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An alternative to an “all or none” approach to contact precautions for patients with MRSA carriage may be a “risk-tailored” approach – using gloves and gowns only for certain high-risk activities, locations, or roles.
Methods:
We distributed a discrete choice experiment to healthcare personnel (HCPs) in three cities. Respondents were presented with eight choice sets, each consisting of two hypothetical policy options for glove and gown use to prevent MRSA transmission. In each comparison, respondents selected their preferred option. Using mixed logit modeling we calculated utility derived from each policy component, probability of uptake for the most favored policies, and heterogeneity in preferences based on HCP role.
Results:
In total, 326 HCPs completed the survey. 237 (54%) respondents reported wearing gloves and gowns ‘all the time’ when required. Respondents’ preferred policy with the highest utility score was to use gloves and gown for all HCPs roles (utility, 0.17; 95% CI, 0.12 to 0.23), in high-risk settings (utility, 0.12; 95% CI 0.07–0.18), when touching the patient (utility, 0.11; 95% CI 0.06–0.17). Sixty-three percent (95% CI 60–66) would support a risk-tailored approach over an approach where contact precautions are used by all HCPs in all settings and for all activities. Support varied by HCP role (p < 0.02), with the strongest probability of support from physicians and advanced practice providers (77%, 95% CI 72%–82%) and the least support from environmental services personnel (45%, 95% CI 37%–53%).
Conclusions:
This discrete choice survey demonstrates that most HCPs prefer a risk-tailored approach to contact precautions when caring for patients with MRSA.
Foliar-applied postemergence applications of glufosinate are often applied to glufosinate-resistant crops to provide nonselective weed control without significant crop injury. Rainfall, air temperature, solar radiation, and relative humidity near the time of application have been reported to affect glufosinate efficacy. However, previous research may have not captured the full range of weather variability to which glufosinate may be exposed before or following application. Additionally, climate models suggest more extreme weather will become the norm, further expanding the weather range to which glufosinate can be exposed. The objective of this research was to quantify the probability of successful weed control (efficacy ≥85%) with glufosinate applied to some key weed species across a broad range of weather conditions. A database of >10,000 North American herbicide evaluation trials was used in this study. The database was filtered to include treatments with a single postemergence application of glufosinate applied to waterhemp [Amaranthus tuberculatus (Moq.) Sauer], morningglory species (Ipomoea spp.), and/or giant foxtail (Setaria faberi Herrm.) <15 cm in height. These species were chosen because they are well represented in the database and listed as common and troublesome weed species in both corn (Zea mays L.) and soybean [Glycine max (L.) Merr.] (Van Wychen 2020, 2022). Individual random forest models were created. Low rainfall (≤20 mm) over the 5 d before glufosinate application was detrimental to the probability of successful control of A. tuberculatus and S. faberi. Lower relative humidity (≤70%) and solar radiation (≤23 MJ m−1 d−1) on the day of application reduced the probability of successful weed control in most cases. Additionally, the probability of successful control decreased for all species when average air temperature over the first 5 d after application was ≤25 C. As climate continues to change and become more variable, the risk of unacceptable control of several common species with glufosinate is likely to increase.
Anxiety disorders and treatment-resistant major depressive disorder (TRD) are often comorbid. Studies suggest ketamine has anxiolytic and antidepressant properties.
Aims
To investigate if subcutaneous racemic ketamine, delivered twice weekly for 4 weeks, reduces anxiety in people with TRD.
Method
The Ketamine for Adult Depression Study was a multisite 4-week randomised, double-blind, active (midazolam)-controlled trial. The study initially used fixed low dose ketamine (0.5 mg/kg, cohort 1), before protocol revision to flexible, response-guided dosing (0.5–0.9 mg/kg, cohort 2). This secondary analysis assessed anxiety using the Hamilton Anxiety (HAM-A) scale (primary measure) and ‘inner tension’ item 3 of the Montgomery–Åsberg Depression Rating Scale (MADRS), at baseline, 4 weeks (end treatment) and 4 weeks after treatment end. Analyses of change in anxiety between ketamine and midazolam groups included all participants who received at least one treatment (n = 174), with a mixed effects repeated measures model used to assess the primary anxiety measure. The trial was registered at www.anzctr.org.au (ACTRN12616001096448).
Results
In cohort 1 (n = 68) the reduction in HAM-A score was not statistically significant: −1.4 (95% CI [−8.6, 3.2], P = 0.37), whereas a significant reduction was seen for cohort 2 (n = 106) of −4.0 (95% CI [−10.6, −1.9], P = 0.0058), favouring ketamine over midazolam. These effects were mediated by total MADRS and were not maintained at 4 weeks after treatment end. MADRS item 3 was also significantly reduced in cohort 2 (P = 0.026) but not cohort 1 (P = 0.96).
Conclusion
Ketamine reduces anxiety in people with TRD when administered subcutaneously in adequate doses.
Recent reports suggest the ON and OFF pathways are differentially susceptible to selective vision loss in glaucoma. Thus, perimetric assessment of ON- and OFF-pathway function may serve as a useful diagnostic. However, this necessitates a developed understanding of normal ON/OFF pathway function around the visual field and as a function of input intensity. Here, using electroencephalography, we measured ON- and OFF-pathway biased contrast response functions in the upper and lower visual fields. Using the steady-state visually evoked potential paradigm, we flickered achromatic luminance probes according to a saw-tooth waveform, the fast phase of which biased responses towards the ON or OFF pathways. Neural responses from the upper and lower visual fields were simultaneously measured using frequency tagging - probes in the upper visual field modulated at 3.75 Hz, while those in the lower visual field modulated at 3 Hz. We find that responses to OFF/decrements are larger than ON/increments, especially in the lower visual field. In the lower visual field, both ON and OFF responses were well described by a sigmoidal non-linearity. In the upper visual field, the ON pathway function was very similar to that of the lower, but the OFF pathway function showed reduced saturation and more cross-subject variability. Overall, this demonstrates that the relationship between the ON and OFF pathways depends on the visual field location and contrast level, potentially reflective of natural scene statistics.
