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Approximate groups have shot to prominence in recent years, driven both by rapid progress in the field itself and by a varied and expanding range of applications. This text collects, for the first time in book form, the main concepts and techniques into a single, self-contained introduction. The author presents a number of recent developments in the field, including an exposition of his recent result classifying nilpotent approximate groups. The book also features a considerable amount of previously unpublished material, as well as numerous exercises and motivating examples. It closes with a substantial chapter on applications, including an exposition of Breuillard, Green and Tao's celebrated approximate-group proof of Gromov's theorem on groups of polynomial growth. Written by an author who is at the forefront of both researching and teaching this topic, this text will be useful to advanced students and to researchers working in approximate groups and related areas.
In January of 2010, North Carolina (NC) USA implemented state-wide Trauma Triage Destination Plans (TTDPs) to provide standardized guidelines for Emergency Medical Services (EMS) decision making. No study exists to evaluate whether triage behavior has changed for geriatric trauma patients.
The impact of the NC TTDPs was investigated on EMS triage of geriatric trauma patients meeting physiologic criteria of serious injury, primarily based on whether these patients were transported to a trauma center.
This is a retrospective cohort study of geriatric trauma patients transported by EMS from March 1, 2009 through September 30, 2009 (pre-TTDP) and March 1, 2010 through September 30, 2010 (post-TTDP) meeting the following inclusion criteria: (1) age 50 years or older; (2) transported to a hospital by NC EMS; (3) experienced an injury; and (4) meeting one or more of the NC TTDP’s physiologic criteria for trauma (n = 5,345). Data were obtained from the Prehospital Medical Information System (PreMIS). Data collected included proportions of patients transported to a trauma center categorized by specific physiologic criteria, age category, and distance from a trauma center.
The proportion of patients transported to a trauma center pre-TTDP (24.4% [95% CI 22.7%-26.1%]; n = 604) was similar to the proportion post-TTDP (24.4% [95% CI 22.9%-26.0%]; n = 700). For patients meeting specific physiologic triage criteria, the proportions of patients transported to a trauma center were also similar pre- and post-TTDP: systolic blood pressure <90 mmHg (22.5% versus 23.5%); respiratory rate <10 or >29 (23.2% versus 22.6%); and Glascow Coma Scale (GCS) score <13 (26.0% versus 26.4%). Patients aged 80 years or older were less likely to be transported to a trauma center than younger patients in both the pre- and post-TTDP periods.
State-wide implementation of a TTDP had no discernible effect on the proportion of patients 50 years and older transported to a trauma center. Under-triage remained common and became increasingly prevalent among the oldest adults. Research to understand the uptake of guidelines and protocols into EMS practice is critical to improving care for older adults in the prehospital environment.
We implemented a guideline for appropriate acid suppressant use in hematology-oncology patients. This intervention resulted in a sustained reduction in proton pump inhibitor (PPI) use without an increase in rates of gastrointestinal bleeding. Practice guidelines are effective in reducing PPI use, which is associated with risk of Clostridioides difficile infection.
Determine the effectiveness of a personal protective equipment (PPE)-free zone intervention on healthcare personnel (HCP) entry hand hygiene (HH) and PPE donning compliance in rooms of patients in contact precautions.
Quasi-experimental, multicenter intervention, before-and-after study with concurrent controls.
All patient rooms on contact precautions on 16 units (5 medical-surgical, 6 intensive care, 5 specialty care units) at 3 acute-care facilities (2 academic medical centers, 1 Veterans Affairs hospital). Observations of PPE donning and entry HH compliance by HCP were conducted during both study phases. Surveys of HCP perceptions of the PPE-free zone were distributed in both study phases.
A PPE-free zone, where a low-risk area inside door thresholds of contact precautions rooms was demarcated by red tape on the floor. Inside this area, HCP were not required to wear PPE.
We observed 3,970 room entries. HH compliance did not change between study phases among intervention units (relative risk [RR], 0.92; P = .29) and declined in control units (RR, 0.70; P = .005); however, the PPE-free zone did not significantly affect compliance (P = .07). The PPE-free zone effect on HH was significant only for rooms on enteric precautions (P = .008). PPE use was not significantly different before versus after the intervention (P = .15). HCP perceived the zone positively; 65% agreed that it facilitated communication and 66.8% agreed that it permitted checking on patients more frequently.
HCP viewed the PPE-free zone favorably and it did not adversely affect PPE or HH compliance. Future infection prevention interventions should consider the complex sociotechnical system factors influencing behavior change.
