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The decision to discontinue isolation in hospitalized patients with persistently positive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) molecular testing is nuanced. Improvement in clinical status should be evaluated with expert consultation when considering whether discontinuation of isolation is appropriate. The cycle threshold value may serve as a useful adjunct to this decision-making process.
The authors surveyed hospitals across the country on their policies regarding overlapping surgery, and found large variation between hospitals in how this practice is regulated. Specifically, institutions chose to define “critical portions” in a variety of ways, ultimately affecting not only surgical efficiency but also the autonomy of surgical trainees and patient experiences at these different hospitals.
We review experiments in the field of comparative politics that take questions related to gender and power as their central theme. We first document the rise of experimental and quasi-experimental methods in this area and discuss their many advantages. We then summarize the most common types of questions asked in this literature. These include, for instance, how women gain and use bargaining power within the home and the effects of increasing the number of women in politics. We also present three design challenges inherent to the experimental study of gender: (1) that adults’ attitudes on women’s place in society tend to change only very slowly, often making them impervious to short-term interventions, (2) that gender biases often operate in context-specific ways that can elude survey experimental measurement, and (3) that scholars often face ethical challenges when designing interventions intended to alter existing gender power hierarchies. We conclude by discussing emerging topics in the subfield, including work that examines how candidate gender affects vote choice in comparative perspective and research that considers how the content and salience of gender identity varies across individuals and contexts.
Debate on the use of lagged dependent variables has a long history in political science. The latest contribution to this discussion is Wilkins (2018, Political Science Research and Methods, 6, 393–411), which advocates the use of an ADL(2,1) model when there is serial dependence in the outcome and disturbance. While this specification does offer some insurance against serially correlated disturbances, this is never the best (linear unbiased estimator) approach and should not be pursued as a general strategy. First, this strategy is only appropriate when the data-generating process (DGP) actually implies a more parsimonious model. Second, when this is not the DGP—e.g., lags of the predictors have independent effects—this strategy mischaracterizes the dynamic process. We clarify this issue and detail a Wald test that can be used to evaluate the appropriateness of the Wilkins approach. In general, we argue that researchers need to always: (i) ensure models are dynamically complete and (ii) test whether more restrictive models are appropriate.
Are policy arguments more or less persuasive when they are made by female politicians? Using a diverse sample of American respondents, we conduct a survey experiment which randomly varies the gender associated with two co-partisan candidates across four policy debates. We find strong effects contingent on respondent partisanship and gender, most notably on the issue of access to birth control. On this issue, regardless of the candidate's stance, Democratic respondents, particularly Democratic men, are much more likely to agree with the female candidate. Conversely, Republican respondents, particularly Republican women, are much more likely to agree with the male candidate. We discuss the implications of our findings for the meaning of gender as a heuristic in a highly partisan environment.
Trypanosoma brucei is unusually reliant on mRNA-binding proteins to control mRNA fate, because its protein-coding genes lack individual promoters. We here focus on three trypanosome RNA-binding proteins. ZC3H22 is specific to Tsetse fly forms, RBP9 is preferentially expressed in bloodstream forms; and DRBD7 is constitutively expressed. Depletion of RBP9 or DRBD7 did not affect bloodstream-form trypanosome growth. ZC3H22 depletion from procyclic forms caused cell clumping, decreased expression of genes required for cell growth and proliferation, and increased expression of some epimastigote markers. Apart from decreases in mRNAs encoding enzymes of glucose metabolism, levels of most ZC3H22-bound transcripts were unaffected by ZC3H22 depletion. We compared ZC3H22, RBP9 and DRBD7 RNA binding with that of 16 other RNA-binding proteins. ZC3H22, PUF3 and ERBP1 show a preference for ribosomal protein mRNAs. RBP9 preferentially binds mRNAs that are more abundant in bloodstream forms than in procyclic forms. RBP9, ZC3H5, ZC3H30 and DRBD7 prefer mRNAs with long coding regions; UBP1-associated mRNAs have long 3′-untranslated regions; and RRM1 prefers mRNAs with long 3′or 5′-untranslated regions. We suggest that proteins that prefer long mRNAs may have relatively short or degenerate binding sites, and that preferences for A or U increase binding in untranslated regions.
