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 email@example.com
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.
Background: Polymerase chain reaction (PCR) testing for the diagnosis of Clostridioides difficile infection (CDI) detects the presence of the organism; a positive result therefore cannot differentiate between colonization and the pathogenic presence of the bacterium. This may result in overdiagnosis, overtreatment, and risking disruption of microbial flora, which may perpetuate the CDI cycle. Algorithm-based testing offers an advantage over PCR testing as it detects toxin, which allows differentiation between colonization and infection. Although previous studies have demonstrated the clinical utility of this testing algorithm in differentiating infection from colonization, it is unknown whether the test changes CDI treatment decisions. Our facility switched from PCR to an algorithm-based testing method for CDI in June 2018. Objective: In this study, we evaluated whether clinicians’ decisions to treat patients are impacted by a test result that implies colonization (GDH+/Tox−/PCR+ test), and we examined the impact of this decision on patient outcomes. Methods: This is a retrospective cohort study of inpatients with a positive C. diff test between June 2017 and June 2019. The primary outcome was the proportion of patients treated for CDI. We compared this outcome in 3 groups of patients: those with a positive PCR test (June 2017–June 2018), those who had a GDH+/Tox−/PCR+ or a GDH+/Tox+ test result (June 2018–June 2019). Secondary outcomes included toxic megacolon, critical care admission, and mortality in patients with GDH+/Tox−/PCR+ who were treated versus those who were untreated. Results: Of patients with a positive PCR test, 86% were treated with CDI-specific antibiotics, whereas 70.4% with GDH+/Tox+ and 29.25% with GDH+/Tox−/PCR+ result were treated (P < .0001). Mortality was not different between patients with GDH+/Tox−/PCR+ who were treated versus those who were untreated (2.7% vs 3.4%; P = .12), neither was critical care admission within 2 or 7 days of test result (2% vs 1.4%; P = .15) and (4.1% vs 5.4%, P = .39), respectively. There were no cases of toxic megacolon during the study period. Conclusions: The change to an algorithm-based C. difficile testing method had a significant impact on the clinicians’ decisions to treat patients with a positive test, as most patients with a GDH+/Tox−/PCR+ result did not receive treatment. These patients did not suffer more adverse outcomes compared to those who were treated, which has implications for testing practices. It remains to be explored whether clinicians are using clinical criteria to decide whether or not to treat patients with a positive algorithm-based test, as opposed to the more reflexive treatment of patients with a positive PCR test.
We report electronic medical record interventions to reduce Clostridioides difficile testing risk ‘alert fatigue.’ We used a behavioral approach to diagnostic stewardship and observed a decrease in the number of tests ordered of ~4.5 per month (P < .0001). Although the number of inappropriate tests decreased during the study period, delayed testing increased.
Interactions between polyphenols and non-digestible carbohydrates (NDC) can impact on polyphenolic metabolites bioavailability, including phenolic acids. The BLEND2 trial (NCT03840746) aims to study longer-term interactions of a flavonoid-rich food with/without NDC on microbiota metabolites and cardiometabolic markers. Trial feasibility using a bespoke food was tested.
Material and Methods
The soup was developed locally containing cherry tomatoes, tomato puree, red onion, fresh lovage, with/without the NDC inulin (10g), but improved and processed with Campden BRI, Chipping Campden, UK. The final product (~400g/ tin) was evaluated with VAS scales (0–10) for appearance, smell, taste and overall palatability, and flavonoid content evaluated using liquid chromatography-mass spectrometry. The 3-arm parallel randomised blinded design (control soup, soup + inulin, habitual diet control) recruited self-reported healthy participants (BMI > 25, 40–70y) with urine, blood, faecal samples collected at baseline, 3-week, 6-weeks.
Both soups scored similarly (n = 8 testers) for visual appeal (with inulin 5.1 ± 2.1; without 4.5 ± 2.0); smell (with 5.9 ± 1.7; without 5.4 ± 0.8); taste (with 6.6 ± 2.0; without 5.5 ± 2.3), aftertaste (with 6.3 ± 2.9; without 5.4 ± 2.3) and overall palatability (with 7.0 ± 1.9; without 6.1 ± 2.1).
