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In a cross-sectional evaluation of healthcare worker reuse of their own 3M N95 respirators, 83% (76/92) passed the seal check and the fit-test after a median of 40 repeated donnings. User seal-check failure correlated with fit-test failure, and it may help HCWs recognize when to appropriately discard a reused N95.
The transformation of evangelical Christians from a discriminated-against minority to full citizens with rights and political influence constitutes an important component of the inclusionary turn in Latin America. In some countries, this process of inclusion has translated into a formidable presence in elected office, with evangelicals leading a socially conservative backlash against progressive policy agendas. In other countries, evangelicals have little presence within the halls of power. This chapter seeks to explain differences in evangelicals’ involvement and success with electoral politics in Brazil and Chile, South America’s two most heavily evangelical countries. Rejecting arguments that focus on external barriers, such as social discrimination or constraints posed by political institutions, I instead emphasize the historical process by which a religious identity is or is not politicized, via struggles for legal equality with the Catholic Church and more recent battles over abortion and same-sex marriage. In Brazil, ongoing threats to evangelicals’ core interests and identities, combined with opportunities to defend against these threats via legislative politics, have produced a much more politicized and electorally successful evangelical community than in Chile.
The coronavirus disease 2019 pandemic resulted in the cessation of elective surgery. The continued provision of complex head and neck cancer surgery was extremely variable, with some UK centres not performing any cancer surgery. During the pandemic, Guy's and St Thomas’ NHS Foundation Trust received high numbers of coronavirus disease 2019 admissions. This paper presents our experience of elective complex major head and neck cancer surgery throughout the pandemic.
A head and neck cancer surgery hub was set up that provided a co-ordinated managed care pathway for cancer patients during the pandemic; the Guy's Cancer Centre provided a separate, self-enclosed coronavirus-free environment within the hospital campus.
Sixty-nine head and neck cancer patients were operated on in two months, and 13 patients had a microvascular free tissue transfer. Nosocomial infection with coronavirus disease 2019 was detected in two cases (3 per cent), neither required critical care unit admission. Both patients made a complete recovery and were discharged home. There were no deaths.
Performing major head and neck surgery, including free flap surgery, is possible during the pandemic; however, significant changes to conventional practice are required to achieve desirable patient outcomes.
The loss of methyl bromide led to vegetable growers relying more heavily on herbicides to control weeds. Although herbicides can be effective, limited options in vegetable production challenge growers. Identifying new, effective tools to be applied over plastic mulch prior to planting for improved weed control with minimal crop injury would be beneficial. The objective of these experiments was to evaluate the persistence of preplant applications of glyphosate (1,125 or 2,250 g ae ha-1) plus 2,4-D (1,065 or 2,130 g ae ha-1) or dicamba (560 g ae ha-1) over plastic mulch using analytical techniques and subsequent squash and watermelon response. Glyphosate and 2,4-D were not analytically detected at damaging concentrations on plastic mulch when at least 3.5 cm of rainfall was received after application and before planting. Additionally, bioassay results for squash and watermelon supported analytical results with less than 10% visual injury for either crop, with no growth or yield suppression observed. In contrast, dicamba concentrations on plastic mulch, regardless of rainfall amount or time between application and planting, remained at damaging levels. Squash yields were reduced by dicamba applied 1 to 30 days before planting while watermelon was more resilient. 2,4-D plus glyphosate applied preplant over plastic mulch can provide an additional herbicide option for vegetable growers. Additional research is needed to understand the impact of residual activity of 2,4-D when transplants land directly in holes present in plastic mulch at the time of application. The relationship of dicamba with plastic mulch is complex as the herbicide cannot be easily removed by rainfall. Thus, dicamba should not be included in a weed management system in plasticulture vegetable production.
In-situ transmission electron microscopy (TEM) provides an avenue to explore time-dependent nanoscale material changes induced by a wide range of environmental conditions that govern material performance and degradation. The In-situ Ion Irradiation TEM (I3TEM) at Sandia National Laboratories is a JEOL 2100 microscope that has been highly modified with an array of hardware and software that makes it particularly well suited to explore fundamental mechanisms that arise from coupled extreme conditions. Examples pertaining to multibeam ion irradiation, rapid thermal cycling, and nanomechanical testing on the I3TEM are highlighted, along with prospective advancements in the field of in-situ microscopy.
