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.
Describe the hemodynamic implications of anaesthetic choice among children with heart disease undergoing cardiac catheterisation.
Methods:
Study 1 was a secondary analysis of data obtained during catheterisation-based hemodynamic assessment of infants with hypoplastic left heart syndrome following Stage 1 palliation, randomised in the Single Ventricle Reconstruction trial. Measured and calculated hemodynamics including pulmonary and systemic vascular resistance indexed to body surface area (PVRi and SVRi respectively) and pulmonary/systemic blood flow (Qp/Qs) were analysed with respect to anaesthetic employed during catheterisation, classified as moderate sedation or general anaesthesia. Study 2 consisted of a single centre, prospective analysis of patients requiring percutaneous closure of a patent ductus arteriosus or endomyocardial biopsy after orthotopic heart transplant. Participants underwent hemodynamic assessment first using inhaled volatile anaesthesia (IA), and then transitioned to total intravenous anaesthesia, comparing hemodynamic measures with respect to anaesthetic approach.
Results:
In Study 1, independent of shunt type, PVRi, and patient size, moderate sedation was associated with a greater than two-fold odds of a Qp/Qs >1 (OR 2.12, 95%CI 1.18–3.87, p = 0.013). In Study 2, while PVRi was similar, SVRi was significantly higher using total intravenous anaesthesia. Among the patent ductus arteriosus subgroup, Qp/Qs increased significantly with a total intravenous anaesthesia relative to IA (p = 0.003); additionally, among the orthotopic heart transplant subgroup, left ventricular end diastolic pressure increased following a transition to total intravenous anaesthesia (p = 0.002).
Conclusions:
Analyses of hemodynamics during catheterisation support a significant impact of anaesthetic type on hemodynamic values including SVRi, left ventricular end diastolic pressure, and Qp/Qs. Anaesthesia choice and intraprocedural management of SVRi are important considerations when making clinical decisions based on hemodynamic data.
This study develops Markov Chain Monte Carlo (MCMC) estimation theory for the General Condorcet Model (GCM), an item response model for dichotomous response data which does not presume the analyst knows the correct answers to the test a priori (answer key). In addition to the answer key, respondent ability, guessing bias, and difficulty parameters are estimated. With respect to data-fit, the study compares between the possible GCM formulations, using MCMC-based methods for model assessment and model selection. Real data applications and a simulation study show that the GCM can accurately reconstruct the answer key from a small number of respondents.
To estimate population-based rates and to describe clinical characteristics of hospital-acquired (HA) influenza.
Design:
Cross-sectional study.
Setting:
US Influenza Hospitalization Surveillance Network (FluSurv-NET) during 2011–2012 through 2018–2019 seasons.
Methods:
Patients were identified through provider-initiated or facility-based testing. HA influenza was defined as a positive influenza test date and respiratory symptom onset >3 days after admission. Patients with positive test date >3 days after admission but missing respiratory symptom onset date were classified as possible HA influenza.
Results:
Among 94,158 influenza-associated hospitalizations, 353 (0.4%) had HA influenza. The overall adjusted rate of HA influenza was 0.4 per 100,000 persons. Among HA influenza cases, 50.7% were 65 years of age or older, and 52.0% of children and 95.7% of adults had underlying conditions; 44.9% overall had received influenza vaccine prior to hospitalization. Overall, 34.5% of HA cases received ICU care during hospitalization, 19.8% required mechanical ventilation, and 6.7% died. After including possible HA cases, prevalence among all influenza-associated hospitalizations increased to 1.3% and the adjusted rate increased to 1.5 per 100,000 persons.
Conclusions:
Over 8 seasons, rates of HA influenza were low but were likely underestimated because testing was not systematic. A high proportion of patients with HA influenza were unvaccinated and had severe outcomes. Annual influenza vaccination and implementation of robust hospital infection control measures may help to prevent HA influenza and its impacts on patient outcomes and the healthcare system.
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 new fossil site in a previously unexplored part of western Madagascar (the Beanka Protected Area) has yielded remains of many recently extinct vertebrates, including giant lemurs (Babakotia radofilai, Palaeopropithecus kelyus, Pachylemur sp., and Archaeolemur edwardsi), carnivores (Cryptoprocta spelea), the aardvark-like Plesiorycteropus sp., and giant ground cuckoos (Coua). Many of these represent considerable range extensions. Extant species that were extirpated from the region (e.g., Prolemur simus) are also present. Calibrated radiocarbon ages for 10 bones from extinct primates span the last three millennia. The largely undisturbed taphonomy of bone deposits supports the interpretation that many specimens fell in from a rock ledge above the entrance. Some primates and other mammals may have been prey items of avian predators, but human predation is also evident. Strontium isotope ratios (87Sr/86Sr) suggest that fossils were local to the area. Pottery sherds and bones of extinct and extant vertebrates with cut and chop marks indicate human activity in previous centuries. Scarcity of charcoal and human artifacts suggests only occasional visitation to the site by humans. The fossil assemblage from this site is unusual in that, while it contains many sloth lemurs, it lacks ratites, hippopotami, and crocodiles typical of nearly all other Holocene subfossil sites on Madagascar.
