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We present a new experimental evidence of how framing affects decisions in the context of a lottery choice experiment for measuring risk aversion. We investigate framing effects by replicating the Holt and Laury's (Am. Econ. Rev. 92:1644-1655, 2002) procedure for measuring risk aversion under various frames. We first examine treatments where participants are confronted with the 10 decisions to be made either simultaneously or sequentially. The second treatment variable is the order of appearance of the ten lottery pairs. Probabilities of winning are ranked either in increasing, decreasing, or in random order. Lastly, payoffs were increased by a factor of ten in additional treatments. The rate of inconsistencies was significantly higher in sequential than in simultaneous treatment, in increasing and random than in decreasing treatment. Both experience and salient incentives induce a dramatic decrease in inconsistent behaviors. On the other hand, risk aversion was significantly higher in sequential than in simultaneous treatment, in decreasing and random than in increasing treatment, in high than in low payoff condition. These findings suggest that subjects use available information which has no value for normative theories, like throwing a glance at the whole connected set of pairwise choices before making each decision in a connected set of lottery pairs.
Flumioxazin and S-metolachlor are widely used in conventional sweetpotato production in North Carolina and other states; however, some growers have recently expressed concerns about potential effects of these herbicides on sweetpotato yield and quality. Previous research indicates that activated charcoal has the potential to reduce herbicide injury. Field studies were conducted in 2021 and 2022 to determine whether flumioxazin applied preplant and S-metolachlor applied before and after transplanting negatively affect sweetpotato yield and quality when activated charcoal is applied with transplant water. The studies evaluated five herbicide treatments and two activated charcoal treatments. Herbicide treatments included two flumioxazin rates, one S-metolachlor rate applied immediately before and immediately after transplanting, and no herbicide. Charcoal treatments consisted of activated charcoal applied at 9 kg ha−1, and no charcoal. No visual injury from herbicides or charcoal was observed. Likewise, no effect of herbicide or charcoal treatment on no. 1, marketable (sum of no. 1 and jumbo grades), or total yield (sum of canner, no. 1, and jumbo grades) was observed. Additionally, shape analysis conducted on calculated length-to-width ratio (LWR) for no. 1 sweetpotato roots found no effect from flumioxazin at either rate on sweetpotato root shape. However, both S-metolachlor treatments resulted in lower LWR of no. 1 sweetpotato roots in 2021. Results are consistent with prior research and indicate that flumioxazin and S-metolachlor are safe for continued use on sweetpotato at registered rates.
This chapter deals with methods of analgesia and anaesthesia for AVB. Previous chapters have discussed the decision-making processes underpinning which type of birth is required and where to perform it; this chapter details the various types of analgesia and anaesthesia used in different situations.
AVB can be undertaken either in the labour room or in theatre. Estimation of the likelihood of vaginal birth proving successful is pivotal to informing decision-making in terms of analgesic and anaesthetic requirements.
Greenhouse trials were conducted to determine the response of stevia to reduced-risk synthetic and nonsynthetic herbicides applied over-the-top post-transplant. In addition, field trials were conducted with stevia grown in a polyethylene mulch production system to determine crop response and weed control in planting holes to reduced-risk synthetic and nonsynthetic herbicides applied post-transplant directed. Treatments included caprylic acid plus capric acid, clove oil plus cinnamon oil, d-limonene, acetic acid (200 grain), citric acid, pelargonic acid, eugenol, ammonium nonanoate, and ammoniated soap of fatty acids. Stevia yield (dry aboveground biomass) in the greenhouse was reduced by all herbicide treatments. Citric acid and clove oil plus cinnamon oil were the least injurious, reducing yield by 16% to 20%, respectively. In field studies, d-limonene, pelargonic acid, ammonium nonanoate, and ammoniated soap of fatty acids controlled Palmer amaranth (>90% 1 wk after treatment (WAT). In field studies caprylic acid plus capric acid, pelargonic acid, and ammonium nonanoate caused >30% injury to stevia plants at 2 WAT, and d-limonene, citric acid, acetic acid, and ammoniated soap of fatty acids caused 18% to 25% injury 2 WAT. Clove oil plus cinnamon oil and eugenol caused <10% injury. Despite being injurious, herbicides applied in the field did not reduce yield compared to the nontreated check. Based upon yield data, these herbicides have potential for use in stevia; however, these products could delay harvest if applied to established stevia. In particular, clove oil plus cinnamon oil has potential for use for early-season weed management for organic production systems. The application of clove oil plus cinnamon oil over-the-top resulted in <10% injury 28 d after treatment (DAT) in the greenhouse and 3% injury 6 WAT postemergence-directed in the field. In addition, this treatment provided 95% control of Palmer amaranth 4 WAT.
