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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.
The DSM-5 describes personality disorders (PDs) as emerging in early life and remaining continuous throughout the life-span. Yet case studies and expert opinion support the existence of late-onset PDs. Little is known about PDs in late life, and our instruments for assessing them are not well validated. Thus, the focus of this exploratory Delphi study was the late-onset PD, with special attention to the accuracy of the core criteria for the diagnosis.
A Delphi study was designed to assess the presentation of PDs in late life. The Delphi consisted of three successive rounds of inquiry. Between rounds, the participants were provided with a summary of the panel’s responses.
A panel of 21 experts included published authors, researchers, and teachers from the USA, the UK, Australia, France, Belgium, and the Netherlands.
Researchers designed a survey that included an introduction, a demographic questionnaire, and five questions that varied in presentation and response format.
Experts reached consensus that a variant of PD appears de novo in old age. The core features of inflexibility and pervasiveness may not pertain to late-onset PD. There was agreement that frequently occurring life events contribute selectively to the expression of late-onset PD, with the major ones being death of a spouse or partner and transition to a nursing or assisted-living facility.
Nearly all participants took the position that PD can present for the first time in old age and be clinically identifiable without having been so identified earlier in life.
Our focus is upon problems of periodization in Belorussian and Ukrainian history. It is tempting, and perhaps even useful, at the outset of this commentary to speculate on what would be the problems addressed in a discussion of this subject had the 1917 revolution resulted in genuine national independence for the main nationalities of the Russian Empire, followed by nearly sixty years of relatively free scholarship within the context of democratic societies. Probably the early period would not have been too different from what actually occurred in the Soviet Union, with a considerable flourishing of the various national historiographies and with vigorous research into the unique elements of the particular national heritage. Indeed, we have the example of the inter-war Baltic states before us which seems to support such speculation.
Molecular characterization of pediatric low-grade glioma (pLGG) over the last decade has identified recurrent alterations, most commonly involving BRAF, and less frequently other pathways including MYB and MYBL1. Many of these molecular markers have been exploited clinically to aid in diagnosis and treatment decisions. However, their frequency and prognostic significance remain unknown. Further, a significant portion of cases do not have any of these alterations and what underlies these cases remains unknown. To address this we compiled a cohort of 562 patients diagnosed at SickKids from 1990-2017. We identified molecular alterations in 454 cases (81% of the cohort). The most frequent events were those involving BRAF; either as fusions (most commonly with KIAA1549 (30%)) or V600E mutations (17%) and NF-1 (22%). Less frequently, we identified recurrent FGFR1 fusions and mutations (3%), MYB/MYBL alterations (2%), H3F3AK27M (2%) or IDH1R132H (0.5%) mutations, as well as other novel rare events. Survival analysis revealed significantly better progression-free survival (PFS) and overall survival (OS) of KIAA1549-BRAF fused patients compared to BRAFV600E with 10-year OS 97.7% (95%, CI 95.5-100) and 83.9% (95%, CI 72.5-95.6), respectively. In addition to survival, molecular alterations predicted differences in response to conventional therapeutics; BRAF fused patients showed a 46% response-rate, versus only 14% in V600E patients. pLGGs harboring H3F3AK27M progressed early with median PFS of 11 months. In patients with MYB/MYBL1, FGFR1/FGFR2 alterations, we observed only one death (FGFR1N546K case). The work here represents the largest cohort of pLGGs with molecular profiling and their impact on the clinical behaviour of the disease.
A complete copy of the compressed COSMOS/UKST Southern Sky Object Catalogue is now available on-line at the Anglo-Australian Observatory and the Australia Telescope National Facility. The catalogue lists image parameters for all objects detected to a limit of BJ ≈ 21·5 in the UK Schmidt Southern Sky Survey. We have written software to access the catalogue efficiently and generate finding charts or text listings of the image parameters. In this paper we describe the software and give some examples of its use. We also discuss the astrometric precision of the catalogue.
We present the largest homogeneous survey of redshift > 4.4 damped Lyα systems (DLAs) using the spectra of 163 quasars that comprise the Giant Gemini GMOS (GGG) survey. With this survey we make the most precise high-redshift measurement of the cosmological mass density of neutral hydrogen, ΩHI. After correcting for systematic effects using a combination of mock and higher-resolution spectra, we find ΩHI= 0.98+0.20-0.18 × 10−3 at 〈z〉 = 4.9, assuming a 20% contribution from lower column density systems below the DLA threshold. By comparing to literature measurements at lower redshifts, we show that ΩHI can be described by the functional form ΩHI(z) ∝ (1 + z)0.4. This gradual decrease from z = 5 to 0 suggests that in the galaxies which dominate the cosmic star formation rate, Hi is a transitory gas phase fuelling star formation which must be continually replenished by more highly-ionized gas from the intergalactic medium, and from recycled galactic winds.
Nutrition labels are an essential source for consumers to obtain nutrition-related information on food products and serve as a population-level intervention with unparalleled reach. The present study systematically reviewed existing evidence on the correlates of nutrition label use among college students and young adults.
Keyword and reference searches were conducted in PubMed, EBSCO, PsycInfo, Cochrane Library and Web of Science. Inclusion criteria included: study design (randomized controlled trial, cohort study, pre–post study or cross-sectional study); population (college students and young adults 18–30 years old); main outcome (nutrition label use); article type (peer-reviewed publication); and language (English).
