was usually restricted to the season of application. Dicamba (3,6-dichloro-o-anisic acid), 2,4-D-[(2,4-dichlorophenoxy)acetic acid], atrazine, and 2,4-D plus atrazine were not effective when applied in the spring or fall. Time required for recovery of false broomweed canopy apparently varied with amounts of rainfall received after herbicide application.
The study aims to assess whether supplementation with the probiotic Lactobacillus rhamnosus HN001 (HN001) can reduce the prevalence of gestational diabetes mellitus (GDM). A double-blind, randomised, placebo-controlled parallel trial was conducted in New Zealand (NZ) (Wellington and Auckland). Pregnant women with a personal or partner history of atopic disease were randomised at 14–16 weeks’ gestation to receive HN001 (6×109 colony-forming units) (n 212) or placebo (n 211) daily. GDM at 24–30 weeks was assessed using the definition of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) (fasting plasma glucose ≥5·1 mmol/l, or 1 h post 75 g glucose level at ≥10 mmol/l or at 2 h ≥8·5 mmol/l) and NZ definition (fasting plasma glucose ≥5·5 mmol/l or 2 h post 75 g glucose at ≥9 mmol/l). All analyses were intention-to-treat. A total of 184 (87 %) women took HN001 and 189 (90 %) women took placebo. There was a trend towards lower relative rates (RR) of GDM (IADPSG definition) in the HN001 group, 0·59 (95 % CI 0·32, 1·08) (P=0·08). HN001 was associated with lower rates of GDM in women aged ≥35 years (RR 0·31; 95 % CI 0·12, 0·81, P=0·009) and women with a history of GDM (RR 0·00; 95 % CI 0·00, 0·66, P=0·004). These rates did not differ significantly from those of women without these characteristics. Using the NZ definition, GDM prevalence was significantly lower in the HN001 group, 2·1 % (95 % CI 0·6, 5·2), v. 6·5 % (95 % CI 3·5, 10·9) in the placebo group (P=0·03). HN001 supplementation from 14 to 16 weeks’ gestation may reduce GDM prevalence, particularly among older women and those with previous GDM.
Various types of sea-ice and snow-cover data are required for operational purposes in real time, for engineering assessments of associated hazards and for regional to global-scale modeling of the climate system. Data on the primary characteristics of ice and snow (extent, depth or thickness, and ice concentration) are becoming available to meet many present types of modeling requirement but secondary properties such as snow-water content, ridging intensity, open-water fraction and ice drift are less readily available.
Data for these major variables of snow and ice cover are considered with respect to problems encountered in obtaining and using digital information necessary for modern computer analyses. Such problems include the limitations of the basic observations (observational or sensor accuracy), the spatial and temporal resolution of different data sets, varying national practices of observing and reporting, and the problems of meshing data collected by different means and having spatial differences and temporal changes of observation time, site location, sensor system and resolution, etc. The relative reliability and climatic “information content” of some historical data sets are briefly examined and available digital data sets on modern global ice- and snow-cover conditions are described.
There has been an explosion of interest in mindfulness-based programs (MBPs) such as Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy. This is demonstrated in increased research, implementation of MBPs in healthcare, educational, criminal justice and workplace settings, and in mainstream interest. For the sustainable development of the field there is a need to articulate a definition of what an MBP is and what it is not. This paper provides a framework to define the essential characteristics of the family of MBPs originating from the parent program MBSR, and the processes which inform adaptations of MBPs for different populations or contexts. The framework addresses the essential characteristics of the program and of teacher. MBPs: are informed by theories and practices that draw from a confluence of contemplative traditions, science, and the major disciplines of medicine, psychology and education; underpinned by a model of human experience which addresses the causes of human distress and the pathways to relieving it; develop a new relationship with experience characterized by present moment focus, decentering and an approach orientation; catalyze the development of qualities such as joy, compassion, wisdom, equanimity and greater attentional, emotional and behavioral self-regulation, and engage participants in a sustained intensive training in mindfulness meditation practice, in an experiential inquiry-based learning process and in exercises to develop understanding. The paper's aim is to support clarity, which will in turn support the systematic development of MBP research, and the integrity of the field during the process of implementation in the mainstream.
The complicated time-dependent flow in the wake of a blunt based body at low speeds is a well known phenomenon, but drastic changes in the wake structure occur as speeds increase. Somewhere in the transonic regime, the periodic vortex shedding ceases, and at supersonic Mach numbers a steady flow pattern is established. The boundary layer on the body separates to form a free shear layer, the two layers from opposite sides of the body meeting at the so-called neck of the wake. Downstream of this point, the viscous wake persists for many hundreds of body diameters, and the term “far wake” is usually taken to refer to downstream distances greater than about ten body diameters. The neck of a hypersonic wake occurs typically one or two diameters from the base, and marks the downstream end of what is often known as the base flow region; this region includes a low speed, recirculating flow bounded by the shear layers and the base wall. Between the base and somewhere a few body diameters beyond the neck, the flow field is known as the near wake, and forms the subject of this survey.