Palmer amaranth (Amaranthus palmeri S. Watson) is the most problematic weed of cotton (Gossypium hirsutum L.)-cropping systems in the U.S. Southeast. Heavy reliance on herbicides has selected for resistance to multiple herbicide mechanisms of action. Effective management of this weed may require the integration of cultural practices that limit germination, establishment, and growth. Cover crops have been promoted as a cultural practice that targets these processes. We conducted a 2-yr study in Georgia, USA, to measure the effects of two annual cover crops (cereal rye [Secale cereale L.] and crimson clover [Trifolium incarnatum L.]), a perennial living mulch (‘Durana®’ white clover [Trifolium repens L.]), and a bare ground control on A. palmeri population dynamics. The study was conducted in the absence of herbicides. Growth stages were integrated into a basic demographic model to evaluate differences in population trajectories. Cereal rye and living mulch treatments suppressed weed seedling recruitment (seedlings seed−1) 19.2 and 13 times and 12 and 25 times more than the bare ground control, respectively. Low recruitment was correlated positively with low light transmission (photosynthetic active radiation: above canopy photosynthetically active radiation [PAR]/below cover crop PAR) at the soil surface. Low recruitment rates were also negatively correlated with high survival rates. Greater survival rates and reduced adult plant densities resulted in greater biomass (g plant−1) and fecundity (seeds plant−1) in cereal rye and living mulch treatments in both years. The annual rate of population change (seeds seed−1) was equivalent across all treatments in the first year but was greater in the living mulch treatment in the second year. Our results highlight the potential of annual cover crops and living mulches for suppressing A. palmeri seedling recruitment and would be valuable tools as part of an integrated weed management strategy.
Despite the increasing rates of carbapenem-resistant Acinetobacter baumannii (CRAB) carriage among hospitalized patients in endemic settings, the role of active surveillance cultures and cohorting is still debated. We sought to determine the long-term effect of a multifaceted infection-control intervention on the incidence of CRAB in an endemic setting.
Methods:
A prospective, quasi-experimental study was performed at a 670-bed, acute-care hospital. The study consisted of 4 phases. In phase I, basic infection control measures were used. In phase II, CRAB carriers were cohorted in a single ward with dedicated nursing and enhanced environmental cleaning. In phase III large-scale screening in high-risk units was implemented. Phase IV comprised a 15-month follow-up period.
Results:
During the baseline period, the mean incidence rate (IDR) of CRAB was 44 per 100,000 patient days (95% CI, 37.7–54.1). No significant decrease was observed during phase II (IDR, 40.8 per 100,000 patient days; 95% CI, 30.0–56.7; P = .97). During phase III, despite high compliance with control measures, ongoing transmission in several wards was observed and the mean IDR was 53.9 per 100,000 patient days (95% CI, 40.5–72.2; P = .55). In phase IV, following the implementation of large-scale screening, a significant decrease in the mean IDR was observed (25.8 per 100,000 patient days; 95% CI, 19.9–33.5; P = .03). An overall reduction of CRAB rate was observed between phase I and phase IV (rate ratio, 0.6; 95% CI, 0.4–0.9; P < .001).
Conclusions:
The comprehensive intervention that included intensified control measures with routine active screening cultures was effective in reducing the incidence of CRAB in an endemic hospital setting.