Foliar-applied postemergence herbicides are a critical component of corn (Zea mays L.) and soybean [Glycine max (L.) Merr.] weed management programs in North America. Rainfall and air temperature around the time of application may affect the efficacy of herbicides applied postemergence in corn or soybean production fields. However, previous research utilized a limited number of site-years and may not capture the range of rainfall and air temperatures that these herbicides are exposed to throughout North America. The objective of this research was to model the probability of achieving successful weed control (≥85%) with commonly applied postemergence herbicides across a broad range of environments. A large database of more than 10,000 individual herbicide evaluation field trials conducted throughout North America was used in this study. The database was filtered to include only trials with a single postemergence application of fomesafen, glyphosate, mesotrione, or fomesafen + glyphosate. Waterhemp [Amaranthus tuberculatus (Moq.) Sauer], morningglory species (Ipomoea spp.), and giant foxtail (Setaria faberi Herrm.) were the weeds of focus. Separate random forest models were created for each weed species by herbicide combination. The probability of successful weed control deteriorated when the average air temperature within the first 10 d after application was <19 or >25 C for most of the herbicide by weed species models. Additionally, drier conditions before postemergence herbicide application reduced the probability of successful control for several of the herbicide by weed species models. As air temperatures increase and rainfall becomes more variable, weed control with many of the commonly used postemergence herbicides is likely to become less reliable.
We continue discussion of row operations to solve linear systems. In particular, we see how to characterise when a system has no solutions (is inconsistent) and, if consistent, we show how the method can be used to find all (possibly infinitely many) solutions, and to express these in vector notation. Here, the notion of the rank of the system, which determines the number of free parameters in the general solutions, is shown to be important. Continuing the earlier discussion of portfolios, we explain how the existence of an arbitrage portfolio is determined by the existence or otherwise of state prices.
We start the chapter with a mathematical model of how consumers might anticipate market trends and what effect this will have on the evolution of prices. This leads us to second-order differential equations. We then embark on describing how to solve linear constant-coefficient second-order differential equations. The general solution is the sum of the solution of a corresponding homogeneous equation and a particular solution. In an analogous way to the way in which second-order recurrence equations are solved, there is a general method for determining the solution of the homogeneous equation, involving the solution of a corresponding quadratic equation known as the auxiliary equation. We explain how to find particular solutions and how to use initial conditions. We also discuss the behaviour of the solutions obtained.
The derivative is introduced as an instantaneous rate of change and it is shown how this can be determined from first principles. Techniques (sum, product, quotient and composite function rules) are then explained and the connection with small changes is illustrated. Economic interpretations via marginals are given.
Elasticity of demand is introduced and it is shown how this characterises how revenue will change upon a price increase (the two distinct possibilities being represented by elastic and inelastic demand). Profit maximisation is considered in general, and it is shown that, when maximising profit, marginal revenue and marginal cost must be equal. Two very different cases are then studied: that in which the firm is a monopoly and that of perfect competition.
Optimisation of two-variable functions is motivated via the example of a firm producing two goods, where the concepts of complementary and substitute goods are discussed. The general idea of a critical point is discussed and it is explained that there can be different types of critical point: maxima, minima and saddle points. It is explained how the second partial derivatives may be used to determine what type of critical point one has. This is shown explicitly for the case in which the two-variable function is quadratic, and then stated in general. Examples involving profit-maximisation are given.
The determinant of a 2 × 2 and a 3 × 3 matrix are defined explicitly, and a more general way of (defining and) calculating determinants of larger matrices is described, involving the use of row operations to transform a matrix to upper-triangular form. It is then explained that a non-zero determinant is equivalent to invertibility. Cramer's rule is presented and a general method (based on the co-factor matrix) is given for inverting 3 × 3 matrices, an alternative to the row operations procedure described in .
Continuing from the previous chapter, this chapter explores the powerful applications of diagonalisation. We demonstrate first how it can be used to determine the powers of a matrix, which can then be applied to solve a coupled system of recurrence equations. An alternative approach to solving such systems also uses diagonalisation, but uses it to effect a change of variable so that the corresponding system in the new variables is much simpler to solve (and can then be used to revert to the solution in the original variables). We show how an analogous approach can be used to solve coupled systems of differential equations. This closing chapter provides an interesting link between the calculus and linear algebra aspects of the course.
This chapter involves the input--output model. Here, there are several goods under production, and some of each is needed to meet the production of the others, and there is also an external demand for each good. The model involves a matrix known as the technology matrix and a related matrix know as the Leontief matrix. It is shown how to solve such problems and it is explained that, in general (under very reasonable conditions), there always will be a solution. It is also shown how to approximate the solution using powers of the technology matrix.
This chapter studies the case of a small efficient firm in a perfectly competitive market. Breakeven and startup points are defined. Relationships between marginal cost, average cost and average variable cost at breakeven and startup points are investigated, and it is shown how to derive the supply set of such firms.
The chapter starts by discussing how we can determine the long-term qualitative behaviour of the solutions to second-order recurrence equations. In particular, in some cases, it can be seen that the solution is oscillatory. In the context of the multiplier-accelerator model, this corresponds to what are known as business cycles. The chapter concludes with an analysis of a dynamic macroeconomic model that is more realistic than the multiplier-accelerator one.