Despite attacks from the criminological, legal, and academic left, “broken windows” theory is a robust policy option in criminal justice practice and crime prevention. It has not only fueled the community policing movement, it has also informed the evolution of community courts, community prosecution, and community probation and parole. The Mid-town Manhattan Community Court, to give just one example, emphasizes broken windows’ ideas in its philosophy and practice. Moreover, the ideas embodied in broken windows have moved beyond criminal justice and criminology to areas like public health, education, parks, and business improvement districts (BIDs).
Giant foxtail, woolly cupgrass, and wild-proso millet infest millions of hectares of land devoted to corn production in the midwestern U.S. Control of these species and effects on corn grain yield were evaluated at various timings using POST applications of nicosulfuron vs. applications of various PRE herbicides at 17 locations across the midwestern U.S. in 1992 and 1993. Nicosulfuron applied to 5 to 10 cm giant foxtail and woolly cupgrass provided greater control than that observed with selected PRE herbicides. Giant foxtail control with nicosulfuron averaged 88%, and control of woolly cupgrass averaged 77% across all sites. Nicosulfuron, applied to 5 to 10 cm wild-proso millet, provided a level of control similar to that of selected PRE herbicides. Corn grain yield was greater when giant foxtail was controlled POST with nicosulfuron vs. PRE control with selected soil-applied herbicides. Corn grain yields were similar when nicosulfuron was applied POST to 5 to 10 cm woolly cupgrass or wild-proso millet vs. PRE control of these grass weeds. Across a broad range of geographical locations, nicosulfuron, applied POST to 5 to 10 cm tall grass, provided greater or similar levels of weed control vs. the selected PRE herbicides, with no deleterious effect on grain yield.
Midwest growers rely heavily on agrichemical retailers and crop consultants for making pest management decisions. A survey was mailed to 793 fertilizer and agricultural chemical dealers in Illinois to help understand their basis for pesticide recommendations, sources of information, and water quality concerns. Survey response rate was approximately 55%, and results indicated that agrichemical retailers use several sources of information, including manufacturers, universities, and company training programs. Newsletters and fact sheets were recognized as the most useful types of university resources, whereas videos were deemed the least useful. Product effectiveness was identified by 85% of the respondents as being the most important factor affecting pesticide selection. Soil erosion was listed as the greatest threat to water quality. Filter strips and best management practices were suggested as being the most likely to succeed in protecting water quality.
The final effort of the CLIMAP project was a study of the last interglaciation, a time of minimum ice volume some 122,000 yr ago coincident with the Substage 5e oxygen isotopic minimum. Based on detailed oxygen isotope analyses and biotic census counts in 52 cores across the world ocean, last interglacial sea-surface temperatures (SST) were compared with those today. There are small SST departures in the mid-latitude North Atlantic (warmer) and the Gulf of Mexico (cooler). The eastern boundary currents of the South Atlantic and Pacific oceans are marked by large SST anomalies in individual cores, but their interpretations are precluded by no-analog problems and by discordancies among estimates from different biotic groups. In general, the last interglacial ocean was not significantly different from the modern ocean. The relative sequencing of ice decay versus oceanic warming on the Stage 6/5 oxygen isotopic transition and of ice growth versus oceanic cooling on the Stage 5e/5d transition was also studied. In most of the Southern Hemisphere, the oceanic response marked by the biotic census counts preceded (led) the global ice-volume response marked by the oxygen-isotope signal by several thousand years. The reverse pattern is evident in the North Atlantic Ocean and the Gulf of Mexico, where the oceanic response lagged that of global ice volume by several thousand years. As a result, the very warm temperatures associated with the last interglaciation were regionally diachronous by several thousand years. These regional lead-lag relationships agree with those observed on other transitions and in long-term phase relationships; they cannot be explained simply as artifacts of bioturbational translations of the original signals.
Studies were conducted to evaluate weed management programs in nontransgenic, bromoxynil-resistant, and glyphosate-resistant cotton in nontilled and tilled environments. Tillage did not affect weed control provided by herbicides. Early-season stunting in nontilled cotton was 3% regardless of the herbicide system and was no longer evident at midseason. Cotton yield was 10 to 15% greater, on an average, under tilled conditions than that under nontilled conditions. Excellent (> 90%) common lambsquarters, entireleaf morningglory, ivyleaf morningglory, jimsonweed, pitted morningglory, prickly sida, tall morningglory, and velvetleaf control was achieved with treatments containing pyrithiobac, bromoxynil, and glyphosate. Preemergence (PRE) or postemergence-directed (PD) herbicide inputs were necessary for adequate large crabgrass and goosegrass control. Bromoxynil and pyrithiobac postemergence did not control sicklepod unless supplemented with MSMA and followed by a late-postdirected treatment of cyanazine plus MSMA. Treatments that included glyphosate controlled sicklepod regardless of the late-PD treatment. Economic returns were at least $930 ha−1 and not different from the higher yielding programs in nontransgenic cotton when fluometuron applied PRE was included in the bromoxynil programs. Late-season weed control was usually greater than 90% from glyphosate programs, and net returns from glyphosate programs were as high or higher than the net returns from programs that used midseason treatments of bromoxynil, pyrithiobac, or fluometuron plus MSMA.
Recent advances in functional neuroimaging (including positron emission tomography, single-photon emission tomography, and fast magnetic resonance imaging) have allowed better understanding of the brain regions involved in regulating normal and pathological moods. Repetitive transcranial magnetic stimulation (rTMS) has the ability to stimulate or temporarily impair brain regions, which makes it a powerful tool for directly testing theories of the neurologic basis of mood regulation.