To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The stereotype of people with autism as unresponsive or uninterested in other people was prominent in the 1980s. However, this view of autism has steadily given way to recognition of important individual differences in the social-emotional development of affected people and a more precise understanding of the possible role social motivation has in their early development.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
Herbicide-resistant weeds are a growing concern globally; in response, new herbicide resistance traits are being inserted into crops. Isoxaflutole-resistant soybean [Glycine max (L.) Merr.] will provide a new mode of action for use in this crop. Ten experiments were conducted over a 2-yr period (2017, 2018) to determine herbicide interactions between isoxaflutole and metribuzin on soybean injury, weed control efficacy, and soybean yield on a range of soil types. Soybean leaf-bleaching injury caused by isoxaflutole was most severe at sites with higher levels of rainfall after application. Control of weed species with isoxaflutole (52.5, 79, and 105 g ai ha−1) and metribuzin (210, 315, and 420 g ai ha−1) differed by site based on amount of rainfall after application. At sites where there was sufficient rainfall for herbicide activation, isoxaflutole at all rates controlled common lambsquarters (Chenopodium album L.), Amaranthus spp., common ragweed (Ambrosia artemisiifolia L.), and velvetleaf (Abutilon theophrasti Medik.) >90%; metribuzin at all rates controlled Amaranthus spp. and witchgrass (Panicum capillare L.) >80%. Control of every weed species evaluated was reduced when there was limited rainfall after herbicide application. The co-application of isoxaflutole + metribuzin resulted in additive or synergistic interactions for the control of C. album, Amaranthus spp., A. artemisiifolia, A. theophrasti, Setaria spp., barnyardgrass [Echinochloa crus-galli (L.) P. Beauv], and P. capillare. Isoxaflutole and metribuzin can be an effective management strategy for common annual broadleaf and grass weeds in Ontario if timely rainfall events occur after herbicide application.
Calls for a return to a traditional method of lawmaking known as “regular order” have proliferated as unorthodox lawmaking has grown more dominant in Congress. Proponents claim regular order enhances deliberation on legislation. This chapter examines deliberation under one form of regular order: open rules permitting unlimited amending in the House of Representatives. We find evidence of substantial minority influence on the inputs and outputs of the appropriations process. Regular order gives the minority party members the opportunity to present and win adoption of their policy proposals. Our evidence also shows that ideological extremists play an outsized role in debate. They offer more amendments than other members, and their amendments tend to win less support and face defeat more often than moderates. The paradox of regular order is that it simultaneously offers the opportunity for bipartisan deliberation over legislation while exposing the majority party to problems that may make its management of the floor more difficult.
The heat transfer properties of the organic molecular crystal α-RDX were studied using three phonon scattering based thermal conductivity models. It was found that the widely used Peierls-Boltzmann model for thermal transport in crystalline materials breaks down for α-RDX. We show this breakdown is due to a large degree of anharmonicity that leads to a dominance of diffusive-like carriers. Despite being developed for disordered systems, the Allen-Feldman theory for thermal conductivity actually gives the best description of thermal transport. This is likely because diffusive carriers contribute to over 95% of the thermal conductivity in α-RDX. The dominance of diffusive carriers is larger than previously observed in other fully ordered crystalline systems. These results indicate that van der Waals bonded organic crystalline solids conduct heat in a manner more akin to amorphous materials than simple atomic crystals.
Overweight/obesity has become a worldwide epidemic, and factors such as a sedentary lifestyle and inadequate eating habits directly contribute to the development of this condition. Studies indicate that rapid weight gain at critical development stages, such as the lactation period, is associated with the development of obesity, cardiovascular diseases, and diabetes in the long term. In addition to metabolic changes during adulthood, overweight/obesity may influence reproductive function of the population. In this context, the present study aimed to evaluate postnatal overfeeding effects on male and female Wistar rat reproductive parameters. Postnatal overfeeding was induced by applying the litter reduction method for both sexes. Forty animals were used, divided into four groups: two with normal litters (NL♂ and NL♀) and two with small litters (SL♂ and SL♀). The males were euthanized at 90 days of age, on the same date the females were mated. Females were also euthanized after the 20-day gestation. Metabolic and reproductive variables were analyzed. Regarding males, SL animals showed increased body weight, adiposity, and decreased relative weight of the seminal vesicle, prostate, and epididymis as well as changes in the ITT and OGTT glycemic tests. Concerning females, SL animals presented increased body weight, relative perigonadal fat weight, glucose intolerance as well as modify the vaginal opening and increased weight of female pup. The litter reduction method was efficient in leading to metabolic and reproductive alterations in male and female Wistar rat.