The Cretaceous radiation of angiosperms initiated a major reorganization of terrestrial plant communities as dominance by pteridophytic and gymnospermic groups eventually gave way to dominance by angiosperms. Previously, patterns of biotic replacement have been assessed using measures based on taxonomic diversity data. However, using measures of both abundance and diversity to investigate replacement patterns provides more information about macroecological change in the fossil record than either can provide alone. Analyses of an updated and expanded database of North American palynological samples from Cretaceous sediments document a rapid increase in angiosperm diversity and abundance within individual fossil palynofloras (representing local/subregional vegetation). New analyses of floristic diversity patterns support previous results and indicate that the decline of free-sporing plants is more pronounced than the decline of gymnosperms. In contrast, analyses of abundance data appear to show that the decline of gymnosperms is far more pronounced than the decline of free-sporing plants. Detailed examination of both data sets segregated by paleolatitude shows that this apparent contradiction reflects biogeographical differences in the patterns of vegetational change (e.g., free-sporing plants declined in abundance at lower latitudes) as well as sampling bias (e.g., greater sampling in the northern region in the Late Cretaceous). Analyses accounting for these biases support the conclusion that as angiosperms radiated, free-sporing plants rather than gymnosperms (in this case, mainly conifers) experienced the most pronounced decline. A thorough understanding of the Cretaceous radiation of angiosperms will require both abundance and diversity data. It also will require expanding the analyses presented here into other geographic regions as well as sampling more completely at all spatial scales.
Fossil leaves and palynomorphs represent different phases of the plant life cycle, are studied as systematically independent entities, and are subject to different taphonomic, sampling, and recognition biases in the paleobotanical record. They thus provide parallel, and largely independent, documentation of long-term trends in land plant diversity, and the palynological record may be used as a comparative test of floristic trends inferred from macrofossil evidence. Analyses of relative “species” richness in 91 macrofossil and 860 palynomorph Cretaceous “floras” (assemblages) from between 25° and 65° N paleolatitude show a major mid-Cretaceous increase in the within-flora diversity of angiosperms, from near 0% prior to the Aptian (120 Ma) to 50–80% by the end of the Maastrichtian (65 Ma). This level of diversity is attained rapidly in macrofloras, but more slowly in palynofloras. In the latest Cretaceous, macrofloras and palynofloras both indicate that “pteridophytes,” conifers, and other “gymnosperms” are generally less diverse than angiosperms. In both data sets, “pteridophyte” diversity shows a clear decline through the Cretaceous, whereas conifer diversity shows no marked temporal trend. Broad congruence of these patterns, in spite of different biases in the macrofossil and palynomorph records, indicates that they provide a robust reflection of floristic trends through the Cretaceous. Nevertheless, discrepancies between the patterns do occur and underline the importance of complementary macrofossil and palynological analyses for accurate resolution of long-term vegetational change.
Observations of red giants in the Bulge globular cluster NGC 6273 with the Michigan/Magellan Fiber System (M2FS) mounted on the Nasmuth-East port of the Magellan-Clay 6.5-m telescope at the Las Campanas Observatory reveal a spread in metallicity. Members have been confirmed with radial velocity. NGC 6273 has at least two populations separated by 0.2-0.3 dex in [Fe/H]. The sodium and aluminum abundances are correlated while the magnesium and aluminum abundances are anti-correlated. The cluster also shows a rise in the abundance of the s-process element lanthanum with [Fe/H] similar to other massive clusters. The cluster contains a possible third population depleted in most elements by 0.3 dex.
The application of synchrotron radiation X-ray tomographic microscopy (SRXTM) to the study of mesofossils of Cretaceous age has created new possibilities for the three-dimensional visualization and analysis of the external and internal structure of critical plant fossil material. SRXTM provides cellular and subcellular resolution of comparable or higher quality to that obtained from permineralized material using thin sections or the peel technique. SRXTM also has the advantage of being non-destructive and results in the rapid acquisition of large quantities of data in digital form. SRXTM thus refocuses the effort of the investigator from physical preparation to the digital post-processing of X-ray tomographic data, which allows great flexibility in the reconstruction, visualization, and analysis of the internal and external structure of fossil material in multiple planes and in two or three dimensions. A review of recent applications in paleobotany demonstrates that SRXTM will dramatically expand the level of information available for diverse fossil plants. Future refinement of SRXTM approaches that further increases resolution and eases digital post-processing, will transform the study of mesofossils and create new possibilities for advancing paleobotanical knowledge. We illustrate these points using a variety of Cretaceous mesofossils, highlighting in particular those cases where SRXTM has been essential for resolving critical structural details that have enhanced systematic understanding and improved phylogenetic interpretations.