How do deported migrants engage in civic and political life after being forcibly returned to their home countries? Do experiences during the migration journey impact how deportees (re)engage? We explore how extortion experienced during migration alters political and civic engagement preferences. We utilize a multi-method approach combining original survey data of Guatemalans deported from the United States and a series of qualitative deportee interviews. We find that extortion during migration has a significant direct effect on increased citizen engagement. Economic hardship exacerbated by extortion may mediate this effect. Overall, extortion experienced while migrating has long-term financial consequences for deportees, with implications for their reintegration and the broader health of civic institutions in their home countries.
Field studies were conducted to assess the efficacy of physical weed management of Palmer amaranth management in cucumber, peanut, and sweetpotato. Treatments were arranged in a 3 × 4 factorial in which the first factor included a treatment method of electrical, mechanical, or hand-roguing Palmer amaranth control and the second factor consisted of treatments applied when Palmer amaranth was approximately 0.3, 0.6, 0.9, or 1.2 m above the crop canopy. Four wk after treatment (WAT), the electrical applications controlled Palmer amaranth at least 27 percentage points more than the mechanical applications when applied at the 0.3- and 0.6-m timings. At the 0.9- and 1.2-m application timings 4 WAT, electrical and mechanical applications controlled Palmer amaranth by at most 87%. Though hand removal generally resulted in the greatest peanut pod count and total sweetpotato yield, mechanical and electrical control resulted in similar yield to the hand-rogued plots, depending on the treatment timing. With additional research to provide insight into the optimal applications, there is potential for electrical control and mechanical control to be used as alternatives to hand removal. Additional studies were conducted to determine the effects of electrical treatments on Palmer amaranth seed production and viability. Treatments consisted of electricity applied to Palmer amaranth at first visible inflorescence, 2 wk after first visible inflorescence (WAI) or 4 WAI. Treatments at varying reproductive maturities did not reduce the seed production immediately after treatment. However, after treatment, plants primarily died and ceased maturation, reducing seed production assessed at 4 WAI by 93% and 70% when treated at 0 and 2 WAI, respectively. Treatments did not have a negative effect on germination or seedling length.
Concussion affects 1.2% of the population annually; rural regions and children have higher rates of concussion.
Methods:
Using administrative health care linked databases, all residents of Ontario with a physician diagnosed concussion were identified using ICD-9 code 850 or ICD-10 code S06. Cases were tracked for 2 years for concussion-related health care utilization with relevant specialist physicians (i.e., neurology, otolaryngology, physiatry, psychiatry, ophthalmology). Billing codes, specialist codes, and time from index to visit were analyzed. Factors associated with increased specialist visits were also examined.
Results:
In total, 1,022,588 cases were identified between 2008 and 2014 with 2 years of post-concussion health care utilization available. Follow-up by physician within 3 days of injury occurred in only 14% of cases. Mean time between ED diagnosis and follow-up by a physician was 83.9 days, whereas for rural regions it was >100 days. About half of adults (51.9%) and children (50.3%) had at least 1 specialist visit following concussion. Mean time between injury and first specialist visit was 203.8 (SD 192.9) days for adults, 213.5 (SD 201.0) days for rural adults, and 276.0 (SD 202.6) days for children. There were 67,420 neurology visits, 70,404 psychiatry visits, 13,571 neurosurgery visits, 19,780 physiatry visits, 101,788 ENT visits, and 103,417 ophthalmology visits in the 2 years tracking period. Factors associated with more specialist use included age > 18 years, urban residence, and pre-injury psychiatric history.
Conclusions:
There are discrepancies in post-concussion health care utilization based on age group and rural/urban residence. Addressing these risk factors could improve concussion care access.
While adult outcome in autism spectrum disorder (ASD) is generally measured using socially valued roles, it could also be understood in terms of aspects related to health status – an approach that could inform on potential gender differences.
Methods
We investigated gender differences in two aspects of outcome related to health-status, i.e. general functioning and self-perceived health status, and co-occurring health conditions in a large multi-center sample of autistic adults. Three hundred and eighty-three participants were consecutively recruited from the FondaMental Advanced Centers of Expertise for ASD cohort (a French network of seven expert centers) between 2013 and 2020. Evaluation included a medical interview, standardized scales for autism diagnosis, clinical and functional outcomes, self-perceived health status and verbal ability. Psychosocial function was measured using the Global Assessment of Functioning scale.