Background: The zona incerta (ZI) is a small structure in the deep brain first identified by Auguste Forel for which robust in vivo visualization has remained elusive. The increased inherent signal from ultra-high field (7-Tesla or greater; 7T) magnetic resonance imaging (MRI) presents an opportunity to see structures not previously visible. In this study, we investigated the possibility of using quantitative T1 mapping at 7T to visualize the ZI region. Methods: We recruited healthy participants (N=32) and patients being considered for deep brain stimulation therapy as part of a prospective imaging study at 7T. Computational methods were used to process and fuse images to produce a high-resolution group average from which ZI anatomy could be delineated. Results: We pooled 7T data using image fusion methods and found that the contrast from quantitative T1 mapping was strikingly similar to classic histological staining, permitting facile identification of the ZI and nearby structures in reference to conventional stereotactic atlases. Conclusions: Using computational neuroimaging techniques, we demonstrate for the first time that the ZI is visible in vivo. Furthermore, we determined that this nuclear region can be decoupled from surrounding fibre pathways. This work paves the way for more accurate patient-specific optimization of deep brain targets for neuromodulation.
Effective POST herbicides and herbicide mixtures are key components of integrated weed management in corn; however, herbicides vary in their efficacy based on application timing. Six field experiments were conducted over 2 yr (2017–2018) in southwestern Ontario, Canada, to determine the effects of herbicide application timing and rate on the efficacy of tolpyralate, a new 4-hydroxyphenyl pyruvate dioxygenase inhibitor. Tolpyralate at 15, 30, or 40 g ai ha−1 in combination with atrazine at 500 or 1,000 g ai ha−1 was applied PRE, early POST, mid-POST, or late POST. Tolpyralate + atrazine at rates ≥30 + 1,000 g ha−1 provided equivalent control of common lambsquarters and Powell amaranth applied PRE or POST, whereas no rate applied PRE controlled common ragweed, velvetleaf, barnyardgrass, or green foxtail. Common ragweed, common lambsquarters, velvetleaf, and Powell amaranth were controlled equally regardless of POST timing. In contrast, control of barnyardgrass and green foxtail declined when herbicide application was delayed to the late-POST timing, irrespective of herbicide rate. Similarly, corn grain yield declined within each tolpyralate + atrazine rate when herbicide applications were delayed to late-POST timing. Overall, the results of this study indicate that several monocot and dicot weed species can be controlled with tolpyralate + atrazine with an early to mid-POST herbicide application timing, before weeds reach 30 cm in height, and Powell amaranth and common lambsquarters can also be controlled PRE. Additionally, this study provides further evidence highlighting the importance of effective, early-season weed control in corn.
Natural disasters often damage or destroy the protective public health service infrastructure (PHI) required to maintain the health and well-being of people with noncommunicable diseases (NCDs). This interruption increases the risk of an acute exacerbation or complication, potentially leading to a worse long-term prognosis or even death. Disaster-related exacerbations of NCDs will continue, if not increase, due to an increasing prevalence and sustained rise in the frequency and intensity of disasters, along with rapid unsustainable urbanization in flood plains and storm-prone coastal zones. Despite this, the focus of disaster and health systems preparedness and response remains on communicable diseases, even when the actual risk of disease outbreaks post-disaster is low, particularly in developed countries. There is now an urgent need to expand preparedness and response beyond communicable diseases to include people with NCDs.
The developing evidence-base describing the risk of disaster-related exacerbation of NCDs does not incorporate the perspectives, concerns, and challenges of people actually living with the conditions. To help address this gap, this research explored the key influences on patient ability to successfully manage their NCD after a natural disaster.
A survey of people with NCDs in Queensland, Australia collected data on demographics, disease, disaster experience, and primary concern post-disaster. Descriptive statistics and chi-square tests with a Bonferroni-adjustment were used to analyze data.
There were 118 responses to the survey. Key influences on the ability to self-manage post-disaster were access to medication, medical services, water, treatment and care, power, and food. Managing disease-specific symptoms associated with cardiovascular disease, diabetes, mental health, and respiratory diseases were primary concerns following a disaster. Stress and anxiety, loss of sleep, weakness or fatigue, and shortness of breath were common concerns for all patients with NCDs. Those dependent on care from others were most worried about shortness of breath and slow healing sores. Accessing medication and medical services were priorities for all patients post-disaster.
The key influences on successful self-management post-disaster for people with NCDs must be reflected in disaster plans and strategies. Achieving this will reduce exacerbations or complications of disease and decrease demand for emergency health care post-disaster.