In May 2019 we launched a special exhibition at the Uganda Museum in Kampala titled “The Unseen Archive of Idi Amin.” It consisted of 150 images made by government photographers in the 1970s. In this essay we explore how political history has been delimited in the Museum, and how these limitations shaped the exhibition we curated. From the time of its creation, the Museum's disparate and multifarious collections were exhibited as ethnographic specimens, stripped of historical context. Spatially and organizationally, “The Unseen Archive of Idi Amin” turned its back on the ethnographic architecture of the Uganda Museum. The transformation of these vivid, evocative, aesthetically appealing photographs into historical evidence of atrocity was intensely discomfiting. We have been obliged to organize the exhibition around categories that did not correspond with the logic of the photographic archive, with the architecture of the Museum, or with the experiences of the people who lived through the 1970s. The exhibition has made history, but not entirely in ways that we chose.
Dopaminergic imaging is an established biomarker for dementia with Lewy bodies, but its diagnostic accuracy at the mild cognitive impairment (MCI) stage remains uncertain.
To provide robust prospective evidence of the diagnostic accuracy of dopaminergic imaging at the MCI stage to either support or refute its inclusion as a biomarker for the diagnosis of MCI with Lewy bodies.
We conducted a prospective diagnostic accuracy study of baseline dopaminergic imaging with [123I]N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane single-photon emission computerised tomography (123I-FP-CIT SPECT) in 144 patients with MCI. Images were rated as normal or abnormal by a panel of experts with access to striatal binding ratio results. Follow-up consensus diagnosis based on the presence of core features of Lewy body disease was used as the reference standard.
At latest assessment (mean 2 years) 61 patients had probable MCI with Lewy bodies, 26 possible MCI with Lewy bodies and 57 MCI due to Alzheimer's disease. The sensitivity of baseline FP-CIT visual rating for probable MCI with Lewy bodies was 66% (95% CI 52–77%), specificity 88% (76–95%) and accuracy 76% (68–84%), with positive likelihood ratio 5.3.
It is over five times as likely for an abnormal scan to be found in probable MCI with Lewy bodies than MCI due to Alzheimer's disease. Dopaminergic imaging appears to be useful at the MCI stage in cases where Lewy body disease is suspected clinically.
Type 2 diabetes results mainly from weight gain in adult life and affects one in twelve people worldwide. In the Diabetes REmission Clinical Trial (DiRECT), the primary care-led Counterweight-Plus weight management program achieved remission of type 2 diabetes (for up to six years) for forty-six percent of patients after one year and thirty-six percent after two years. The objective of this study was to estimate the implementation costs of the program, as well as its two-year within-trial cost effectiveness and lifetime cost effectiveness.
Within-trial cost effectiveness included the Counterweight-Plus costs (including training, practitioner appointments, and low-energy diet), medications, and all routine healthcare contacts, combined with achieved remission rates. Lifetime cost per quality-adjusted life-year (QALY) was estimated according to projected durations of remissions, assuming continued relapse rates as seen in year two of DiRECT and the consequent life expectancy, quality of life and healthcare costs.
The two-year intervention cost was EUR 1,580 per participant, with over eighty percent of the costs incurred in year one. Compared with the control group, medication savings were EUR 259 (95% confidence interval [CI]: 166–352) for anti-diabetes drugs and EUR 29 (95% CI: 12–47) for anti-hypertensive medications. The intervention was modeled with a lifetime horizon to achieve a mean 0.06 (95% CI: 0.04–0.09) gain in QALYs for the DiRECT population and a mean total lifetime cost saving per participant of EUR 1,497 (95% CI: 755–2,331), with the intervention becoming cost-saving within six years.