Results
While autistic women in this study were more likely than men to have socially valued roles, female gender was associated with poorer physical and mental health (e.g. a 7-fold risk for having three or more co-occurring physical health conditions) and a poorer self-perceived health status. Psychosocial function was negatively associated with depression and impairment in social communication. Half of the sample had multiple co-occurring health conditions but more than 70% reported that their visit at the Expert Center was their first contact with mental health services.
Conclusions
To improve objective and subjective aspects of health outcome, gender differences and a wide range of co-occurring health conditions should be taken into account when designing healthcare provision for autistic adults.
Ambulance patients who are unable to be quickly transferred to an emergency department (ED) bed represent a key contributing factor to ambulance offload delay (AOD). Emergency department crowding and associated AOD are exacerbated by multiple factors, including infectious disease outbreaks such as the coronavirus disease 2019 (COVID-19) pandemic. Initiatives to address AOD present an opportunity to streamline ambulance offload procedures while improving patient outcomes.
Study Objective:
The goal of this study was to evaluate the initial outcomes and impact of a novel Emergency Medical Service (EMS)-based Hospital Liaison Program (HLP) on ambulance offload times (AOTs).
Methods:
Ambulance offload times associated with EMS patients transported to a community hospital six months before and after HLP implementation were retrospectively analyzed using proportional significance tests, t-tests, and multiple regression analysis.
Results:
A proportional increase in incidents in the zero to <30 minutes time category after program implementation (+2.96%; P <.01) and a commensurate decrease in the proportion of incidents in the 30 to <60 minutes category (−2.65%; P <.01) were seen. The fully adjusted regression model showed AOT was 16.31% lower (P <.001) after HLP program implementation, holding all other variables constant.
Conclusion:
The HLP is an innovative initiative that constitutes a novel pathway for EMS and hospital systems to synergistically enhance ambulance offload procedures. The greatest effect was demonstrated in patients exhibiting potentially life-threatening symptoms, with a reduction of approximately three minutes. While small, this outcome was a statistically significant decrease from the pre-intervention period. Ultimately, the HLP represents an additional strategy to complement existing approaches to mitigate AOD.
Laboratory and greenhouse studies were conducted to evaluate the effects of chemical treatments applied to Palmer amaranth seeds or gynoecious plants that retain seeds to determine seed germination and quality. Treatments applied to physiologically mature Palmer amaranth seed included acifluorfen, dicamba, ethephon, flumioxazin, fomesafen, halosulfuron, linuron, metribuzin, oryzalin, pendimethalin, pyroxasulfone, S-metolachlor, saflufenacil, trifluralin, and 2,4-D plus crop oil concentrate applied at 1× and 2× the suggested use rates from the manufacturer. Germination was reduced by 20% when 2,4-D was used, 15% when dicamba was used, and 13% when halosulfuron and pyroxasulfone were used. Use of dicamba, ethephon, halosulfuron, oryzalin, trifluralin, and 2,4-D resulted in decreased seedling length by an average of at least 50%. Due to the observed effect of dicamba, ethephon, halosulfuron, oryzalin, trifluralin, and 2,4-D, these treatments were applied to gynoecious Palmer amaranth inflorescence at the 2× registered application rates to evaluate their effects on progeny seed. Dicamba use resulted in a 24% decrease in seed germination, whereas all other treatment results were similar to those of the control. Crush tests showed that seed viability was greater than 95%, thus dicamba did not have a strong effect on seed viability. No treatments applied to Palmer amaranth inflorescence affected average seedling length; therefore, chemical treatments did not affect the quality of seeds that germinated.