College students and young adults.
Sixteen studies based on data from college surveys in four countries (USA, UK, Canada, South Korea) were identified from keyword and reference search. Reported prevalence of nutrition label use varied substantially across studies; a weighted average calculation showed 36·5 % of college students and young adults reported using labels always or often. Females were more likely to use nutrition labels than males. Nutrition label use was found to be associated with attitudes towards healthy diet, beliefs on the importance of nutrition labels in guiding food selection, self-efficacy, and nutrition knowledge and education.
The impact of nutrition labelling on food purchase and intake could differ by population subgroups. Nutrition awareness campaigns and education programmes may be important mechanisms for promoting nutrition label use among college students and young adults. Future research is warranted to assess the role of label use on improved dietary decisions.
An increasing number of middle-aged and older Americans are using social network sites (SNSs), but little research has addressed how SNS use is associated with social wellbeing outcomes in this population. Using a nationally representative sample of 1,620 Americans older than 50 from the 2012 Health and Retirement Study (HRS), we examine the relationship between older adults’ SNS use and social wellbeing associated with non-kin and kin relations and explore how these associations vary by age. Results of ordinary least-squares regression analyses suggest that SNS use is positively associated with non-kin-related social wellbeing outcomes, including perceived support from friends (β = 0.13; p < 0.001; N = 460) and feelings of connectedness (β = 0.10; p < 0.001; N = 463). Regression models employing interaction terms of age and SNS use further reveal that SNS use contributes to feelings of connectedness to a greater extent as people age (β = 0.10; p < 0.001; N = 463). Of all kin-related social wellbeing outcomes, SNS use only predicts increased perceived support from children (β = 0.08; p < 0.05; N = 410), and age negatively shapes this relationship (β = −0.14; p < 0.001; N = 410). As older people engage with an increasingly smaller and narrower network with a greater proportion of kin contacts, our results suggest that SNS use may help older adults access differential social benefits throughout later life.
This case of a 65-year-old male with dermatillomania, diffuse anxiety symptoms, and avoidant personality disorder (PD) illustrates the interference of attention-deficit hyperactivity disorder (ADHD) in the diagnostic process and during schema-focused therapy. In conclusion, ADHD in older adults and interference with PD is a subject of clinical importance and worth further investigation.
Two alkali-tin-silicate (ATS) glasses have been prepared at Argonne National
Laboratory (ANL) as part of our ongoing research in radioactive waste glass
development. These glasses dissolved 5% and approximately 7% Pu. Early
corrosion test results indicate that Pu-bearing ATS glass is extremely
durable. The initial goal in this project concerned equally both the
solubility of Pu and the durability of the ATS glasses; however, our primary
emphasis has changed recently to maximizing the loading of Pu in the glass.
ATS-based glasses, using Th(VI) and Ce(III) as surrogates for Pu(IV), are
now being investigated to increase the solubility of Pu without
substantially sacrificing the durability of the current ATS formulations.
The solution data from various corrosion tests on the original Pu-containing
ATS glasses are also presented.
Field, petrographic and geochemical evidence from the K-feldspar megacrystic Kameruka pluton, Lachlan Fold Belt, southeastern Australia, suggests that complex, multicomponent, mafic microgranular enclaves (MME) are produced by two-stage hybridisation processes. Stage 1 mixing occurs in composite dykes below the pluton, as mafic and silicic melts ascend through shared conduits. Pillows formed in these conduits are homogeneous, fine-to medium-grained stage 1 MME, which typically range from basaltic to granitic compositions that plot as a sublinear array on Harker diagrams. Stage 2 hybridisation occurs in the magma chamber when the composite dykes mix with the resident magma as synplutonic dykes. The stage 2 hybrids also form linear chemical arrays and range from basaltic to granodioritic compositions, the latter resembling the more mafic phases of the pluton. Stage 2 MME are distinguished from stage 1 types by the presence of K-feldspar xenocrysts and a more heterogeneous nature: they commonly contain stage 1 enclaves. Subsequent disaggregation and dispersal of stage 2 hybrid synplutonic dykes within the magma chamber produces a diverse array of multi-component MME.
Field evidence for conduit mixing is consistent with published analogue experimental studies, which show that hybrid thermo-mechanical boundary layers (TMBL) develop between mafic and silicic liquids in conduits. A mechanical mixing model is developed, suggesting that the TMBL expands and interacts with the adjacent contrasting melts during flow, producing an increasing compositional range of hybrids with time that are mafic in the axial zone, grading to felsic in the peripheral zones in the conduit. Declining flow rates in the dyke and cooling of the TMBL zones produce a pillowing sequence progressing from mafic to felsic, which explains the general observation of more MME in more silicic hosts.
The property of granitic magmas to undergo transient brittle failure in seismic regimes allows analogies with fractured solids to be drawn. The fracture network in granitic magmas consists of through-going ‘backbone’ mafic and silicic ± composite dykes, and smaller ‘dangling’ granitic dykes locally generated in the magma chamber. Stage 1 hybrids form in composite backbone dykes and stage 2 hybrids form where they intersect dangling dykes in the magma chamber. With subsequent shear stress recovery, the host magma chamber reverts to a visco-plastic material capable of flow, resulting in disaggregation and dispersal of these complex, hybrid synplutonic dykes, and a vast array of double and multicomponent enclaves potentially develop in the pluton.