The soups (A&B), 1 tin/day, provide 68.5 ± 10.9 mg total flavonoids (soup A n = 3, quercetin equivalents) and 74.0 ± 16.1 mg (soup B, n = 3): quercetin (A 1.2 ± 0.1 mg; B 1.3 ± 0.6 mg), quercetin-4-glucoside (A 3.9 ± 1.0 mg; B 4.1 ± 1.9 mg), quercetin-3-rutinoside (A 23.0 ± 3.2 mg; B 20.5 ± 1.0 mg), quercetin 3,4-diglucosides (A 40.5 ± 6.9 mg; B 48.2 ± 14.9 mg).
Following notes of interest (n = 415), n = 111 attended screening, n = 34 did not proceed (medications, opt-out; 31%). Participants (n = 77) are mostly British (79%), median age 56y (IQR 49-62) with a median BMI of 31 (IQR 28-35). Dropout was low (12%) and early in the study (personal issues, n = 2; gastrointestinal issues, n = 2; failure to comply with protocol, n = 2; acid reflux symptoms, n = 1; dislike of test food, n = 1). Adverse events included acid reflux/heartburn (n = 4), gastrointestinal distress (n = 3) accounting for 3 drop-outs.
To date, urine, blood and faecal samples (study day or day + 1) were collected at all timepoints, for all participants. Participation (soup arms) has not led to body weight or blood lipids changes compared to control group.
The protocol for this 6-week trial has proved feasible with lower dropout than expected. Soup flavonoid content representing ~16% of average European flavonoid intakes, with inulin (10g) half the UK daily fibre intake. The soup was well accepted with few reports of adverse issues. Recruitment in this population is challenging, due to high levels of medication and ill health.
A robust biomedical informatics infrastructure is essential for academic health centers engaged in translational research. There are no templates for what such an infrastructure encompasses or how it is funded. An informatics workgroup within the Clinical and Translational Science Awards network conducted an analysis to identify the scope, governance, and funding of this infrastructure. After we identified the essential components of an informatics infrastructure, we surveyed informatics leaders at network institutions about the governance and sustainability of the different components. Results from 42 survey respondents showed significant variations in governance and sustainability; however, some trends also emerged. Core informatics components such as electronic data capture systems, electronic health records data repositories, and related tools had mixed models of funding including, fee-for-service, extramural grants, and institutional support. Several key components such as regulatory systems (e.g., electronic Institutional Review Board [IRB] systems, grants, and contracts), security systems, data warehouses, and clinical trials management systems were overwhelmingly supported as institutional infrastructure. The findings highlighted in this report are worth noting for academic health centers and funding agencies involved in planning current and future informatics infrastructure, which provides the foundation for a robust, data-driven clinical and translational research program.
Cir X-1 is a young X-ray binary exhibiting X-ray flux changes of four orders of magnitude over several decades. It has been observed many times since the launch of the Chandra X-ray Observatory with high energy transmission grating spectrometer and each time the source gave us a vastly different look. At its very lowest X-ray flux we found a single 1.7 keV blackbody spectrum with an emission radius of 0.5 km. Since the neutron star in Cir X-1 is only few thousand years old we identify this as emission from an accretion column since at this youth the neutron star is assumed to be highly magnetized. At an X-ray flux of 1.8×10−11 erg cm−2 s−1 this implies a moderate magnetic field of a few times of 1011 G. The photoionized X-ray emission line properties at this low flux are consistent with B5-type companion wind. We suggest that Cir X-1 is a very young Be-star binary.
High-mass X-ray binaries (HMXBs) provide an exciting window into the underlying processes of both binary as well as massive star evolution. Because HMXBs are systems containing a compact object accreting from a high-mass star at close orbital separations they are also likely progenitors of gamma-ray bursts and gravitational wave sources. We present classification and age measurements for HMXBs in M33 using a combination of deep Chandra X-ray imaging, and archival Hubble Space Telescope data. We constrain the ages of the HMXB candidates by fitting the color-magnitude diagrams of the surrounding stars, which yield the star formation histories of the surrounding region. Unlike the age distributions measured for HMXB populations in the Magellanic Clouds, the age distribution for the HMXB population in M33 contains a number of extremely young (<5 Myr) sources. We discuss these results the context of the effect of host galaxy properties on the observed HMXB population.
We use deep Chandra and HST data to uniquely classify the X-ray binary (XRB) populations in M81 on the basis of their donor stars and local stellar populations (into early-type main sequence, yellow giant, supergiant, low-mass, and globular cluster). First, we find that more massive, redder, and denser globular clusters are more likely to be associated with XRBs. Second, we find that the high-mass XRBs (HMXBs) overall have a steeper X-ray luminosity function (XLF) than the canonical star-forming galaxy XLF, though there is some evidence of variations in the slopes of the sub-populations. On the other hand, the XLF of the prototypical starburst M82 is described by the canonical powerlaw (αcum ∼ 0.6) down to LX ∼ 1036 erg s−1. We attribute variations in XLF slopes to different mass transfer modes (Roche-lobe overflow versus wind-fed systems).