We exhibit an action of Conway’s group – the automorphism group of the Leech lattice – on a distinguished super vertex operator algebra, and we prove that the associated graded trace functions are normalized principal moduli, all having vanishing constant terms in their Fourier expansion. Thus we construct the natural analogue of the Frenkel–Lepowsky–Meurman moonshine module for Conway’s group. The super vertex operator algebra we consider admits a natural characterization, in direct analogy with that conjectured to hold for the moonshine module vertex operator algebra. It also admits a unique canonically twisted module, and the action of the Conway group naturally extends. We prove a special case of generalized moonshine for the Conway group, by showing that the graded trace functions arising from its action on the canonically twisted module are constant in the case of Leech lattice automorphisms with fixed points, and are principal moduli for genus-zero groups otherwise.
Sugarcane has been cultivated since at least 8000 B.C. (Barnes, p. 2) and today is grown throughout the world's tropical and subtropical regions. In Florida, sugarcane has been produced commercially since 1920 (Zepp). Before 1960, however, Florida sugar production was not significant; only three mills were in operation. With the ban on importation of Cuban sugar and the lifting of domestic sugarcane acreage restrictions in 1960, the industry grew rapidly.
Post-traumatic stress disorder (PTSD) in response to the World Trade Center (WTC) disaster of 11 September 2001 (9/11) is one of the most prevalent and persistent health conditions among both professional (e.g. police) and non-traditional (e.g. construction worker) WTC responders, even several years after 9/11. However, little is known about the dimensionality and natural course of WTC-related PTSD symptomatology in these populations.
Method
Data were analysed from 10 835 WTC responders, including 4035 police and 6800 non-traditional responders who were evaluated as part of the WTC Health Program, a clinic network in the New York area established by the National Institute for Occupational Safety and Health. Confirmatory factor analyses (CFAs) were used to evaluate structural models of PTSD symptom dimensionality; and autoregressive cross-lagged (ARCL) panel regressions were used to examine the prospective interrelationships among PTSD symptom clusters at 3, 6 and 8 years after 9/11.
Results
CFAs suggested that five stable symptom clusters best represent PTSD symptom dimensionality in both police and non-traditional WTC responders. This five-factor model was also invariant over time with respect to factor loadings and structural parameters, thereby demonstrating its longitudinal stability. ARCL panel regression analyses revealed that hyperarousal symptoms had a prominent role in predicting other symptom clusters of PTSD, with anxious arousal symptoms primarily driving re-experiencing symptoms, and dysphoric arousal symptoms primarily driving emotional numbing symptoms over time.
Conclusions
Results of this study suggest that disaster-related PTSD symptomatology in WTC responders is best represented by five symptom dimensions. Anxious arousal symptoms, which are characterized by hypervigilance and exaggerated startle, may primarily drive re-experiencing symptoms, while dysphoric arousal symptoms, which are characterized by sleep disturbance, irritability/anger and concentration difficulties, may primarily drive emotional numbing symptoms over time. These results underscore the importance of assessment, monitoring and early intervention of hyperarousal symptoms in WTC and other disaster responders.
In most countries, male pigs are physically castrated soon after birth to reduce the risk of boar taint and to avoid behaviours such as fighting and mounting. However, entire male pigs are more feed efficient and deposit less fat than barrows. In addition, many animal welfare organizations are lobbying for a cessation of castration, with a likelihood that this could lead to inferior pork unless an alternative method is used to control boar taint. An alternative to physical castration is immunization against gonadotrophin releasing factor (GnRF) which allows producers to capitalize on the superior feed efficiency and carcass characteristics of boars without the risk of boar taint. From a physiological perspective, immunized pigs are entire males until shortly after the second dose, typically given 4 to 6 weeks before slaughter. Following full immunization, there is a temporary suppression of testicular function and a hormonal status that resembles that of a barrow. Nutrient requirements will be different in these two phases, before and after full immunization. Given that there have been few published studies comparing the lysine requirements of entire males and barrows in contemporary genotypes, it is useful to use gilt requirements as a benchmark. A series of meta-analyses comparing anti-GnRF immunized boars and physical castrates and use of nutritional models suggest that the lysine requirement of entire males before the second immunization is 5% higher than for gilts, from 25 to 50 kg BW, and by 8% from 50 to 95 kg. Given that the penalty in growth performance for having inadequate dietary lysine is greater in males than in gilts or barrows, it is important to ensure that lysine requirements are met to obtain the maximum benefits of entire male production during this phase. After the second immunization, the lysine requirement of immunized males decreases and may become more like that of barrows. In addition, a consistent effect of full immunization is a marked increase in voluntary feed intake from about 10 days after the second dose. Putting these together, the estimated lysine requirement, expressed in terms of diet composition, falls to 94% of the gilt level. Although general principles can be described now, further research is needed to fully define the lysine requirements of immunized boars. It is important that the temporal pattern of tissue deposition rates and feed intake be explored to be incorporated into models to predict nutrient requirements over the period of rapidly changing metabolism.