If there is consensus about how to handle a patient with a specific condition, from the ambulance service point of view, it matters less for the patient which ambulance arrives to take care of the patient. Guidelines are a way of standardizing treatment or management of the patient for a given patient condition. Clear and implemented guidelines that promote the handling of the patients is done from best practice and are evidence-based according to the best ability of the organization.
The aim of the current study was to implement guidelines into an organization that was not currently using guidelines. The study was conducted as a collaborative effort between a Swedish pre-hospital training organization and the local ambulance service organization in Kosovo.
An iterative process of implementing the guidelines was applied:
1.Identify guidelines appropriate for the local organization. For each iteration, five guidelines are chosen.
2.Have the five guidelines translated into Albanian.
3.The guidelines are adapted to local conditions and context.
4.The five guidelines are approved by an expert group.
5.The five guidelines are implemented in the organization.
The initial iteration included was carried out in the form of a workshop where 22 persons (doctors and nurses) from the local ambulance service in Kosovo participated. During the workshop, the first three implementation steps were taken, while remaining steps were carried out by the local organization.
With the local management and ambulance personnel involved throughout the process, the implementation of guidelines were delivered in a more feasible way as well as more easily accepted and adhered to. Supporting a standardized treatment or management of the patient will benefit future patients. These standards should be based in evidence-based practice adopted to local conditions.
Micronutrient supplementation is recommended in Ebola Virus Disease (EVD). However, there is limited data on its therapeutic impacts. This study evaluated the association between vitamin A supplementation and mortality outcomes in EVD patients.
This retrospective cohort study accrued patients with EVD admitted to five International Medical Corps run Ebola Treatment Units (ETU) in two countries from 2014-2015. Protocolized treatments with antimicrobials and micronutrients were used at all ETUs. However, due to resource limitations and care variations, only a subset of patients received vitamin A. Standardized data on demographics, clinical characteristics, malaria status, and Ebola virus RT-PCR cycle threshold (CT) values were collected. The outcome of interest was mortality compared between cases treated with 200,000 International Units of vitamin A on care days one and two and those not. Propensity scores (PS) based on the first 48-hours of care were derived using the covariates of age, duration of ETU function, malaria status, CT values, symptoms of confusion, hemorrhage, diarrhea, dysphagia, and dyspnea. Treated and non-treated cases were matched 1:1 based on nearest neighbors with replacement. Covariate balance met predefined thresholds. Mortality proportions between cases treated and untreated with vitamin A were compared using generalized estimating equations to calculate relative risks (RR) with associated 95% confidence intervals (CI).
There were 424 cases analyzed, with 330 (77.8%) being vitamin A-treated cases. The mean age was 30.5 years and 57.0% were female. The most common symptoms were diarrhea (86%), anorexia (81%), and vomiting (77%). Mortality proportions among cases untreated and treated with vitamin A were 71.9% and 55.0%, respectively. In a propensity-matched analysis, mortality was significantly lower among cases receiving vitamin A (RR = 0.77 95%; CI:0.59-0.99; p = 0.041).
Early vitamin A supplementation was associated with reduced mortality in EVD patients and should be provided routinely during future epidemics.
Transgenic crops are being developed with herbicide resistance traits to expand innovative weed management solutions for crop producers. Soybean with traits that confer resistance to the hydroxyphenylpyruvate dioxygenase herbicide isoxaflutole is under development and will provide a novel herbicide mode of action for weed management in soybean. Ten field experiments were conducted over 2 years (2017 and 2018) on five soil textures with isoxaflutole-resistant soybean to evaluate annual weed control using one- and two-pass herbicide programs. The one-pass weed control programs included isoxaflutole plus metribuzin, applied PRE, at a low rate (52.5 + 210 g ai ha−1), medium rate (79 + 316 g ai ha−1), and high rate (105 + 420 g ai ha−1); and glyphosate applied early postemergence (EPOST) or late postemergence (LPOST). The two-pass weed control programs included isoxaflutole plus metribuzin, applied PRE, followed by glyphosate applied LPOST, and glyphosate applied EPOST followed by LPOST. At 4 weeks after the LPOST application, control of common lambsquarters, pigweed species, common ragweed, and velvetleaf was variable at 25% to 69%, 49% to 86%, and 71% to 95% at the low, medium, and high rates of isoxaflutole plus metribuzin, respectively. Isoxaflutole plus metribuzin at the low, medium, and high rates controlled grass species evaluated (i.e., barnyardgrass, foxtail, crabgrass, and witchgrass) 85% to 97%, 75% to 99%, and 86% to 100%, respectively. All two-pass weed management programs provided 98% to 100% control of all species. Weed control improved as the rate of isoxaflutole plus metribuzin increased. Two-pass programs provided excellent, full-season annual grass and broadleaf weed control in isoxaflutole-resistant soybean.