The intensive weight loss and maintenance program reduced the cost of anti-diabetes drugs through improved metabolic control, achieved diabetes remission in over one-third of participants, and reduced total healthcare contacts and costs over two years. A substantial lifetime healthcare cost saving is anticipated from periods of diabetes remission and delaying complications. Healthcare resources could be shifted cost effectively to establish diabetes remission services, using the existing DiRECT intervention, even if remissions are only maintained for limited durations. However, more research investment is needed to further improve weight-loss maintenance and extend remissions.
Thin films of platinum deposited by physical vapor deposition (PVD) processes such as evaporation and sputtering are used in many academic and industrial settings, for example to provide metallization when tolerance to corrosive thermal cycling is desired, or in electrocatalysis research. In this review, various practical considerations for platinum (Pt) metallization on both Si and SiO2 are placed in context with a comprehensive data review of diffusion measurements. The relevance of diffusion phenomena to the development of microstructure during deposition as well as the effect of microstructure on the properties of deposited films are discussed with respect to the Pt–Si system. Since Pt and Si readily form silicides, diffusion barriers are essential components of Pt metallization on Si, and various failure modes for diffusion barriers between Pt and Si are clarified with images obtained by electron microscopy. Adhesion layers for Pt films deposited on SiO2 are also considered.
Agronomic crops engineered with resistance to 2,4-D or dicamba have been commercialized and widely adopted throughout the United States. Because of this, increased use of these herbicides in time and space has increased damage to sensitive crops. From 2014 to 2016, cucumber and cantaloupe studies were conducted in Tifton, GA, to demonstrate how auxinic herbicides (namely, 2,4-D or dicamba), herbicide rate (1/75 or 1/250 field use), and application timing (26, 16, and 7 d before harvest [DBH] of cucumber; 54, 31, and 18 DBH of cantaloupe) influenced crop injury, growth, yield, and herbicide residue accumulation in marketable fruit. Greater visual injury, reductions in vine growth, and yield loss were observed at higher rates when herbicides were applied during early-season vegetative growth compared with late-season with fruit development. Dicamba was more injurious in cucumber, whereas cantaloupe responded similarly to both herbicides. For cucumber, total fruit number and relative weights were reduced (16% to 19%) when either herbicide was applied at the 1/75 rate 26 DBH. Cantaloupe fruit weight was also reduced 21% and 10% when either herbicide was applied at the 1/75 rate 54 or 31 DBH, respectively. Residue analysis noted applications made closer to harvest were more likely to be detectable in fruit than earlier applications. In cucumber, dicamba was detected at both rates when applied 7 DBH, whereas in cantaloupe, it was detected at both rates when applied 18 or 31 DBH in 2016 and at the 1/75 rate applied 18 or 31 DBH in 2014. Detectable amounts of 2,4-D were not observed in cucumber but were detected in cantaloupe when applied at either rate 18 or 31 DBH. Although early-season injury will more likely reduce cucumber or cantaloupe yields, the quantity of herbicide residue detected will be most influenced by the time interval between the off-target incident and sampling.
A Canadian outbreak investigation into a cluster of Escherichia coli O121 was initiated in late 2016. When initial interviews using a closed-ended hypothesis-generating questionnaire did not point to a common source, cases were centrally re-interviewed using an open-ended approach. The open-ended interviews led cases to describe exposures with greater specificity, as well as food preparation activities. Data collected supported hypothesis generation, particularly with respect to flour exposures. In March 2017, an open sample of Brand X flour from a case home, and a closed sample collected at retail of the same brand and production date, tested positive for the outbreak strain of E. coli O121. In total, 76% (16/21) of cases reported that they used or probably used Brand X flour or that it was used or probably was used in the home during their exposure period. Crucial hypothesis-generating techniques used during the course of the investigation included a centralised open-ended interviewing approach and product sampling from case homes. This was the first outbreak investigation in Canada to identify flour as the source of infection.
Historical foundations rooted in reproductive oppression have implications for how racism has been integrated into the structures of society, including public policies, institutional practices, and cultural representations that reinforce racial inequality in maternal health. This article examines these connections and sheds light on how they perpetuate both racial disparities in maternal health and high rates of maternal mortality and morbidity among Black women.
