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The annual bluegrass weevil (ABW) is a pest of fine turfgrass, but recent research has found that withholding insecticides for ABW control can reduce annual bluegrass cover. The objective of this research was to evaluate threshold-based insecticide and paclobutrazol programs for annual bluegrass control. The effect of three insecticide programs (preventive, threshold, and no insecticide) and four rates of paclobutrazol (0, 70, 105, or 210 g ha−1 applied monthly) were evaluated. Replicate experiments were conducted from April to November in both 2018 and 2019 on a mixed creeping bentgrass and annual bluegrass fairway in North Brunswick, NJ. By the conclusion of both experiments, all paclobutrazol programs exhibited reduced annual bluegrass cover compared with the nontreated plots. In threshold and no-insecticide programs, reduction in annual bluegrass cover was enhanced by paclobutrazol applied at 105 g ha−1 in both years, and at 70 g ha−1 in the 2019 experiment. Paclobutrazol at 210 g ha−1 resulted in annual bluegrass cover of <20% regardless of insecticide program. In 2019, threshold-based ABW control without paclobutrazol provided similar annual bluegrass control as monthly applications of paclobutrazol at 70 and 105 g ha−1 with the preventive insecticide program. A reduction in turfgrass quality from threshold-based insecticide programs persisted for a shorter duration than the no-insecticide program, regardless of paclobutrazol treatment. Threshold-based ABW insecticide programs that allow ABW feeding damage to occur can result in reduced annual bluegrass cover. These reductions were further enhanced by paclobutrazol applications. The combination of threshold-level insecticide with moderate rates of paclobutrazol (70 to 105 g ha−1) provided reductions in annual bluegrass cover that were similar to the highest rate of paclobutrazol (210 g ha−1) without ABW damage. Turfgrass managers who integrate the threshold-level insecticide approach and monthly paclobutrazol applications may achieve greater annual bluegrass control than either strategy alone if temporary reductions in turf quality can be tolerated.
To determine the impact of an inpatient stewardship intervention targeting fluoroquinolone use on inpatient and postdischarge Clostridioides difficile infection (CDI).
Design:
We used an interrupted time series study design to evaluate the rate of hospital-onset CDI (HO-CDI), postdischarge CDI (PD-CDI) within 12 weeks, and inpatient fluoroquinolone use from 2 years prior to 1 year after a stewardship intervention.
Setting:
An academic healthcare system with 4 hospitals.
Patients:
All inpatients hospitalized between January 2017 and September 2020, excluding those discharged from locations caring for oncology, bone marrow transplant, or solid-organ transplant patients.
Intervention:
Introduction of electronic order sets designed to reduce inpatient fluoroquinolone prescribing.
Results:
Among 163,117 admissions, there were 683 cases of HO-CDI and 1,104 cases of PD-CDI. In the context of a 2% month-to-month decline starting in the preintervention period (P < .01), we observed a reduction in fluoroquinolone days of therapy per 1,000 patient days of 21% after the intervention (level change, P < .05). HO-CDI rates were stable throughout the study period. In contrast, we also detected a change in the trend of PD-CDI rates from a stable monthly rate in the preintervention period to a monthly decrease of 2.5% in the postintervention period (P < .01).
Conclusions:
Our systemwide intervention reduced inpatient fluoroquinolone use immediately, but not HO-CDI. However, a downward trend in PD-CDI occurred. Relying on outcome measures limited to the inpatient setting may not reflect the full impact of inpatient stewardship efforts.
Sleep problems in children with common psychiatric disorders present a considerable challenge for clinicians in developing effective diagnosis and treatment strategies. Whilst sleep-disordered breathing (SDB) and periodic leg movements in sleep (PLMS) are very frequent in children with attention-deficit/hyperactivity disorder (ADHD) which can deviate sleep architecture, their co-existence in Tic disorder (TD) and ADHD/TD co-morbidity is less well understood.
Objectives
To investigate the frequency of SDB and PLMS across children with ADHD, TD and ADHD/TD co-morbidity compared with healthy peers.
Aims
We asked whether and how the frequency of SDB and PLMS relates to sleep architecture.
Methods
Twenty-four children with ADHD, 21 with TD, 21 with ADHD/TD co-morbidity and 22 healthy controls underwent a two-night polysomnography supplemented by monitoring of apnea-hypopnea (AH) and PLMS events per hour of total sleep time.