Hypoactive sexual desire disorder (HSDD) is a common female sexual dysfunction and is estimated to affect approximately 10% of women in the United States. It has been suggested that HSDD is associated with an imbalance of hormone and neurotransmitter levels in the brain, resulting in decreased excitation, increased inhibition, or a combination of both. Evidence suggests neurotransmitters, including dopamine (DA), norepinephrine, and serotonin, as well as hormones such as estradiol and testosterone, contribute to female sexual desire and response. Current treatments for HSDD include psychotherapy, and two US Food and Drug Administration-approved medications for premenopausal women: flibanserin, a serotonin mixed agonist and antagonist, and bremelanotide, a melanocortin receptor (MCR) agonist. Melanocortins are endogenous neuropeptides associated with the excitatory pathway of the female sexual response system. MCRs are found throughout the body, including the brain. Bremelanotide is an MCR agonist that nonselectively activates several of the receptor subtypes, of which subtype 4 (MC4R) is the most relevant at therapeutic doses. MC4R is predominantly expressed in the medial preoptic area (mPOA) of the hypothalamus in the brain, and is important for female sexual function. Animal studies suggest that bremelanotide may affect female sexual desire by activating presynaptic MC4Rs on neurons in the mPOA of the hypothalamus, leading to increased release of DA, an excitatory neurotransmitter that increases sexual desire. This review presents what is known about the mechanism of action of bremelanotide in the context of treating HSDD.
Infants asymptomatically excrete Clostridioides difficile during their first year of life, suggesting that they may represent a source of infection for adults who acquire community-associated C. difficile infection (CA-CDI). The genetic relationship of C. difficile strains from asymptomatic infants and adults with CA-CDI is not well defined.
In this study, 50 infants were recruited at birth, and stool samples were collected at routine well-child visits. Adult stool samples collected during the same period and geographical area from patients who were diagnosed with CA-CDI were selected for comparison. C. difficile was cultivated and probed by PCR for toxin genes and were typed by PCR fluorescent ribotyping. Isolates from adults and infants with shared ribotypes were subjected to whole-genome sequencing (WGS).
Of these 50 infants, 36 were positive for C. difficile at least once in their first year of life, with a peak incidence at 6 months. Among 180 infant stool samples, 48 were positive. Of 48 isolates from positive stools, 29 were toxigenic by polymerase chain reaction (PCR) and 8 of 48 stool samples were positive for toxin by enzyme immunoassays (EIAs). Ribotypes F106 and F014-020 were present in both colonized infants and adults with CA-CDI. WGS identified 1 adult–infant pair that differed by 5 single-nucleotide polymorphisms (SNPs). Also, 4 additional adult–infant clusters differed by ≤16 SNPs.
Infants that are colonized with C. difficile share ribotypes with adults from the same geographical region with CA-CDI. Selected isolates in the 2 populations show a genetic relationship by WGS.
Cleaning mutualisms are important interactions on coral reefs. Intraspecific variation in cleaning rate and behaviour occurs geographically and is often attributed to local processes. However, our understanding of fine-scale variation is limited, but would allow us to control for geography and region-specific behavioural patterns. Here, we compare the cleaning activity of Pederson's cleaner shrimp (Ancylomenes pedersoni) on two neighbouring, yet ecologically dissimilar, reef systems in Honduras: Banco Capiro, an offshore bank close to significant land runoff with high coral cover but a depleted fish population, and an oligotrophic fringing reef around the island of Utila, with lower coral cover but high fish abundance and diversity. The proportion of realized to potential fish clientele was <60% at both sites, and the composition of clientele was neither reflective of the demographics of the resident assemblages at each site nor similar between sites. Parrotfishes represented 13–15% of total fish abundance at both sites yet accounted for >50% (Banco Capiro) and 10% (Utila) of all cleans. Conversely, the schoolmaster snapper (Lutjanus apodus) represented ~1% of total fish abundance at both sites yet accounted for 40% (Utila) and 1% (Banco Capiro) of all cleans. After standardizing our cleaning rate data by clientele abundance, we find that clientele at Banco Capiro engage in over four times as many cleaning encounters per hour with A. pedersoni than at Utila. Our study highlights the variable nature of coral reef cleaning interactions and the need to better understand the ecological and environmental drivers of this biogeographic variation.