An automated- electron microprobe system using an on-line 8,000 word minicomputer has been designed. The general principles and need for such a system is discussed. The microprobe-computer interface hardware consists of computer addressable axis positioners, scalers, timer and a digital to analog converter. The axis positioners are used to position the spectrometers and specimen stage, whereas the digital to analog converter is used to position the electron beam in a 1000 × 1000 point matrix. The digital to analog converter is also used to drive a X-Y recorder for computer plotting of calibration curves, pulse amplitude distributions, X-ray line profiles and wavelength scans. System software is written in the interactive CLASS language which was designed specifically for laboratory instrument control. The language permits large computer programs to be chained through a minicomputer while passing variables from one function to the next. The operating software consists of automatic peak location, sequencing of data collection, statistical analysis of data, and correction of data for fluorescence, absorption and atomic number effects. An automated quantitative analysis of several copper-gold alloys and a computerized test for specimen homogeneity is described to demonstrate system operation. Future automation considerations are also discussed.
Aluminum film conducting stripes are widely used for semiconductor device interconnection networks. The addition of a low percentage of copper significantly increases their life. Composition must be controlled to maintain product quality.
The paper discusses various methods used to analyze the copper composition in the aluminum films, and adaptation of one of these methods for process control application. A portable instrument designed for field use was adapted for use as an on-line instrument.
Based on the experimentally determined framework structure of porous MnO2 octahedral molecular sieve (OMS)-5, we used density functional theory-based calculations to evaluate the effect of Na+ cation on pore dimensionality and structural stability, and the interaction between CO2 and OMS-5. We quantified the formation energy of one CO2/unit tunnel and two CO2/unit tunnel, and projected the electronic density of states on the OMS-5 framework, CO2 molecules, and Na+ cations to reveal their individual contributions and bonding nature. Partial charge densities were also calculated to investigate CO2 adsorption behavior in the OMS-5. Our studies predict the initial stage and driving force for the adsorption of CO2 in the OMS-5, guiding the OMS material design for carbon capture and storage applications.
Medical procedures and patient care activities may facilitate environmental dissemination of healthcare-associated pathogens such as methicillin-resistant Staphylococcus aureus (MRSA).
Observational cohort study of MRSA-colonized patients to determine the frequency of and risk factors for environmental shedding of MRSA during procedures and care activities in carriers with positive nares and/or wound cultures. Bivariate analyses were performed to identify factors associated with environmental shedding.
A Veterans Affairs hospital.
This study included 75 patients in contact precautions for MRSA colonization or infection.
Of 75 patients in contact precautions for MRSA, 55 (73%) had MRSA in nares and/or wounds and 25 (33%) had positive skin cultures. For the 52 patients with MRSA in nares and/or wounds and at least 1 observed procedure, environmental shedding of MRSA occurred more frequently during procedures and care activities than in the absence of a procedure (59 of 138, 43% vs 8 of 83, 10%; P < .001). During procedures, increased shedding occurred ≤0.9 m versus >0.9 m from the patient (52 of 138, 38% vs 25 of 138, 18%; P = .0004). Contamination occurred frequently on surfaces touched by personnel (12 of 38, 32%) and on portable equipment used for procedures (25 of 101, 25%). By bivariate analysis, the presence of a wound with MRSA was associated with shedding (17 of 29, 59% versus 6 of 23, 26%; P = .04).
Environmental shedding of MRSA occurs frequently during medical procedures and patient care activities. There is a need for effective strategies to disinfect surfaces and equipment after procedures.
Outcome analyses in large administrative databases are ideal for rare diseases such as Becker and Duchenne muscular dystrophy. Unfortunately, Becker and Duchenne do not yet have specific International Classification of Disease-9/-10 codes. We hypothesised that an algorithm could accurately identify these patients within administrative data and improve assessment of cardiovascular morbidity.
Hospital discharges (n=13,189) for patients with muscular dystrophy classified by International Classification of Disease-9 code: 359.1 were identified from the Pediatric Health Information System database. An identification algorithm was created and then validated at three institutions. Multi-variable generalised linear mixed-effects models were used to estimate the associations of length of stay, hospitalisation cost, and 14-day readmission with age, encounter severity, and respiratory disease accounting for clustering within the hospital.
The identification algorithm improved identification of patients with Becker and Duchenne from 55% (code 359.1 alone) to 77%. On bi-variate analysis, left ventricular dysfunction and arrhythmia were associated with increased cost of hospitalisation, length of stay, and mortality (p<0.001). After adjustment, Becker and Duchenne patients with left ventricular dysfunction and arrhythmia had increased length of stay with rate ratio 1.4 and 1.2 (p<0.001 and p=0.004) and increased cost of hospitalization with rate ratio 1.4 and 1.4 (both p<0.001).