To estimate the prevalence of unmet needs for assistance among middle-aged and older adults with subjective cognitive decline (SCD) in the US and to evaluate whether unmet needs were associated with health-related quality of life (HRQOL).
US – 50 states, District of Columbia, and Puerto Rico
Community-dwelling adults aged 45 years and older who completed the Cognitive Decline module on the 2015-–2018 Behavioral Risk Factor Surveillance System reported experiencing SCD and always, usually, or sometimes needed assistance with day-to-day activities because of SCD (n = 6,568).
We defined SCD as confusion or memory loss that was happening more often or getting worse over the past 12 months. Respondents with SCD were considered to have an unmet need for assistance if they sometimes, rarely, or never got the help they needed with day-to-day activities. We measured three domains of HRQOL: (1) mental (frequent mental distress, ≥14 days of poor mental health in the past 30 days), (2) physical (frequent physical distress, ≥14 days of poor physical health in the past 30 days), and (3) social (SCD always, usually, or sometimes interfered with the ability to work, volunteer, or engage in social activities outside the home). We used log-binomial regression models to estimate prevalence ratios (PRs). All estimates were weighted.
In total, 40.2% of people who needed SCD-related assistance reported an unmet need. Among respondents without depression, an unmet need was associated with a higher prevalence of frequent mental distress (PR = 1.55, 95% CI: 1.12–2.13, p = 0.007). Frequent physical distress and social limitations did not differ between people with met and unmet needs.
Middle-aged and older adults with SCD-related needs for assistance frequently did not have those needs met, which could negatively impact their mental health. Interventions to identify and meet the unmet needs among people with SCD may improve HRQOL.
Recently published diagnostic criteria for mild cognitive impairment with Lewy bodies (MCI-LB) include five neuropsychiatric supportive features (non-visual hallucinations, systematised delusions, apathy, anxiety and depression). We have previously demonstrated that the presence of two or more of these symptoms differentiates MCI-LB from MCI due to Alzheimer's disease (MCI-AD) with a likelihood ratio >4. The aim of this study was to replicate the findings in an independent cohort.
Participants ⩾60 years old with MCI were recruited. Each participant had a detailed clinical, cognitive and imaging assessment including FP-CIT SPECT and cardiac MIBG. The presence of neuropsychiatric supportive symptoms was determined using the Neuropsychiatric Inventory (NPI). Participants were classified as MCI-AD, possible MCI-LB and probable MCI-LB based on current diagnostic criteria. Participants with possible MCI-LB were excluded from further analysis.
Probable MCI-LB (n = 28) had higher NPI total and distress scores than MCI-AD (n = 30). In total, 59% of MCI-LB had two or more neuropsychiatric supportive symptoms compared with 9% of MCI-AD (likelihood ratio 6.5, p < 0.001). MCI-LB participants also had a significantly greater delayed recall and a lower Trails A:Trails B ratio than MCI-AD.
MCI-LB is associated with significantly greater neuropsychiatric symptoms than MCI-AD. The presence of two or more neuropsychiatric supportive symptoms as defined by MCI-LB diagnostic criteria is highly specific and moderately sensitive for a diagnosis of MCI-LB. The cognitive profile of MCI-LB differs from MCI-AD, with greater executive and lesser memory impairment, but these differences are not sufficient to differentiate MCI-LB from MCI-AD.
Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.
The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.
We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.
We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.
Our aim was to develop a brief cognitive behavioural therapy (CBT) protocol to augment treatment for social anxiety disorder (SAD). This protocol focused specifically upon fear of positive evaluation (FPE). To our knowledge, this is the first protocol that has been designed to systematically target FPE.
To test the feasibility of a brief (two-session) CBT protocol for FPE and report proof-of-principle data in the form of effect sizes.
Seven patients with a principal diagnosis of SAD were recruited to participate. Following a pre-treatment assessment, patients were randomized to either (a) an immediate CBT condition (n = 3), or (b) a comparable wait-list (WL) period (2 weeks; n = 4). Two WL patients also completed the CBT protocol following the WL period (delayed CBT condition). Patients completed follow-up assessments 1 week after completing the protocol.