Results
Compared with controls, only ADHD children displayed a significantly higher AH and PLMS indices. Yet correlation analyses showed significant and negative association between AH and PLMS indices and rapid eye movement (REM) sleep amount in all, the ADHD, the TD (Fig. 1), the co-morbid, and the control (Fig. 2) groups. No such associations with the other sleep stages were found for all the groups.
[Figure 1]
Conclusions
Our preliminary results suggest that
(1) presence of co-existing sleep-related disorders may partially explain the contradicting sleep results found so far in children with ADHD,
(2) high frequency of SDB and PLMS could be associated with REM sleep reduction regardless of psychopathology.
To determine the effect of an electronic medical record (EMR) nudge at reducing total and inappropriate orders testing for hospital-onset Clostridioides difficile infection (HO-CDI).
Design:
An interrupted time series analysis of HO-CDI orders 2 years before and 2 years after the implementation of an EMR intervention designed to reduce inappropriate HO-CDI testing. Orders for C. difficile testing were considered inappropriate if the patient had received a laxative or stool softener in the previous 24 hours.
Setting:
Four hospitals in an academic healthcare network.
Patients:
All patients with a C. difficile order after hospital day 3.
Intervention:
Orders for C. difficile testing in patients administered a laxative or stool softener in <24 hours triggered an EMR alert defaulting to cancellation of the order (“nudge”).
Results:
Of the 17,694 HO-CDI orders, 7% were inappropriate (8% prentervention vs 6% postintervention; P < .001). Monthly HO-CDI orders decreased by 21% postintervention (level-change rate ratio [RR], 0.79; 95% confidence interval [CI], 0.73–0.86), and the rate continued to decrease (postintervention trend change RR, 0.99; 95% CI, 0.98–1.00). The intervention was not associated with a level change in inappropriate HO-CDI orders (RR, 0.80; 95% CI, 0.61–1.05), but the postintervention inappropriate order rate decreased over time (RR, 0.95; 95% CI, 0.93–0.97).
Conclusion:
An EMR nudge to minimize inappropriate ordering for C. difficile was effective at reducing HO-CDI orders, and likely contributed to decreasing the inappropriate HO-CDI order rate after the intervention.
Activity of brown and beige adipocytes could contribute to breed differences in fat deposition. Therefore, we compared the abundance of markers for adipocyte types in steers from three cattle breeds differing in fat deposition (Japanese Black, Holstein, Charolais). Markers for white (leptin (LEP)), beige (transmembrane protein 26 (TMEM26), uncoupling protein 1 (UCP1)), and brown adipocytes (Zic family member 1 (ZIC1), UCP1) were analysed by quantitative reverse transcription PCR in subcutaneous fat (SCF), intramuscular fat (IMF), intermuscular fat (IRMF), perirenal fat (PF) and visceral fat (VF). LEP messenger RNA (mRNA) was less abundant in VF compared with other depots (P<0.05). TMEM26 was weakly but evenly expressed in all depots in all animals, whereas UCP1 mRNA showed higher individual variation in some depots. ZIC1 was not detectable in VF and PF but abundant in SCF, IMF and even more abundant in IRMF (P<0.05). No significant breed differences were detected. Using antibodies against UCP1, TMEM26 and ZIC1, we demonstrated that fat depots of 26-month-old cattle still comprise different adipocyte types. However, our results did not support the hypothesis that higher energy expenditure associated with higher abundance or activity of beige or brown adipocytes contributed to differences in fat deposition.
Making confident statements about the evolution of an ice-sheet–shelf system with a numerical model requires the capability to reproduce the migration of the grounding line. Here we show that the shallow-ice approximation/shallow-shelf approximation hybrid-type Parallel Ice Sheet Model (PISM), with its recent improvements, is capable of modeling the grounding line motion in a perturbed ice-sheet–shelf system. The model is set up according to the three-dimensional Marine Ice-Sheet Model Intercomparison Project (MISMIP3d), and simulations are carried out across a broad range of spatial resolutions. Using (1) a linear interpolation of the grounding line with locally interpolated basal friction and (2) an improved driving-stress computation across the grounding line, the reversibility of the grounding line (i.e. its retreat after an advance forced by a local perturbation of basal resistance) is captured by the model even at medium and low resolutions (∆x > 10 km). The transient model response is qualitatively similar to that of higher-order models but reveals a higher initial sensitivity to perturbations on very short timescales. Our findings support the application of PISM to the Antarctic ice sheet from regional up to continental scales and on relatively low spatial resolutions.