This article presents the first meta-analysis documenting the extent of publication selection biases in stated preference estimates of the value of a statistical life (VSL). Stated preference studies fail to overcome the publication biases that affect much of the VSL literature. Such biases account for approximately 90% of the mean value of published VSL estimates in this subset of the literature. The bias is greatest for the largest estimates, possibly because the high-income labor market and stated preference estimates from the USA serve as an anchor for the VSL in other higher income countries. Estimates from lower-income countries exhibit less bias but remain unreliable for benefit-cost analysis. Unlike labor market estimates of the VSL, there is no evidence that any subsample of VSL estimates is free of significant publication selection biases. Although stated preference studies often provide the most readily accessible country-specific VSL estimates, a preferable approach to monetizing mortality risk benefits is to draw on income-adjusted estimates from labor market studies in the USA that use Census of Fatal Occupational Injuries risk data. These estimates lack publication selection effects as well as the limitations that are endemic to stated preference methods.
Copper is one of the six transition metals that have important biochemical roles in humans, particularly in catalysis and electron transport [1, 2]. Because it can exist in two redox states (Cu2+/Cu+), it can participate in redox reactions involving transfer of an electron, but if it builds up it can also generate potentially toxic reactive oxygen species by Fenton chemistry. Examples of copper in redox enzymes include: complex IV of the mitochondrial respiratory chain, copper–zinc superoxide dismutase, ceruloplasmin (ferroxidase), lysyl oxidase, dopamine beta-hydroxylase, and tyrosinase.
Lengthy debates over the process of secularization in the West have concluded. In many ways, secularization theorists appear to have “won” the debate: traditional measures of religious vitality reveal a decline in religion. Yet, recent events, especially those involving politics and national identity, have encouraged scholars and members of the public to reconsider the ways in which something like religion might endure and influence public life in secularized Western nations. This paper uses the “exceptional-typical” case of Iceland—a modern, Western, secularized country of comparatively small population size—to observe and conceptualize a variety of processes which are here collectively named “post-secularization.” Its findings suggest that processes which may appear as unrelated or opposing forces—the emergence of new religious movements, the transformation of traditional religious symbols into profane branding, far right nationalist movements—may be part of a single, post-secularization process. Secularization, having fissured the sacred, leaves religion a pliable cultural tool.
Prehospital intramuscular (IM) ketamine is increasingly used for chemical restraint of agitated patients. However, few studies have assessed emergency department (ED) follow-up of patients receiving prehospital ketamine for this indication, with previous reports suggesting a high rate of post-administration intubation. This study examines the rate of and reasons for intubation and other airway interventions in agitated patients who received ketamine by Emergency Medical Services (EMS).
This retrospective cohort study included patients who received prehospital ketamine for agitation and were transported to two community hospital EDs. Charts were reviewed for demographics, ketamine dose, and airway intervention by EMS or in the ED. Characteristics of patients who were intubated versus those who did not receive airway intervention were analyzed.
Over 28 months, 86 patients received ketamine for agitation. Fourteen (16.3%) underwent endotracheal intubation. Patients with a higher temperature and a lower Glasgow Coma Score (GCS) were more likely to require intubation. There was no age or dose-dependent association on intubation rate. Intubated patients averaged 39 years old versus 44 for patients not intubated (negative five-year difference; 95% CI, -16 to 6). The mean ketamine dose was 339.3mg in patients intubated versus 350.7mg in patients not (-11.4mg difference; 95% CI, -72.4 to 49.6). The mean weight-based ketamine dose was 4.44mg/kg in patients intubated versus 4.96mg/kg in patients not (-0.53mg/kg difference; 95% CI, -1.49 to 0.43).
The observed rate of intubation in patients receiving prehospital ketamine for agitation was 16.3%. Study data did not reveal an age or dose-dependent rate of intubation. Further research should be conducted to compare the airway intervention rate of agitated patients receiving ketamine versus other sedatives in a controlled fashion.