We analyse the vertical distribution of High Mass X-ray Binaries (HMXBs) in NGC 55, the nearest edge-on galaxy to the Milky Way. Our analysis reveals significant spatial offsets of HMXBs from the star forming regions, greater than those observed in the SMC and the LMC but similar with the Milky Way. The spatial offsets can be explained by a momentum kick the X-ray binaries receive during the formation of the compact object. The difference between the scale height of the vertical distribution of HMXBs and the vertical distribution of star-forming activity is 0.48±0.04 kpc. The centre-of-mass velocity of the distribution of HMXBs in NGC 55 is moving at a velocity of 52.4±11.4 km s−1, greater than the corresponding velocity of HMXBs in the SMC and LMC, but consistent with velocities of Milky Way HMXBs.
Isotopic investigations of human burials from excavations of the Autonomous University of Campeche (CIHS) at the prehispanic Maya capital of Calakmul in southeastern Mexico, near the border with Guatemala, include determination of radiocarbon dates; carbon and nitrogen isotope ratios in collagen; and strontium, carbon, and oxygen isotope ratios in tooth enamel. A total of 22 human and 5 faunal samples analyzed for strontium isotopes reveal a narrow range of variation in values, pointing to the likely local origin of over two-thirds of the central population of Calakmul, including two of its rulers. Carbon and nitrogen data confirm a typical Classic Maya diet at the site and identify a diet high in meat consumption for one dynastic individual. Interpreted jointly, the isotopic information offers new perspectives on the provenience and lifestyles of the residents of Calakmul, including a potential place of origin for the royal occupant of chamber tomb Burial VII-1.
Knowledge of the effects of burial depth and burial duration on seed viability and, consequently, seedbank persistence of Palmer amaranth (Amaranthus palmeri S. Watson) and waterhemp [Amaranthus tuberculatus (Moq.) J. D. Sauer] ecotypes can be used for the development of efficient weed management programs. This is of particular interest, given the great fecundity of both species and, consequently, their high seedbank replenishment potential. Seeds of both species collected from five different locations across the United States were investigated in seven states (sites) with different soil and climatic conditions. Seeds were placed at two depths (0 and 15 cm) for 3 yr. Each year, seeds were retrieved, and seed damage (shrunken, malformed, or broken) plus losses (deteriorated and futile germination) and viability were evaluated. Greater seed damage plus loss averaged across seed origin, burial depth, and year was recorded for lots tested at Illinois (51.3% and 51.8%) followed by Tennessee (40.5% and 45.1%) and Missouri (39.2% and 42%) for A. palmeri and A. tuberculatus, respectively. The site differences for seed persistence were probably due to higher volumetric water content at these sites. Rates of seed demise were directly proportional to burial depth (α=0.001), whereas the percentage of viable seeds recovered after 36 mo on the soil surface ranged from 4.1% to 4.3% compared with 5% to 5.3% at the 15-cm depth for A. palmeri and A. tuberculatus, respectively. Seed viability loss was greater in the seeds placed on the soil surface compared with the buried seeds. The greatest influences on seed viability were burial conditions and time and site-specific soil conditions, more so than geographical location. Thus, management of these weed species should focus on reducing seed shattering, enhancing seed removal from the soil surface, or adjusting tillage systems.
