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Many preoperative urine cultures are of low value and may even lead to patient harms. This study sought to understand practices around ordering preoperative urine cultures and prescribing antibiotic treatment.
We interviewed participants using a qualitative semi-structured interview guide. Collected data was coded inductively and with the Dual Process Model (DPM) using MAXQDA software. Data in the “Testing Decision-Making” code was further reviewed using the concept of perceived risk as a sensitizing concept.
Results:
We identified themes relating to surgeons’ concerns about de-implementing preoperative urine cultures to detect asymptomatic bacteriuria (ASB) in patients undergoing non-urological procedures: (1) anxiety and uncertainty surrounding missing infection signs spanned surgical specialties, (2) there were perceived risks of negative consequences associated with omitting urine cultures and treatment prior to specific procedure sites and types, and additionally, (3) participants suggested potential routes for adjusting these perceived risks to facilitate de-implementation acceptance. Notably, participants suggested that leadership support and peer engagement could help improve surgeon buy-in.
Conclusions:
Concerns about perceived risks sometimes outweigh the evidence against routine preoperative urine cultures to detect ASB. Evidence from trusted peers may improve openness to de-implementing preoperative urine cultures.
We present a systematic search for radio counterparts of novae using the Australian Square Kilometer Array Pathfinder (ASKAP). Our search used the Rapid ASKAP Continuum Survey, which covered the entire sky south of declination $+41^{\circ}$ ($\sim$$34000$ square degrees) at a central frequency of 887.5 MHz, the Variables and Slow Transients Pilot Survey, which covered $\sim$$5000$ square degrees per epoch (887.5 MHz), and other ASKAP pilot surveys, which covered $\sim$200–2000 square degrees with 2–12 h integration times. We crossmatched radio sources found in these surveys over a two–year period, from 2019 April to 2021 August, with 440 previously identified optical novae, and found radio counterparts for four novae: V5668 Sgr, V1369 Cen, YZ Ret, and RR Tel. Follow-up observations with the Australian Telescope Compact Array confirm the ejecta thinning across all observed bands with spectral analysis indicative of synchrotron emission in V1369 Cen and YZ Ret. Our light-curve fit with the Hubble Flow model yields a value of $1.65\pm 0.17 \times 10^{-4} \rm \:M_\odot$ for the mass ejected in V1369 Cen. We also derive a peak surface brightness temperature of $250\pm80$ K for YZ Ret. Using Hubble Flow model simulated radio lightcurves for novae, we demonstrate that with a 5$\sigma$ sensitivity limit of 1.5 mJy in 15-min survey observations, we can detect radio emission up to a distance of 4 kpc if ejecta mass is in the range $10^{-3}\rm \:M_\odot$, and upto 1 kpc if ejecta mass is in the range $10^{-5}$–$10^{-3}\rm \:M_\odot$. Our study highlights ASKAP’s ability to contribute to future radio observations for novae within a distance of 1 kpc hosted on white dwarfs with masses $0.4$–$1.25\:\rm M_\odot$, and within a distance of 4 kpc hosted on white dwarfs with masses $0.4$–$1.0\:\rm M_\odot$.
Double-cropping winter rye cover crops (CC) with soybean in the North Central US could help with the global effort to sustainably intensify agriculture. Studies addressing the management of these systems are limited. Therefore, a field study was conducted from 2017 to 2019 in Central Iowa, US to evaluate winter rye CC biomass production, aboveground N accumulation, estimated economics, estimated within-field energy balance and estimated greenhouse gas (GHG) emissions under three N application rates (0, 60, 120 kg N ha−1) and three planting methods (pre- and post-harvest broadcast and post-harvest drilling). Averaged over N rates, all planting methods resulted in >5.0 Mg ha−1 year−1 rye aboveground biomass dry matter. Averaged over the 2-year study and compared with unfertilized treatments, applying 60 kg N ha−1 produced 1.1 Mg ha−1 more aboveground biomass (6.1 vs 5.0 Mg ha−1), accumulated 30 kg ha−1 more N in aboveground biomass (88 vs 58 kg N ha−1), and led to 20 GJ ha−1 more net energy. Biomass production was not significantly higher with 120 kg N ha−1 compared with the 60 kg N ha−1 rate. Even when accounting for an estimated 0.75 Mg ha−1 of above ground rye biomass left in the field after harvesting, more N was removed than applied at the 60 kg N ha−1 rate. The minimum rye prices over the 2-year study needed for double-cropping winter rye CC to be profitable (breakeven prices) averaged $117 and $104 Mg−1 for the 0 and 60 kg N ha−1 rates, which factors in estimated soybean yield reductions in 2019 compared with local averages but not off-site transportation. GHG emissions were estimated to increase approximately threefold between the unfertilized and 60 kg N ha−1 rates without considering bioenergy offsets. While environmental tradeoffs need further study, results suggest harvesting fertilized rye CC biomass before planting soybean is a promising practice for the North Central US to maximize total crop and net energy production.