Field studies were conducted to evaluate linuron for POST control of Palmer amaranth in sweetpotato to minimize reliance on protoporphyrinogen oxidase (PPO)-inhibiting herbicides. Treatments were arranged in a two by four factorial in which the first factor consisted of two rates of linuron (420 and 700 g ai ha−1), and the second factor consisted of linuron applied alone or in combinations of linuron plus a nonionic surfactant (NIS; 0.5% vol/vol), linuron plus S-metolachlor (800 g ai ha−1), or linuron plus NIS plus S-metolachlor. In addition, S-metolachlor alone and nontreated weedy and weed-free checks were included for comparison. Treatments were applied to ‘Covington’ sweetpotato 8 d after transplanting (DAP). S-metolachlor alone provided poor Palmer amaranth control because emergence had occurred at applications. All treatments that included linuron resulted in at least 98% and 91% Palmer amaranth control 1 and 2 wk after treatment (WAT), respectively. Including NIS with linuron did not increase Palmer amaranth control compared to linuron alone, but it resulted in greater sweetpotato injury and subsequently decreased total sweetpotato yield by 25%. Including S-metolachlor with linuron resulted in the greatest Palmer amaranth control 4 WAT, but increased crop foliar injury to 36% 1 WAT compared to 17% foliar injury from linuron alone. Marketable and total sweetpotato yields were similar between linuron alone and linuron plus S-metolachlor or S-metolachlor plus NIS treatments, though all treatments resulted in at least 39% less total yield than the weed-free check resulting from herbicide injury and/or Palmer amaranth competition. Because of the excellent POST Palmer amaranth control from linuron 1 WAT, a system that includes linuron applied 7 DAP followed by S-metolachlor applied 14 DAP could help to extend residual Palmer amaranth control further into the critical period of weed control while minimizing sweetpotato injury.
Field studies were conducted in 2019 and 2020 to compare the effects of shade cloth light interception and Palmer amaranth (Amaranthus palmeri S. Watson) competition on ‘Covington’ sweetpotato [Ipomoea batatas (L.) Lam.]. Treatments consisted of a seven by two factorial arrangement, in which the first factor included shade cloth with an average measured light interception of 41%, 59%, 76%, and 94% and A. palmeri thinned to 0.6 or 3.1 plants m−2 or a nontreated weed-free check; and the second factor included shade cloth or A. palmeri removal timing at 6 or 10 wk after planting (WAP). Amaranthus palmeri light interception peaked around 710 to 840 growing degree days (base 10 C) (6 to 7 WAP) with a maximum light interception of 67% and 84% for the 0.6 and 3.1 plants m−2 densities, respectively. Increasing shade cloth light interception by 1% linearly increased yield loss by 1% for No. 1, jumbo, and total yield. Yield loss increased by 36%, 23%, and 35% as shade cloth removal was delayed from 6 to 10 WAP for No. 1, jumbo, and total yield, respectively. F-tests comparing reduced versus full models of yield loss provided no evidence that the presence of yield loss from A. palmeri light interception caused yield loss different than that explained by the shade cloth at similar light-interception levels. Results indicate that shade cloth structures could be used to simulate Covington sweetpotato yield loss from A. palmeri competition, and light interception could be used as a predictor for expected yield loss from A. palmeri competition.
The origin and stability of ground ice in the stable uplands of the McMurdo Dry Valleys remains poorly understood, with most studies focusing on the near-surface permafrost. The 2016 Friis Hills Drilling Project retrieved five cores reaching 50 m depth in mid-Miocene permafrost, a period when Antarctica transitioned to a hyper-arid environment. This study characterizes the cryostratigraphy of arguably the oldest permafrost on Earth and assesses 15 Myr of ground ice evolution using the REGO model. Four cryostratigraphic units were identified: 1) surficial dry permafrost (0–30 cm), 2) ice-rich to ice-poor permafrost (0.3–5.0 m) with high solute load and δ18O values (-16.2 ± 1.8‰) and low D-excess values (-65.6 ± 4.3‰), 3) near-dry permafrost (5–20 m) and 4) ice-poor to ice-rich permafrost (20–50 m) containing ice lenses with low solute load and δ18O values (-34.6 ± 1.2‰) and D-excess of 6.9 ± 2.6‰. The near-surface δ18O profile of ground ice is comparable to other sites in the stable uplands, suggesting that this ice is actively responding to changing surface environmental conditions and challenging the assumption that the surface has remained frozen for 13.8 Myr. The deep ice lenses probably originate from the freezing of meteoric water during the mid-Miocene, and their δ18O composition suggests mean annual air temperatures ~7–11°C warmer than today.