Palmer amaranth (Amaranthus palmeri S. Watson) is a problematic weed encountered in U.S. cotton (Gossypium hirsutum L.) and soybean [Glycine max (L.) Merr.] production, with infestations spreading northward. This research investigated the influence of planting date (early, mid-, and late season) and population (AR, IN, MO, MS, NE, and TN) on A. palmeri growth and reproduction at two locations. All populations planted early or midseason at Throckmorton Purdue Agricultural Center (TPAC) and Arkansas Agriculture Research and Extension Center (AAREC) measured 196 and 141 cm or more, respectively. Amaranthus palmeri height did not exceed 168 and 134 cm when planted late season at TPAC and AAREC, respectively. Early season planted A. palmeri from NE grew to 50% of maximum height 8 to 13 d earlier than all other populations under TPAC conditions. In addition, the NE population planted early, mid-, and late season achieved 50% inflorescence emergence 5, 4, and 6 d earlier than all other populations, respectively. All populations established at TPAC produced fewer than 100,000 seeds plant−1. No population planted at TPAC and AAREC produced more than 740 and 1,520 g plant−1 of biomass at 17 and 19 wk after planting, respectively. Planting date influenced the distribution of male and female plants at TPAC, but not at AAREC. Amaranthus palmeri from IN and MS planted late season had male-to-female plant ratios of 1.3:1 and 1.7:1, respectively. Amaranthus palmeri introduced to TPAC from NE can produce up to 7,500 seeds plant−1 if emergence occurs in mid-July. An NE A. palmeri population exhibited biological characteristics allowing it to be highly competitive if introduced to TPAC due to a similar latitudinal range, but was least competitive when introduced to AAREC. Although A. palmeri originating from different locations can vary biologically, plants exhibited environmental plasticity and could complete their life cycle and contribute to spreading populations.
We deposited TaWSi amorphous metal thin films to determine how composition affects film crystallization and oxidation at high temperatures. Films were deposited by magnetron sputtering from targets of nominal compositions Ta : W : Si = 40 : 40 : 20, 30 : 50 : 20, and 30 : 30 : 40, and studied by electron probe microanalysis, electron microscopy, electrical methods, x-ray diffraction, x-ray photoelectron spectroscopy, and atomic-force microscopy. All films remained amorphous to 800 °C or higher temperatures. Films prepared from the target composition 30 : 30 : 40 yielded the film composition Ta41.7W38.4Si19.9, which retained its film integrity and amorphous structure to 1100 °C, even after annealing in air.
Adoption of soybean that is resistant to 2,4-D will result in more use of glyphosate plus 2,4-D premixes and tank mixtures. Preliminary whole-plant greenhouse assays confirm most Palmer amaranth populations found in Indiana are glyphosate-resistant (GR), and some biotypes exhibit tolerance to 2,4-D amine. Dose–response experiments were conducted to determine the level of glyphosate resistance and 2,4-D amine tolerance in four Palmer amaranth biotypes. A premix formulation of glyphosate plus 2,4-D choline was also evaluated. The R1, R2, and R3 biotypes were 31- to 66-fold more resistant to glyphosate (R:S ratio) than the S1 biotype based on the herbicide dose to cause 90% mortality (LD90). The maximum POST rate of the premix formulation of Enlist Duo® labeled in ‘Enlist®’ soybean is 2,195 g ae ha−1. When separated by active ingredient, the maximum POST rate of Enlist Duo® is equivalent to 1,141 and 1,054 g ae ha−1 of glyphosate and 2,4-D choline, respectively. In the absence of glyphosate, the maximum rate of 2,4-D (1,054 g ae ha−1) in the premix formulation of Enlist Duo® controlled S1, R2, and R3 biotypes, but failed to control all plants from the R1 biotype. Estimates for LD90 showed the R1 biotype was 3-fold more tolerant than the S1 biotype to 2,4-D amine. However, no plants survived the 1,155 g ae ha−1 (600 g ae ha−1 of glyphosate plus 555 g ae ha−1 2,4-D) treatment with the premix formulation of glyphosate plus 2,4-D choline. Overall, results from this experiment suggest GR Palmer amaranth that also exhibits increased tolerance to 2,4-D amine will be difficult to control with glyphosate or 2,4-D alone, but can be controlled POST with Enlist Duo® at lower than labeled field rates (1,618 to 2,195 g ae ha−1).
A field study was conducted for the 2014 and 2015 growing season in Arkansas, Indiana, Illinois, Missouri, Ohio, and Tennessee to determine the effect of cereal rye and either oats, radish, or annual ryegrass on the control of Amaranthus spp. when integrated with comprehensive herbicide programs in glyphosate-resistant and glufosinate-resistant soybean. Amaranthus species included redroot pigweed, waterhemp, and Palmer amaranth. The two herbicide programs included were: a PRE residual herbicide followed by POST application of foliar and residual herbicide (PRE/POST); or PRE residual herbicide followed by POST application of foliar and residual herbicide, followed by another POST application of residual herbicide (PRE/POST/POST). Control was not affected by type of soybean resistance trait. At the end of the season, herbicides controlled 100 and 96% of the redroot pigweed and Palmer amaranth, respectively, versus 49 and 29% in the absence of herbicides, averaged over sites and other factors. The PRE/POST and PRE/POST/POST herbicide treatments controlled 83 and 90% of waterhemp at the end of the season, respectively, versus 14% without herbicide. Cover crop treatments affected control of waterhemp and Palmer amaranth and soybean yield, only in the absence of herbicides. The rye cover crop consistently reduced Amaranthus spp. density in the absence of herbicides compared to no cover treatment.