Our algorithm accurately identifies patients with Becker and Duchenne and can be used for future analysis of administrative data. Our analysis demonstrates the significant effects of cardiovascular disease on length of stay and hospitalisation cost in patients with Becker and Duchenne. Better recognition of the contribution of cardiovascular disease during hospitalisation with earlier more intensive evaluation and therapy may help improve outcomes in this patient population.
Childhood maltreatment is one of the strongest predictors of adulthood depression and alterations to circulating levels of inflammatory markers is one putative mechanism mediating risk or resilience.
To determine the effects of childhood maltreatment on circulating levels of 41 inflammatory markers in healthy individuals and those with a major depressive disorder (MDD) diagnosis.
We investigated the association of childhood maltreatment with levels of 41 inflammatory markers in two groups, 164 patients with MDD and 301 controls, using multiplex electrochemiluminescence methods applied to blood serum.
Childhood maltreatment was not associated with altered inflammatory markers in either group after multiple testing correction. Body mass index (BMI) exerted strong effects on interleukin-6 and C-reactive protein levels in those with MDD.
Childhood maltreatment did not exert effects on inflammatory marker levels in either the participants with MDD or the control group in our study. Our results instead highlight the more pertinent influence of BMI.
Declaration of interest
D.A.C. and H.W. work for Eli Lilly Inc. R.N. has received speaker fees from Sunovion, Jansen and Lundbeck. G.B. has received consultancy fees and funding from Eli Lilly. R.H.M.-W. has received consultancy fees or has a financial relationship with AstraZeneca, Bristol-Myers Squibb, Cyberonics, Eli Lilly, Ferrer, Janssen-Cilag, Lundbeck, MyTomorrows, Otsuka, Pfizer, Pulse, Roche, Servier, SPIMACO and Sunovian. I.M.A. has received consultancy fees or has a financial relationship with Alkermes, Lundbeck, Lundbeck/Otsuka, and Servier. S.W. has sat on an advisory board for Sunovion, Allergan and has received speaker fees from Astra Zeneca. A.H.Y. has received honoraria for speaking from Astra Zeneca, Lundbeck, Eli Lilly, Sunovion; honoraria for consulting from Allergan, Livanova and Lundbeck, Sunovion, Janssen; and research grant support from Janssen. A.J.C. has received honoraria for speaking from Astra Zeneca, honoraria for consulting with Allergan, Livanova and Lundbeck and research grant support from Lundbeck.
Patients with Parkinson’s disease psychosis (PDP) are often treated with an atypical antipsychotic, especially quetiapine or clozapine, but side effects, lack of sufficient efficacy, or both may motivate a switch to pimavanserin, the first medication approved for management of PDP. How best to implement a switch to pimavanserin has not been clear, as there are no controlled trials or case series in the literature to provide guidance. An abrupt switch may interrupt partially effective treatment or potentially trigger rebound effects from antipsychotic withdrawal, whereas cross-taper involves potential drug interactions. A panel of experts drew from published data, their experience treating PDP, lessons from switching antipsychotic drugs in other populations, and the pharmacology of the relevant drugs, to establish consensus recommendations. The panel concluded that patients with PDP can be safely and effectively switched from atypical antipsychotics used off label in PDP to the recently approved pimavanserin by considering each agent’s pharmacokinetics and pharmacodynamics, receptor interactions, and the clinical reason for switching (efficacy or adverse events). Final recommendations are that such a switch should aim to maintain adequate 5-HT2A antagonism during the switch, thus providing a stable transition so that efficacy is maintained. Specifically, the consensus recommendation is to add pimavanserin at the full recommended daily dose (34 mg) for 2–6 weeks in most patients before beginning to taper and discontinue quetiapine or clozapine over several days to weeks. Further details are provided for this recommendation, as well as for special clinical circumstances where switching may need to proceed more rapidly.