A total of five patients completed the brief, FPE-specific CBT protocol (two of the seven patients were wait-listed only and did not complete delayed CBT). All five patients completed the protocol and provided 1-week follow-up data. CBT patients demonstrated large reductions in FPE-related concerns as well as overall social anxiety symptoms, whereas WL patients demonstrated an increase in FPE-related concerns.
Our brief FPE-specific CBT protocol is feasible to use and was associated with large FPE-specific and social anxiety symptom reductions. To our knowledge, this is the first treatment report that has focused on systematic treatment of FPE in patients with SAD. Our protocol warrants further controlled evaluation.
In 2017, transgender woman Danica Roem stunned political observers in Virginia by unseating a long-time anti-LGBTQ legislator from a conservative district in the Virginia House of Delegates.1 She was the first openly transgender person elected and seated to a state legislature. Delegate Roem’s election was historic in LGBTQ political representation, but it also occurred in a period when backlash against the LGBTQ community seemed to be growing (Taylor, Lewis, and Haider-Markel 2018). These two threads led us to ask: How are LGBTQ candidates achieving historic successes even as forces seem mobilized against them?
We study direct numerical simulations of turbulence arising from the interaction of an initial background shear, a linear background stratification and an external body force. In each simulation the turbulence produced is spatially intermittent, with dissipation rates varying over orders of magnitude in the vertical. We focus analysis on the statistically quasi-steady states achieved by applying large-scale body forcing to the domain, and compare flows forced by internal gravity waves with those forced by vertically uniform vortical modes. By considering the turbulent energy budgets for each simulation, we find that the injection of potential energy from the wave forcing permits a reversal in the sign of the mean buoyancy flux. This change in the sign of the buoyancy flux is associated with large, convective density overturnings, which in turn lead to more efficient mixing in the wave-forced simulations. The inhomogeneous dissipation in each simulation allows us to investigate localised correlations between the kinetic and potential energy dissipation rates. These correlations lead us to the conclusion that an appropriate definition of an instantaneous mixing efficiency,
are the volume-averaged turbulent viscous dissipation rate and fluctuation density variance destruction rate respectively) in the wave-forced cases is independent of an appropriately defined local turbulent Froude number, consistent with scalings proposed for low Froude number stratified turbulence.
Clusters of Salmonella Enteritidis cases were identified by the Minnesota Department of Health using both pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS) single nucleotide polymorphism analysis from 1 January 2015 through 31 December 2017. The median turnaround time for obtaining WGS results was 11 days longer than for PFGE (12 vs. 1 day). WGS analysis more than doubled the number of clusters compared to PFGE analysis, but reduced the total number of cases included in clusters by 34%. The median cluster size was two cases for WGS compared to four for PFGE, and the median duration of WGS clusters was 27 days shorter than PFGE clusters. While the percentage of PFGE clusters with a confirmed source (46%) was higher than WGS clusters (32%), a higher percentage of cases in clusters that were confirmed as outbreaks reported the vehicle or exposure of interest for WGS (78%) than PFGE (46%). WGS cluster size was a significant predictor of an outbreak source being confirmed. WGS data have enhanced S. Enteritidis cluster investigations in Minnesota by improving the specificity of cluster case definitions and has become an integral part of the S. Enteritidis surveillance process.
To utilise a community-based participatory approach in the design and implementation of an intervention targeting diet-related health problems on Navajo Nation.
A dual strategy approach of community needs/assets assessment and engagement of cross-sectorial partners in programme design with systematic cyclical feedback for programme modifications.
Navajo Nation, USA.
Navajo families with individuals meeting criteria for programme enrolment. Participant enrolment increased with iterative cycles.
The Navajo Fruit and Vegetable Prescription (FVRx) Programme.
A broad, community-driven and culturally relevant programme design has resulted in a programme able to maintain core programmatic principles, while also allowing for flexible adaptation to changing needs.