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Introduction: Cognitive processing theories postulate that decision making depends on both fast and slow thinking. Experienced physicians (EPs) make diagnoses quickly and with less effort by using fast, intuitive thinking, whereas inexperienced medical students rely on slow, analytical thinking. This study used a cognitive task analysis to examine EPs cognitive processes and ability to provide knowledge translation to learners. Methods: A novel mind mapping approach was used to examine how EPs translate their clinical reasoning to learners, when evaluating a patient for a possible venous thromboembolism (VTE). Nine EPs were interviewed and shown two different videos of a medical student patient interview (randomized from six possible videos). Results: EPs were asked to demonstrate their clinical approach to the scenario using a mind map, assuming they were teaching a learner in the Emergency Department. EPs were later re-interviewed to examine response stability, and given the opportunity to make clarifying or substantive mind map modifications. Maps were broken into component pieces and analyzed using mixed-methods techniques. A mean of 15.7 component pieces were identified within each mind map (standard deviation (SD) 7.8). Maps were qualitatively coded, with a mean of 2.8 clarifying amendments (e.g. adding a time course caveat) (SD 1.5-5.75) and 4.4 substantive modifications (e.g. changing the flow of the map) (SD 2-5). Conclusion: Resulting mind maps displayed significant heterogeneity in teaching points and the degree to which EPs used slow thinking. EPs frequently made fast thinking jumps, although learners could prompt slow thinking by questioning unclear points. This is particularly important as learners engage in cognitive apprenticeship throughout their training. An improved understanding of EPs cognitive processes through mind mapping will allow learners to improve their own clinical reasoning (Merrit et al., 2017). Educating EPs on these processes will allow modification of their teaching styles to better suit learners.
Research consistently demonstrates that common polymorphic variation in monoamine oxidase A (MAOA) moderates the influence of childhood maltreatment on later antisocial behavior, with growing evidence that the “risk” allele (high vs. low activity) differs for females. However, little is known about how this Gene × Environment interaction functions to increase risk, or if this risk pathway is specific to antisocial behavior. Using a prospectively assessed, longitudinal sample of females (n = 2,004), we examined whether changes in emotional reactivity (ER) during adolescence mediated associations between this Gene × Environment and antisocial personality disorder in early adulthood. In addition, we assessed whether this putative risk pathway also conferred risk for borderline personality disorder, a related disorder characterized by high ER. While direct associations between early maltreatment and later personality pathology did not vary by genotype, there was a significant difference in the indirect path via ER during adolescence. Consistent with hypotheses, females with high-activity MAOA genotype who experienced early maltreatment had greater increases in ER during adolescence, and higher levels of ER predicted both antisocial personality disorder and borderline personality disorder symptom severity. Taken together, findings suggest that the interaction between MAOA and early maltreatment places women at risk for a broader range of personality pathology via effects on ER.
Palmer amaranth, a dioecious summer annual weed species, is the most troublesome weed in agronomic crop production systems in the United States. Palmer amaranth resistant to photosystem (PS) II- and 4-hydroxyphenylpyruvate dioxygenase (HPPD) inhibitors is of particular concern in south central Nebraska. The objectives of this study were to determine the effect of PRE followed by POST herbicide programs on PS II- and HPPD-inhibitor-resistant Palmer amaranth control, crop yield, and net economic return in conventional corn. A field study was conducted in 2014, 2015, and 2016 in a grower’s field infested with PS II- and HPPD-inhibitor-resistant Palmer amaranth near Shickley in Fillmore County, Nebraska. A contrast analysis suggested that mesotrione+S-metolachlor+atrazine applied PRE provided 83% Palmer amaranth control at 21 d after application compared to 78 and 72% control with pyroxasulfone+fluthiacet-ethyl+atrazine and saflufenacil+dimethenamid-P, respectively. Most of the PRE followed by POST herbicide programs provided ≥85% Palmer amaranth control. Based on contrast analysis, POST application of dicamba+diflufenzopyr provided 93% Palmer amaranth control compared to 87, 79, and 42% control with dicamba, dicamba+halosulfuron, and acetochlor, respectively, at 28 d after POST. All PRE followed by POST herbicide programs, aside from mesotrione+S-metolachlor+atrazine followed by acetochlor (2,530 to 7,809 kg ha−1), provided 9,550 to 10,500 kg ha−1 corn yield compared with 2,713 to 6,110 kg ha−1 from nontreated control. Similarly, PRE followed by POST herbicide programs, except for mesotrione+S-metolachlor+atrazine followed by acetochlor ($191 and $897 ha−1), provided similar net return of $427 to $707 ha−1 and $1,127 to $1,727 ha−1 in 2014 and 2015-16, respectively. It is concluded that herbicide programs based on multiple sites of action are available for control of PS II- and HPPD-inhibitor-resistant Palmer amaranth in conventional corn.
