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Previous genetic association studies have failed to identify loci robustly associated with sepsis, and there have been no published genetic association studies or polygenic risk score analyses of patients with septic shock, despite evidence suggesting genetic factors may be involved. We systematically collected genotype and clinical outcome data in the context of a randomized controlled trial from patients with septic shock to enrich the presence of disease-associated genetic variants. We performed genomewide association studies of susceptibility and mortality in septic shock using 493 patients with septic shock and 2442 population controls, and polygenic risk score analysis to assess genetic overlap between septic shock risk/mortality with clinically relevant traits. One variant, rs9489328, located in AL589740.1 noncoding RNA, was significantly associated with septic shock (p = 1.05 × 10–10); however, it is likely a false-positive. We were unable to replicate variants previously reported to be associated (p < 1.00 × 10–6 in previous scans) with susceptibility to and mortality from sepsis. Polygenic risk scores for hematocrit and granulocyte count were negatively associated with 28-day mortality (p = 3.04 × 10–3; p = 2.29 × 10–3), and scores for C-reactive protein levels were positively associated with susceptibility to septic shock (p = 1.44 × 10–3). Results suggest that common variants of large effect do not influence septic shock susceptibility, mortality and resolution; however, genetic predispositions to clinically relevant traits are significantly associated with increased susceptibility and mortality in septic individuals.
Vitamin K has important physiological functions which relate to blood coagulation (its classical role), bone health, inhibition of arterial calcification, as well as anti-inflammatory effects. National nutrition survey data have shown that over half of all adults in Ireland and the UK have low vitamin K1 intakes (£1 μg/kg body weight/d). Vitamin K biofortification of food may be an important complementary food-based approach for improving vitamin K intakes. Our study aimed to explore the feasibility of producing vitamin K-biofortified eggs via increasing the vitamin K3 content of the hen diet, and to examine any effects on hen performance and egg/eggshell quality parameters. A 12-week hen feeding trial was conducted in the Agri-Food and Biosciences Institute, Belfast, UK. Hyline chickens (n = 128) were randomized into 4 treatment (T) groups (n = 32 hens/group) and fed diets containing 3 (T1-industry standard), 12.9 (T2), 23.7 (T3) and 45.7 (T4) mg vitamin K3/kg of feed. Hens were provided feed ad libitum and feed intake was recorded weekly. Eggs were collected daily and weighed. While egg quality and vitamin K content was assessed at week 0, 4, 6, 8 and 12, the trial endpoint (week 12) data was prioritized for the current analysis. Total vitamin K content (i.e., vitamin K1 plus menaquinone (MK)-4 and MK-7) of composite samples (n = 12 eggs/treatment), measured using a novel, sensitive liquid chromatography-mass spectrometry method at Teagasc, increased from 22.4 μg/100 g (whole egg) in T1 (control and commercial level of vitamin K3) to 57.8 μg/100 g in T4. MK-4 was the most abundant form of vitamin K found in the eggs. Eggshell weight and eggshell thickness in T2 and T3 (but not T4) were significantly higher than in T1 (by 20–28%, P < 0.05). Likewise, based on colourimetric assessment, yellowness (parameter b*) of the egg yolk in all three biofortified groups was significantly higher compared to T1 (by 27–45%, P < 0.05). Haugh unit of the eggs and hen performance parameters, such as feed intake, feed conversion ratio and egg production, were unaffected by vitamin K-biofortification. In conclusion, increasing the level of addition of vitamin K3 to hen feed significantly increased the total vitamin K content of eggs, and without any evidence of negative effects on egg quality or hen performance. Consumption of an average sized (60 g) vitamin K-biofortified egg could contribute an additional 35 μg total vitamin K. The effects on eggshell parameters could be of importance in terms of revenue loss due to breakages.
We analyze individual white dwarfs in open clusters observed by Gaia. In particular, we determine ages when different model ingredients are used. We also explore fundamental properties of the white dwarfs, including temperature and mass, when using different filter combinations. Such tests are important to understanding any systematic effects when applying similar techniques to field stars.
We employ Pan-STARRS photometry, Gaia trigonometric parallaxes, modern stellar evolution and atmosphere models, and our Bayesian fitting approach to determine cooling and total ages for 159,238 white dwarfs. In many cases we are able to derive precise ages (better than 5%) for individual white dwarfs. These results are meant for broad use within the white dwarf and stellar astrophysics communities and we plan to make available on-line the posterior distributions for cooling age, total age, initial stellar mass, and other parameters.
Chronic aggression and violence in schizophrenia are rare, but receive disproportionate negative media coverage. This contributes to the stigma of mental illness and reduces accessibility to mental health services. Substance Use Disorders (SUD), antisocial behavior, non-adherence and recidivism are known risk factors for violence. Treatment with antipsychotic medication can reduce violence. Aside from clozapine, long-acting injectable antipsychotics (LAI) appear to be superior to oral antipsychotics for preventing violence, addressing adherence and recidivism. LAI also facilitate the implementation of functional skills training. For the high-risk recidivist target population with schizophrenia, better life skills have the potential to also reduce the risk for contact with the legal system, including an improved ability to live independently in supported environments and interact appropriately with others. High-risk patients who are resistant to treatment with other antipsychotics should receive treatment with clozapine due to its direct positive effects on impulsive violence, along with a reduction in comorbid risk factors such as SUDs.
To sustainably improve cleaning of high-touch surfaces (HTSs) in acute-care hospitals using a multimodal approach to education, reduction of barriers to cleaning, and culture change for environmental services workers.
The study was conducted in 2 academic acute-care hospitals, 2 community hospitals, and an academic pediatric and women’s hospital.
Frontline environmental services workers.
A 5-module educational program, using principles of adult learning theory, was developed and presented to environmental services workers. Audience response system (ARS), videos, demonstrations, role playing, and graphics were used to illustrate concepts of and the rationale for infection prevention strategies. Topics included hand hygiene, isolation precautions, personal protective equipment (PPE), cleaning protocols, and strategies to overcome barriers. Program evaluation included ARS questions, written evaluations, and objective assessments of occupied patient room cleaning. Changes in hospital-onset C. difficile infection (CDI) and methicillin-resistant S. aureus (MRSA) bacteremia were evaluated.
On average, 357 environmental service workers participated in each module. Most (93%) rated the presentations as ‘excellent’ or ‘very good’ and agreed that they were useful (95%), reported that they were more comfortable donning/doffing PPE (91%) and performing hand hygiene (96%) and better understood the importance of disinfecting HTSs (96%) after the program. The frequency of cleaning individual HTSs in occupied rooms increased from 26% to 62% (P < .001) following the intervention. Improvement was sustained 1-year post intervention (P < .001). A significant decrease in CDI was associated with the program.
A novel program that addressed environmental services workers’ knowledge gaps, challenges, and barriers was well received and appeared to result in learning, behavior change, and sustained improvements in cleaning.