The Variables and Slow Transients Survey (VAST) on the Australian Square Kilometre Array Pathfinder (ASKAP) is designed to detect highly variable and transient radio sources on timescales from 5 s to
$\sim\!5$
yr. In this paper, we present the survey description, observation strategy and initial results from the VAST Phase I Pilot Survey. This pilot survey consists of
$\sim\!162$
h of observations conducted at a central frequency of 888 MHz between 2019 August and 2020 August, with a typical rms sensitivity of
$0.24\ \mathrm{mJy\ beam}^{-1}$
and angular resolution of
$12-20$
arcseconds. There are 113 fields, each of which was observed for 12 min integration time, with between 5 and 13 repeats, with cadences between 1 day and 8 months. The total area of the pilot survey footprint is 5 131 square degrees, covering six distinct regions of the sky. An initial search of two of these regions, totalling 1 646 square degrees, revealed 28 highly variable and/or transient sources. Seven of these are known pulsars, including the millisecond pulsar J2039–5617. Another seven are stars, four of which have no previously reported radio detection (SCR J0533–4257, LEHPM 2-783, UCAC3 89–412162 and 2MASS J22414436–6119311). Of the remaining 14 sources, two are active galactic nuclei, six are associated with galaxies and the other six have no multi-wavelength counterparts and are yet to be identified.
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.
The Rapid ASKAP Continuum Survey (RACS) is the first large-area survey to be conducted with the full 36-antenna Australian Square Kilometre Array Pathfinder (ASKAP) telescope. RACS will provide a shallow model of the ASKAP sky that will aid the calibration of future deep ASKAP surveys. RACS will cover the whole sky visible from the ASKAP site in Western Australia and will cover the full ASKAP band of 700–1800 MHz. The RACS images are generally deeper than the existing NRAO VLA Sky Survey and Sydney University Molonglo Sky Survey radio surveys and have better spatial resolution. All RACS survey products will be public, including radio images (with
$\sim$
15 arcsec resolution) and catalogues of about three million source components with spectral index and polarisation information. In this paper, we present a description of the RACS survey and the first data release of 903 images covering the sky south of declination
$+41^\circ$
made over a 288-MHz band centred at 887.5 MHz.
For the conduct of controlled clinical trials, epidemiologic surveys or even of medical practice of varieties of peripheral neuropathy, the usefulness, error rate and cost-effectiveness of scannable case-report forms has not been studied. Materials and
Methods:
The overall performance, the frequency of the problems identified and corrected, and the time saved from use of a standard paper case report form was evaluated in multicenter treatment trials, single center epidemiologic surveys and in our neurologic practice. The paper case report form (Clinical Neuropathy Assessment [CNA]) for pen entry at study medical centers for patient, disease and demographic information (Lower Limb Function [LLF] and Neuropathy Impairment Score [NIS]) can be faxed to a core Reading and Quality Assurance Center where the form and data is electronically and interactively evaluated and corrected, if needed, by participating medical centers before electronic entry into database.
Observations and conclusions:
1) The approach provides a standard, scannable paper case report form for pen entry of neuropathy symptoms, impairments and disability at the bedside or in the office which is retained as a source document at the participating medical center but a facsimile can be transferred instantaneously, its data can be programmed, interactively evaluated, modified and stored while maintaining an audit trail; 2) it allowed efficient and accurate reading, transfer, analysis, and storage of data of more than 15,000 forms used in multicenter trials; 3) in 500 consecutive CNA evaluations, software programs identified and facilitated interactive corrections of omissions, discrepancies, and disease and study inconsistencies, introducing only a few readily identified and corrected entry errors; and 4) use of programmed, as compared to non-programmed assessment, was more accurate than double keyboard entry of data and was approximately five times faster.
Human campylobacteriosis exhibits a distinctive seasonality in temperate regions. This paper aims to identify the origins of this seasonality. Clinical isolates [typed by multi-locus sequence typing (MLST)] and epidemiological data were collected from Scotland. Young rural children were found to have an increased burden of disease in the late spring due to strains of non-chicken origin (e.g. ruminant and wild bird strains from environmental sources). In contrast the adult population had an extended summer peak associated with chicken strains. Travel abroad and UK mainland travel were associated with up to 17% and 18% of cases, respectively. International strains were associated with chicken, had a higher diversity than indigenous strains and a different spectrum of MLST types representative of these countries. Integrating empirical epidemiology and molecular subtyping can successfully elucidate the seasonal components of human campylobacteriosis. The findings will enable public health officials to focus strategies to reduce the disease burden.