Endocrine conditions and diabetes (with the exception of type 2 diabetes) are associated in the minds of physicians with the early part of life: many thyroid disorders, especially primary hypothyroidism and Graves’ disease, present in people in their teens, 20s, and 30s. Pituitary tumors have usually been diagnosed in younger people, as a cardinal presenting symptom is menstrual abnormalities, especially amenorrhea.
Writing about the perfect fifths that begin the first movement of Beethoven's Ninth Symphony, Donald Francis Tovey made the following observation:
Half the musical miseducation in the world comes from people who know that the Ninth Symphony begins on the dominant of D minor, when the fact is that its opening bare fifth may mean anything within D major, D minor, A major, A minor, E major, E minor, C sharp minor, G major, C major, and F major … A true analysis takes the standpoint of a listener who knows nothing beforehand, but hears and remembers everything.
The Allegretto from Beethoven's Symphony no. 7 in A Major, op. 92 (1811–12), remains one of his most popular works—an instantaneous “hit” ever since its first public performance in Vienna's University Aula on December 8, 1813, evidenced by the audience's demand for an immediate encore. The same reaction greeted the Allegretto at its second performance, an event that took place one week later. The reasons for this movement's popularity are, it would seem, self-evident. To begin with, it is relatively short, clocking in at anywhere from approximately seven to ten minutes, depending on what tempo is chosen by the conductor. Its brevity alone is an especially interesting feature given the immense size of the movement that precedes it and those that follow. Its A-minor modality, beginning with a simple, but oddly unsettling, second-inversion chord in the winds, is followed by a staccato theme in the lower strings, with a rhythmic profile comprising dactyls and spondees. Together these create a hypnotic effect. The legato counter-theme, first introduced in measure 27 in the cellos, adds an attractive new element of seductive sensuality and exoticism, created in part by its Schleifer (grace-note slides) and the subtle chromatic inflections in the counter-theme's second half. Finally, the two contrasting episodes in A major bring a welcome contrasting element of lyricism, calm, and warmth. The unveiling of its opening theme with its monotone repeated notes on the dominant of the central tonality of A minor (E), unfolds as if to suggest that we are experiencing a theme and variations form. The movement's macrostructure ultimately presents itself as a five-part rondo, although it deviates slightly from the strict definition of the form.
Administration of antimicrobials to patients with asymptomatic bacteriuria (ASB) is a common error that can lead to worse outcomes. However, controlled analyses quantifying the commonality and impact of this practice are lacking. We analyzed the independent predictors for antimicrobials misuse in ASB and quantified the impact of this practice on clinical outcomes.
Design:
Retrospective case-control and cohort analyses for calendar year 2017.
Setting:
Tertiary-care, university-affiliated medical center.
Patients:
The study included adult (>18 years) patients with positive urine culture. Pregnant women, renal transplant recipients, and patients who underwent urologic procedures were excluded.
Methods:
ASB was determined according to US Centers for Disease Control and Prevention (CDC) criteria. Multivariable logistic regression models were constructed to analyze predictors and outcomes associated with antimicrobial use for patients with ASB.
Results:
The study included 1,530 patient-unique positive urine cultures. Among these patients, 610 patients (40%) were determined to have ASB. Of the 696 isolates, 219 (36%) were multidrug-resistant organisms (MDROs). Also, 178 (29%) patients received antimicrobials specifically due to the ASB. Independent predictors for improper administration of antimicrobials were dependent functional status (adjusted odds ratio [aOR], 2.3; 95% CI, 1.4–3.6) and male sex (aOR, 2; 95% CI, 1.25–2.6). Use of antimicrobials was independently associated with re-hospitalizations (aOR, 1.7; 95% CI, 1.1–2.6) and later, acute Clostridioides difficile infections (CDI) in the following 90 days (aOR, 4.5; 95% CI, 2–10.6).
Conclusions:
ASB is a common condition, frequently resulting from an MDRO. Male sex and poor functional status were independent predictors for mistreatment, and this practice was independently associated with rehospitalizations and CDI in the following 90 days.