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Proximal environments could facilitate smoking cessation among low-income smokers by making cessation appealing to strive for and tenable.
We sought to examine how home smoking rules and proximal environmental factors such as other household members' and peers' smoking behaviors and attitudes related to low-income smokers' past quit attempts, readiness, and self-efficacy to quit.
This analysis used data from Offering Proactive Treatment Intervention (OPT-IN) (randomized control trial of proactive tobacco cessation outreach) baseline survey, which was completed by 2,406 participants in 2011/12. We tested the associations between predictors (home smoking rules and proximal environmental factors) and outcomes (past-year quit attempts, readiness to quit, and quitting self-efficacy).
Smokers who lived in homes with more restrictive household smoking rules, and/or reported having ‘important others’ who would be supportive of their quitting, were more likely to report having made a quit attempt in the past year, had greater readiness to quit, and greater self-efficacy related to quitting.
Adjustments to proximal environments, including strengthening household smoking rules, might encourage cessation even if other household members are smokers.
Identifying routes of transmission among hospitalized patients during a healthcare-associated outbreak can be tedious, particularly among patients with complex hospital stays and multiple exposures. Data mining of the electronic health record (EHR) has the potential to rapidly identify common exposures among patients suspected of being part of an outbreak.
We retrospectively analyzed 9 hospital outbreaks that occurred during 2011–2016 and that had previously been characterized both according to transmission route and by molecular characterization of the bacterial isolates. We determined (1) the ability of data mining of the EHR to identify the correct route of transmission, (2) how early the correct route was identified during the timeline of the outbreak, and (3) how many cases in the outbreaks could have been prevented had the system been running in real time.
Correct routes were identified for all outbreaks at the second patient, except for one outbreak involving >1 transmission route that was detected at the eighth patient. Up to 40 or 34 infections (78% or 66% of possible preventable infections, respectively) could have been prevented if data mining had been implemented in real time, assuming the initiation of an effective intervention within 7 or 14 days of identification of the transmission route, respectively.
Data mining of the EHR was accurate for identifying routes of transmission among patients who were part of the outbreak. Prospective validation of this approach using routine whole-genome sequencing and data mining of the EHR for both outbreak detection and route attribution is ongoing.
Palmer amaranth is native to the United States, but was discovered in 2015 in Brazil. Palmer amaranth populations in Brazil were very difficult to control using glyphosate, which resulted in many changes to standard weed management practices. A genotyping assay was used to confirm that the population detected in Mato Grosso State, Brazil, was correctly identified as Palmer amaranth and that it was not tall waterhemp. Greenhouse dose–response curves and shikimate accumulation assays showed that the Brazilian population was highly resistant to glyphosate, with an LD50 value (3,982 g glyphosate ha−1) more than twice the typical use rates and very little shikimate accumulation at 1 mM glyphosate concentrations in a leaf-disk assay. The Brazilian population was also resistant to sulfonylurea and imidazolinone acetolactate synthase (ALS) inhibitor herbicides. The resistance mechanisms in the Brazilian population were identified as increased EPSPS gene copy number for glyphosate resistance (between 50- and 179-fold relative EPSPS gene copy number increase) and two different alleles for target-site mutations in the ALS gene (W574L and S653N). These results confirm the introduction of Palmer amaranth to Brazil using a genetic marker for species identification, as well as resistance to glyphosate and ALS inhibitors.
The middle B to the early F Main Sequence stars have some of the most quiet stellar atmospheres. In this part of the HR diagram we find stars with atmospheres in radiative equilibrium. They lack the convective circulations of the middle F and cooler stars and the massive stellar winds of hotter stars. When stars of different mass evolve off the Main Sequence in this part of the HR Diagram their evolutionary paths do not cross initially. Thus stars with the same effective temperature and surface gravity have the same luminosity and mass. By comparing their elemental abundances, we might be able to identify physical processes which cause any differences in their abundances. Here we begin with stars whose effective temperatures and surface gravities are similar, and which have been analyzed by us using spectra obtained from the Dominion Astrophysical Observatory (DAO). Improvements in our knowledge of the energy distributions of stars (for example via GAIA measurements) should lead to improved estimates of stellar effective temperatures and surface gravities.
We hypothesised that infants with ventricular dysfunction after cardiac surgery have impaired haemodynamic response to arginine–vasopressin therapy. We retrospectively reviewed the medical records of neonates and infants treated with arginine–vasopressin within 48 hours of corrective or palliative cardiac surgery who underwent echocardiographic assessment of ventricular function before initiation of therapy. Patients were classified as “responders” if their systolic blood pressure increased by ⩾10% without increase in catecholamine score or if it was maintained with decreased catecholamine score. Response was assessed 1 hour after maximum upward titration of arginine–vasopressin. A total of 36 children (15 neonates) were reviewed (17 male). The median (interquartile) age was 10.4 weeks (1.1–26.9), and the median weight was 4.3 kg (3.2–5.8). Diagnoses included single ventricle (eight), arch abnormalities (five), atrioventricular septal defect (four), double-outlet right ventricle (three), tetralogy of Fallot (three), and others (13). In all, 12 patients (33%) had ventricular dysfunction. Only 15 (42%) responded favourably according to our definition 1 hour after the “target” arginine–vasopressin dose was achieved. Ventricular dysfunction was not associated with poor response. The overall mortality was 25%, but mortality in patients with ventricular dysfunction was 42%. Favourable response was associated with shorter ICU stay (9.5 days versus 19.5 days, p=0.01). We conclude that arginine–vasopressin fails to increase blood pressure in ~50% of hypotensive children after cardiac surgery. The response rate does not increase with duration of therapy. Ventricular function does not predict haemodynamic response. The mortality in this group is very high. Prospective comparison of vasopressin with other vasoactive agents and/or inotropes is warranted.
Talmudic legislation prescribed penalty for a Jew to testify in a non-Jewish court, against a fellow Jew, to benefit a gentile - for breach of a duty of loyalty to a fellow Jew. Through close textual analysis, Saul Berman explores how Jewish jurists responded when this virtue of loyalty conflicted with values such as Justice, avoidance of desecration of God's Name, deterrence of crime, defence of self, protection of Jewish community, and the duty to adhere to Law of the Land. Essential for scholars and graduate students in Talmud, Jewish law and comparative law, this key volume details the nature of these loyalties as values within the Jewish legal system, and how the resolution of these conflicts was handled. Berman additionally explores why this issue has intensified in contemporary times and how the related area of 'Mesirah' has wrongfully come to be prominently associated with this law regulating testimony.