Poor post-prandial glucose control is a risk factor for multiple health conditions. The second-meal effect refers to the progressively improved glycaemic control with repeated feedings, an effect which is achievable with protein ingestion at the initial eating occasion. The most pronounced glycaemic response each day therefore typically occurs following breakfast, so the present study investigated whether ingesting protein during the night could improve glucose control at the first meal of the day. In a randomised crossover design, fifteen adults (seven males, eight females; age, 22 (sd 3) years; BMI, 24·0 (sd 2·8) kg/m2; fasting blood glucose, 4·9 (sd 0·5) mmol/l) woke at 04.00 (sd 1) hours to ingest 300 ml water with or without 63 g whey protein. Participants then completed a mixed-macronutrient meal tolerance test (1 g carbohydrate/kg body mass, 2356 (sd 435) kJ), 5 h 39 min following the nocturnal feeding. Nocturnal protein ingestion increased the glycaemic response (incremental AUC) to breakfast by 43·5 (sd 55·5) mmol × 120 min/l (P = 0·009, d = 0·94). Consistent with this effect, individual peak blood glucose concentrations were 0·6 (sd 1·0) mmol/l higher following breakfast when protein had been ingested (P = 0·049, d = 0·50). Immediately prior to breakfast, rates of lipid oxidation were 0·02 (sd 0·03) g/min higher (P = 0·045) in the protein condition, followed by an elevated post-prandial energy expenditure (0·38 (sd 0·50) kJ/min, P = 0·018). Post-prandial appetite and energy intake were similar between conditions. The present study reveals a paradoxical second-meal phenomenon whereby nocturnal whey protein feeding impaired subsequent glucose tolerance, whilst increasing post-prandial energy expenditure.
The objective of this study was to evaluate the effectiveness of a 911 trauma re-triage protocol implemented at a new community hospital in a region with a high volume of trauma and frequent transports by private vehicle.
This retrospective cohort study included all trauma patients ≥15 years old transferred via 911 trauma re-triage from a new community hospital over a 10-month period from August 2015 through April 2016. Criteria for 911 trauma re-triage were developed with input from local Emergency Medical Services (EMS) and trauma experts. An educational module, along with the criteria and implementation steps, was distributed to the emergency department (ED) personnel at the community hospital. Data were abstracted from the regional trauma registry, and the EMS patient care records were reviewed. Primary outcomes were: (1) median total transport time; and (2) proportion of patients who met the 911 re-triage criteria.
During the study period, 32 patients with traumatic injuries were transferred via 911 re-triage to the closest trauma center (TC). The median age of patients was 31 years (IQR 24-45 years) with 78% male and 66% suffering from a penetrating mechanism. The median prehospital provider scene time was 10 minutes (IQR 8-12 minutes) and transport time was seven minutes (IQR 6-9 minutes). Median total transport time was 17 minutes (IQR 15-20 minutes). Seventeen patients (53%) met 911 re-triage criteria as determined by study investigators. The most common criteria met was “penetrating injury to the head, neck, or torso” in 14 cases.
This study demonstrated that 911 re-triage was a feasible strategy to expeditiously transfer critical trauma patients to a TC within a mature trauma system in an urban-suburban setting with a median total transport time of 17 minutes.
Trypanosomes strongly rely on post-transcriptional mechanisms to control gene expression. Several Opisthokont Pumilio domain proteins are known to suppress expression when bound to mRNAs. The Trypanosoma brucei Pumilio domain protein PUF3 is a cytosolic mRNA-binding protein that suppresses expression when tethered to a reporter mRNA. RNA-binding studies showed that PUF3 preferentially binds to mRNAs with a classical Pumilio-domain recognition motif, UGUA[U/C]AUU. RNA-interference-mediated reduction of PUF3 in bloodstream forms caused a minor growth defect, but the transcriptome was not affected. Depletion of PUF3 also slightly delayed differentiation to the procyclic form. However, both PUF3 genes could be deleted in cultured bloodstream- and procyclic-form trypanosomes. Procyclic forms without PUF3 also grew somewhat slower than wild-type, but ectopic expression of C-terminally tagged PUF3 impaired their viability. PUF3 was not required for RBP10-induced differentiation of procyclic forms to bloodstream forms. Mass spectrometry revealed no PUF3 binding partners that might explain its suppressive activity. We conclude that PUF3 may have a role in fine-tuning gene expression. Since PUF3 is conserved in all Kinetoplastids, including those that do not infect vertebrates, we suggest that it might confer advantages within the invertebrate host.