Listronotus montanus (Dietz) is a little known species, distributed in central North America. O'Brien and Wibmer (1982) record its occurrence from Indiana west to Nevada and north to the Prairie Provinces. In Montana, it occurs widely in grasslands east of the Continental Divide (Montana Entomological Collection, unpublished), but is also recorded from Saunders Co. in western Montana (Russell 1968). Nothing has been reported on the biology of this species, but it has been observed on grasses in the Cypress Hills of Alberta (CWOB unpublished). We report the occurrence of this species as a potential pest of small grains.
This Summary for Policymakers presents key findings from the Special Report on Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation (SREX). The SREX approaches the topic by assessing the scientific literature on issues that range from the relationship between climate change and extreme weather and climate events (‘climate extremes’) to the implications of these events for society and sustainable development. The assessment concerns the interaction of climatic, environmental, and human factors that can lead to impacts and disasters, options for managing the risks posed by impacts and disasters, and the important role that non-climatic factors play in determining impacts. Box SPM.1 defines concepts central to the SREX.
The character and severity of impacts from climate extremes depend not only on the extremes themselves but also on exposure and vulnerability. In this report, adverse impacts are considered disasters when they produce widespread damage and cause severe alterations in the normal functioning of communities or societies. Climate extremes, exposure, and vulnerability are influenced by a wide range of factors, including anthropogenic climate change, natural climate variability, and socioeconomic development (Figure SPM.1). Disaster risk management and adaptation to climate change focus on reducing exposure and vulnerability and increasing resilience to the potential adverse impacts of climate extremes, even though risks cannot fully be eliminated (Figure SPM.2). Although mitigation of climate change is not the focus of this report, adaptation and mitigation can complement each other and together can significantly reduce the risks of climate change. [SYR AR4, 5.3]
A major challenge for scanned probe microscopy is to identify structures and chemical species on a surface, which have not already been inferred from other analytical techniques. Progress is impeded by the fact that in general the structure and composition of the tip atom is not known. To illustrate some of the issues involved, we report simultaneous scanning tunneling microscopy/atomic force microscopy (STM/AFM) of the TiO2 (110) surface. The use of small amplitudes enabled the simultaneous acquisition of force gradient and barrier height images during standard STM imaging. Surprisingly, we find most STM images exhibit a corrugation contrast inverse to that usually reported in the literature. However, regardless of the contrast in STM, force gradient images always showed greater attraction over O rows. Barrier height images also show this consistency, always being greater over O rows. This supports the theoretical model of the electronic structure of the surface, but shows that the tip structure and interaction cannot be ignored in modeling STM images. We conclude that there is a fine balance between topography and local density of states (LDOS) in STM imaging of this surface; which of them dominates the STM image is determined by the tip. Simultaneous multi-parameter imaging is useful in interpreting images reliably, particularly on multi-component surfaces.
By
Karen W. L. Yee, Department of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, ON, Canada,
Susan M. O'Brien, Hematopathology and Oncology Department, Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, USA
Chronic lymphocytic leukemia (CLL) is the most common form of leukemia in adults in the Western world, accounting for nearly 25% of all leukemias with an estimated annual age-adjusted incidence of 3 per 100,000 persons in the United States. The median age at diagnosis is approximately 70 years, with 81% of the patients diagnosed when aged ≥ 60 years. Under the World Health Organization (WHO) classification, CLL is a B-cell neoplasm and the entity T-cell CLL has been reclassified as T-cell prolymphocytic leukemia (PLL). Recent data from the Surveillance, Epidemiology, and End Results (SEER) cancer statistics indicate that 5-year survival of patients with CLL is 73%.
Significant changes in the understanding and management of CLL have occurred in the last two decades. With the advent of newer treatment modalities, such as purine analogs and monoclonal antibodies, substantial improvements have been made in achieving complete responses (CR), with a proportion achieving molecular remissions and durable responses. Despite the advances in the treatment of patients with CLL, the majority of patients will relapse after primary therapy.
Diagnosis
The current diagnosis of CLL is based on minor modifications of the criteria originally proposed by the National Cancer Institute (NCI) (Table 5.1). A bone marrow evaluation is no longer required for diagnosis but is useful to determine the extent and pattern of involvement and to clarify the etiology of cytopenias.
The morphology and immunophenotype are adequate for diagnosis and to distinguish CLL from other disorders (Table 5.2).