Direct numerical simulations of flows in cylinders subjected to both rapid rotation and axial precession are presented and analysed in the context of a stability theory based on the triadic resonance of Kelvin modes. For a case that was chosen to provide a finely tuned resonant instability with a small nutation angle, the simulations are in good agreement with the theory and previous experiments in terms of mode shapes and dynamics, including long-time-scale regularization of the flow and recurrent collapses. Cases not tuned to the most unstable triad, but with the nutation angle still small, are also in quite good agreement with theoretical predictions, showing that the presence of viscosity makes the physics of the triadic-resonance model robust to detuning. Finally, for a case with $45^{\circ }$ nutation angle for which it has been suggested that resonance does not occur, the simulations show that a slowly growing triadic resonance predicted by theory is in fact observed if sufficient evolution time is allowed.
The purpose of this study was to identify the clinical outcomes of ambulatory-treated Clostridium difficile infection (CDI) and risk factors associated with community-associated CDI (CA-CDI). Adult patients diagnosed with CDI in the institutional or ambulatory-care setting between 1 April 2005 and 30 April 2011, with no other CDI diagnosis in the previous 180 days, and who purchased an ambulatory, anti-CDI agent within 7 days of CDI diagnosis were included. A total of 1201 patients were included with 914 (76%) and 287 (24%) identified with CA-CDI and nosocomial CDI (N-CDI), respectively. Patients with N-CDI were more likely to have had a recurrent CDI (P = 0·043) and died from any cause (P < 0·001). Patients with CA-CDI were younger, healthier, and had fewer traditional risk factors compared to patients with N-CDI. To prevent CA-CDI, clinicians should be aware that patients at risk for CA-CDI are unique from those at risk for N-CDI.
Patients with attention deficit-hyperactivity disorder (ADHD) exhibit difficulties in multiple attentional functions. Although high heritability rates suggest a strong genetic impact, aetiological pathways from genes and environmental factors to the ADHD phenotype are not well understood. Tracking the time course of deviant task processing using event-related electrophysiological brain activity should characterize the impact of familiality on the sequence of cognitive functions from preparation to response control in ADHD.
Method
Preparation and response control were assessed using behavioural and electrophysiological parameters of two versions of a cued continuous performance test with varying attentional load in boys with ADHD combined type (n = 97), their non-affected siblings (n = 27) and control children without a family history of ADHD (n = 43).
Results
Children with ADHD and non-affected siblings showed more variable performance and made more omission errors than controls. The preparatory Cue-P3 and contingent negative variation (CNV) following cues were reduced in both ADHD children and their non-affected siblings compared with controls. The NoGo-P3 was diminished in ADHD compared with controls whilst non-affected siblings were located intermediate but did not differ from both other groups. No clear familiality effects were found for the Go-P3. Better task performance was further associated with higher CNV and P3 amplitudes.
Conclusions
Impairments in performance and electrophysiological parameters reflecting preparatory processes and to some extend also for inhibitory response control, especially under high attentional load, appeared to be familially driven in ADHD and may thus constitute functionally relevant endophenotypes for the disorder.
National and international policies have encouraged the establishment of a representative network of marine protected areas (MPAs) in South Africa, with the aim of protecting marine biodiversity. The extent to which these marine and estuarine protected areas (EPAs) represent marine fish species and communities was assessed by comparing their species compositions with those of exploited areas, as sampled using four fishing techniques. Seven hundred fish species were sampled, representing one-third of South Africa's marine fishes. MPAs in coastal habitats scored c. 40% on the Bray-Curtis measure of similarity for species representativeness, but this score declined markedly for offshore ‘trawlable’ fishing grounds. The combined effects of sampling error, temporal variation and the effects of fishing on relative abundance suggest that 80% similarity would be the maximum achieveable. Forty-nine per cent of all fish species that were recorded were found in the 14 MPAs sampled. Redundancy in the MPA network was low, with fish species most commonly being represented in only one MPA or absent. There was greater redundancy in the 33 EPAs, with 40% of species being found in two or more EPAs, but many of these estuaries were adjacent to each other and embedded in large MPAs. Deep water fish communities (>80 m deep) and communities located on the west and south-east coasts of South Africa were most poorly represented by MPAs. Routine fishery surveys provide a robust and repeatable opportunity to assess species representativeness in MPAs, and the method used could form the basis of an operational definition of ‘representative’. In contrast to an assessment based on presence-absence data, this analysis of quantitative data presents a more pessimistic assessment of protection.