Determining infectious cross-transmission events in healthcare settings involves manual surveillance of case clusters by infection control personnel, followed by strain typing of clinical/environmental isolates suspected in said clusters. Recent advances in genomic sequencing and cloud computing now allow for the rapid molecular typing of infecting isolates.
To facilitate rapid recognition of transmission clusters, we aimed to assess infection control surveillance using whole-genome sequencing (WGS) of microbial pathogens to identify cross-transmission events for epidemiologic review.
Clinical isolates of Staphylococcus aureus, Enterococcus faecium, Pseudomonas aeruginosa, and Klebsiella pneumoniae were obtained prospectively at an academic medical center, from September 1, 2016, to September 30, 2017. Isolate genomes were sequenced, followed by single-nucleotide variant analysis; a cloud-computing platform was used for whole-genome sequence analysis and cluster identification.
Most strains of the 4 studied pathogens were unrelated, and 34 potential transmission clusters were present. The characteristics of the potential clusters were complex and likely not identifiable by traditional surveillance alone. Notably, only 1 cluster had been suspected by routine manual surveillance.
Our work supports the assertion that integration of genomic and clinical epidemiologic data can augment infection control surveillance for both the identification of cross-transmission events and the inclusion of missed and exclusion of misidentified outbreaks (ie, false alarms). The integration of clinical data is essential to prioritize suspect clusters for investigation, and for existing infections, a timely review of both the clinical and WGS results can hold promise to reduce HAIs. A richer understanding of cross-transmission events within healthcare settings will require the expansion of current surveillance approaches.
Astrophysics Telescope for Large Area Spectroscopy Probe is a concept for a National Aeronautics and Space Administration probe-class space mission that will achieve ground-breaking science in the fields of galaxy evolution, cosmology, Milky Way, and the Solar System. It is the follow-up space mission to Wide Field Infrared Survey Telescope (WFIRST), boosting its scientific return by obtaining deep 1–4 μm slit spectroscopy for ∼70% of all galaxies imaged by the ∼2 000 deg2 WFIRST High Latitude Survey at z > 0.5. Astrophysics Telescope for Large Area Spectroscopy will measure accurate and precise redshifts for ∼200 M galaxies out to z < 7, and deliver spectra that enable a wide range of diagnostic studies of the physical properties of galaxies over most of cosmic history. Astrophysics Telescope for Large Area Spectroscopy Probe and WFIRST together will produce a 3D map of the Universe over 2 000 deg2, the definitive data sets for studying galaxy evolution, probing dark matter, dark energy and modifications of General Relativity, and quantifying the 3D structure and stellar content of the Milky Way. Astrophysics Telescope for Large Area Spectroscopy Probe science spans four broad categories: (1) Revolutionising galaxy evolution studies by tracing the relation between galaxies and dark matter from galaxy groups to cosmic voids and filaments, from the epoch of reionisation through the peak era of galaxy assembly; (2) Opening a new window into the dark Universe by weighing the dark matter filaments using 3D weak lensing with spectroscopic redshifts, and obtaining definitive measurements of dark energy and modification of General Relativity using galaxy clustering; (3) Probing the Milky Way’s dust-enshrouded regions, reaching the far side of our Galaxy; and (4) Exploring the formation history of the outer Solar System by characterising Kuiper Belt Objects. Astrophysics Telescope for Large Area Spectroscopy Probe is a 1.5 m telescope with a field of view of 0.4 deg2, and uses digital micro-mirror devices as slit selectors. It has a spectroscopic resolution of R = 1 000, and a wavelength range of 1–4 μm. The lack of slit spectroscopy from space over a wide field of view is the obvious gap in current and planned future space missions; Astrophysics Telescope for Large Area Spectroscopy fills this big gap with an unprecedented spectroscopic capability based on digital micro-mirror devices (with an estimated spectroscopic multiplex factor greater than 5 000). Astrophysics Telescope for Large Area Spectroscopy is designed to fit within the National Aeronautics and Space Administration probe-class space mission cost envelope; it has a single instrument, a telescope aperture that allows for a lighter launch vehicle, and mature technology (we have identified a path for digital micro-mirror devices to reach Technology Readiness Level 6 within 2 yr). Astrophysics Telescope for Large Area Spectroscopy Probe will lead to transformative science over the entire range of astrophysics: from galaxy evolution to the dark Universe, from Solar System objects to the dusty regions of the Milky Way.