If 2015 saw the largest wave of migration to Europe since the Second World War, 2016 might be defined as the year of migration policy responses. While the mass movement of human beings across the Mediterranean Sea and the southern borders of Europe garnered unprecedented global attention in 2015, many analysts turned their attention to the ensuing financial costs, not so much for the countries migrants left, but for the various Southern European and North Atlantic nations to which they fled. The extent of the financial crisis was particularly evident in the success of a popular referendum (colloquially called “Brexit”), which called for the United Kingdom to leave the European Union in order to gain greater control over its borders. Donald J. Trump echoed the rhetoric of crisis in his proposal to build a wall along the United States’ southern border—and then bill Mexico for its construction—as did UK Prime Minister David Cameron in his proposal to expel immigrants whose income was deemed inadequate for contributing to national prosperity. Gestures like these imply that the economic underdevelopment of the global South, the outbreak of civil war in relatively poor countries, and the rise of international terror organizations like the so-called Islamic State are problems for the world's largest economies to the degree that they strain national budgets, which are meant to serve national citizens. In the rhetoric of crisis, migrants are depicted as liabilities more often than fellow citizens of the world, and they are rarely depicted as potential new laborers, taxpayers, or innovators in the global North. As an article in the Atlantic suggested, the “crisis” was less about migration and more about the status of the modern welfare state and its relationship to the increasingly global movement of labor and the bodies that perform it. Indeed, at the heart of the Brexit decision, and the rise of other nationalist policy positions around the world, is an important question about who is responsible for ensuring that ordinary people have access to work and social security in an increasingly interconnected world. Are welfare states responsible only to their natural-born citizens? What about the external workers and resources upon which the economies of welfare states rely? The 2016 immigration crisis raises a critical and productive question for social and cultural theory: What is the relationship between the concept of the welfare state and the concept of borders?
In the Upper Mississippi River Region, invasive faucet snails (Bithynia tentaculata) and their trematode parasites have been implicated in more than 182 000 waterfowl deaths since 1996. Estimating transmission potential depends on accurate assessments of susceptible host population size. However, little is known about the mechanisms underlying snail–host susceptibility in this system. Prior field studies suggest that very small, likely young, faucet snails are less suitable secondary intermediate hosts. Here, we test whether the patterns observed in the field are because small snails (1) are refractory to infection by cercariae, (2) die from infection and are removed from sampled populations, and/or (3) are not preferred by cercariae. Our own field collections were consistent with the observation that smaller faucet snails exhibit lower metacercarial infection prevalence and abundance than larger snails. However, laboratory-based experiments show that smaller snails were actually more susceptible to infection than larger snails. Moreover, the smallest snail size class had significantly higher mortality than larger snails following infection, which may explain their reduced infection levels observed in the field. Our study demonstrates the importance of pairing field and laboratory studies to better understand mechanisms underlying patterns of infection.
Our current global food system – from food production to consumption, including manufacture, packaging, transport, retail and associated businesses – is responsible for extensive negative social and environmental impacts which threaten the long-term well-being of society. This has led to increasing calls from science–policy organizations for major reform and transformation of the global food system. However, our knowledge regarding food system transformations is fragmented and this is hindering the development of co-ordinated solutions. Here, we collate recent research across several academic disciplines and sectors in order to better understand the mechanisms that ‘lock-in’ food systems in unsustainable states.
IN THE FINAL DECADES Of the eighteenth century, writers regularly borrowed fictional characters invented by other authors for use in their own texts. Most commonly, these works took the form of sequels—what German contemporaries dubbed “Fortsetzungen einer fremden Hand” (continuations by another hand), and what this article names “appropriative sequels.” In the absence of formal legal regulation, many authors felt free to write such texts, including Goethe. But little work has been done to understand this surprisingly widespread writing practice, particularly in light of the commercial realities of the German theater. As William Hinrichs recently put it: “We do not know what to call these sequels; we do not know how to talk about them; we do not know how they function; and we do not know why people read and write them.” Turning to Goethe begins to provide answers.
It is well known that Goethe was preoccupied with sequels; after all, he devoted much of his literary life to Faust II, as well as sequels to Wilhelm Meister, Des Künstlers Erdewallen (1773) and Des Künstlers Vergötterung (1774). Fewer scholars have noted, however, that Goethe also made something of a habit of writing sequels to other authors’ works. Between 1793 and 1806, Goethe began Die Aufgeregten (1793), conceived with Schiller a sequel to Die Hagestolzen (sometime between 1793 and 1805), and published two sequels: Der Bürgergeneral (1793) and Der Zauberflöte, Zweyter Theil (begun in 1795, and first published in 1806). Goethe wrote his appropriative sequels when he was faced with new pressures as director of the Weimar Court Theater and increasingly conscious of the market value of literature.
Taken together, Der Bürgergeneral and Der Zauberflöte, Zweyter Theil offer new insights into the business of appropriative stage sequels. To date, scholarship has overlooked the self-reflexivity of Goethe's Zauberflöte and its own observation of sequels on the German stage. Analyzing Der Zauberflöte,
Zweyter Theil as an aesthetic comment on appropriative sequels offers a new reading of Goethe's perplexing libretto and helps explain why these texts proliferated around 1800. Furthermore, studying the reception of Der Bürgergeneral, a sequel to Heyne's Die beiden Billets (1782), illuminates how the issues raised in Goethe's Zauberflöte sequel played out in the literary field, highlighting the uncontainable nature of these works.