Care theory's efforts to valorize care have depended upon the development of a minimally coherent conception of “care.” Despite many disagreements, there is a shared assumption that care is the Other to concepts and activities that are male‐dominated and so better paid, more powerful, and included in instead of excluded from politics. However, such an assumption ignores the other, noncaring forms of labor women do, which are likewise underpaid, exploited, and excluded from politics. This becomes a problem when care theorists propose greater inclusion for care workers, for example Joan Tronto's argument to extend citizenship on the basis of care work, because it does not consider the hierarchies it may reproduce between care and its Others, especially feminized commodity production. Using Dorothy Roberts's distinction between spiritual and menial housework, I argue that care theory is susceptible to perpetuating hierarchies among women. Extending Roberts's argument, I argue that the care/noncare division of feminized labor reproduces hierarchies among women in the Global South, and between consumers and producers. Although we do not need to abandon the category of care altogether, we do need to address care's exclusions and its relationship to other forms of feminized labor.
Background: Rumination predicts depression in adults and adolescents. The development of rumination has been linked to parenting practices, but only limited research has investigated this and research has tended to rely on self-report parenting measures. Aims: To investigate the relationship between female adolescent rumination and maternal modelling, criticism and positivity using an observational measure of parental behaviour. Method: A cross-sectional design was used. Daughters aged 16–18 years and their mothers (n = 154 dyads) completed questionnaire measures of rumination and affect. Mothers of girls with rumination scores in the upper and lower quartile (both n = 26) also completed the Five Minute Speech Sample, which was used to measure maternal criticism and positivity. Results: Mothers of low rumination girls made significantly more positive comments about their daughters than the mothers of high ruminators. Mothers made very few critical comments. Self-reported rumination was not correlated in mothers and daughters, suggesting a lack of support for the potential role of modelling. Conclusion: Overall, low maternal positivity was associated with rumination in female adolescents. There was no evidence that maternal rumination or criticism were associated with adolescent rumination. The results suggest a number of implications for future research, including the need for prospective longitudinal studies using observational parenting measures.
Because individuals develop dementia as a manifestation of neurodegenerative or neurovascular disorder, there is a need to develop reliable approaches to their identification. We are undertaking an observational study (Ontario Neurodegenerative Disease Research Initiative [ONDRI]) that includes genomics, neuroimaging, and assessments of cognition as well as language, speech, gait, retinal imaging, and eye tracking. Disorders studied include Alzheimer’s disease, amyotrophic lateral sclerosis, frontotemporal dementia, Parkinson’s disease, and vascular cognitive impairment. Data from ONDRI will be collected into the Brain-CODE database to facilitate correlative analysis. ONDRI will provide a repertoire of endophenotyped individuals that will be a unique, publicly available resource.
Because polarization encodes geometrical information about unresolved scattering regions, it provides a unique tool for analyzing the 3-D structures of supernovae (SNe) and their surroundings. SNe of all types exhibit time-dependent spectropolarimetric signatures produced primarily by electron scattering. These signatures reveal physical phenomena such as complex velocity structures, changing illumination patterns, and asymmetric morphologies within the ejecta and surrounding material. Interpreting changes in polarization over time yields unprecedentedly detailed information about supernovae, their progenitors, and their evolution.
Begun in 2012, the SNSPOL Project continues to amass the largest database of time-dependent spectropolarimetric data on SNe. I present an overview of the project and its recent results. In the future, combining such data with interpretive radiative transfer models will further constrain explosion mechanisms and processes that shape SN ejecta, uncover new relationships among SN types, and probe the properties of progenitor winds and circumstellar material.
Skeletal remains from a burial in New South Wales exhibit evidence of fatal
trauma, of a kind normally indicative of sharp metal weapons, yet the burial
dates to the mid thirteenth century—600 years before European settlers
reached the area. Could sharp-edged wooden weapons from traditional
Aboriginal culture inflict injuries similar to those resulting from later,
metal blades? Analysis indicates that the wooden weapons known as
‘Lil-lils’ and the fighting boomerangs
(‘Wonna’) both have blades that could fit within the
dimensions of the major trauma and are capable of having caused the fatal