We examined norovirus contamination on hands of ill patients during 12 norovirus outbreaks in 12 long-term care facilities (LTCFs). The higher frequency and norovirus titers on hands of residents compared to hands of heathcare workers highlights the importance of adhering to appropriate hand hygiene practices during norovirus outbreaks in LTCFs.
Cattle manure value chains play important biological and economic roles in smallholder crop–livestock systems in developing countries, but relative to other livestock products our understanding of the nature and impact of manure sales is limited. In regions with an active manure trade, farmers face a choice between manure use on-farm and sales, which affects nutrient flows and participant incomes. We analyzed the manure value chain operating in south-central Vietnam as an example of the function and role of manure trade in crop–livestock systems. Lowland cattle farmers sell manure through a network of chain participants, including small-scale collectors, lowland and highland traders, to pepper, coffee, dragon fruit and rubber farms in the central highlands and southeast coast. We collected and summarized quantitative data (e.g., manure-related labor, manure transactions, and fertilizer and manure use) gathered in semi-structured interviews with value-chain participants [lowland cattle owners (n = 101), traders (n = 27) and end users (n = 72)]. Lowland cattle owners were selected by stratified random sampling, and subsequent participants were identified in preceding interviews. One key finding concerns the seasonality of the manure value chain: most manure flowed between February and August (lowland dry season and period of peak highland demand) from lowland communes to highland coffee and pepper farms for use as organic soil amendments. Fewer sales occurred, at a lower price, to southeast coastal dragon fruit farms and rubber companies. Value addition to manure occurred via drying, bagging, collection, transport and composting. The presence of local traders facilitated market sales for smallholder cattle owners, and prices through the value chain generally reflected costs for value addition. The geographic distribution of cattle relative to agricultural land influenced the flow of manure, with net outflows from regions with higher animal density to regions with lower density and higher value crop production. Manure trade was an important source of supplementary income for farmers and a primary livelihood activity for traders. Value chain participant net incomes ranged from near US$100 yr−1 for lowland farmers to over US$13,000 yr−1 for traders, and returns to labor were just over US$0.50 h−1 for lowland farmers and US$2 h−1 for traders. The quantitative information generated during our descriptive assessment provides an important first step toward manure value chain improvement, indicates survey methods that can be applied in other areas, and identifies next steps necessary to evaluate chain evolution and resilience.
Field and greenhouse experiments were conducted in Nebraska to (1) confirm the 4-hydroxyphenylpyruvate dioxygenase (HPPD)-inhibiting resistant-waterhemp biotype (HPPD-RW) by quantifying the resistance levels in dose-response studies, and (2) to evaluate efficacy of PRE-only, POST-only, and PRE followed by POST herbicide programs for control of HPPD-RW in corn. Greenhouse dose-response studies confirmed that the suspected waterhemp biotype in Nebraska has evolved resistance to HPPD-inhibiting herbicides with a 2- to 18-fold resistance depending upon the type of HPPD-inhibiting herbicide being sprayed. Under field conditions, at 56 d after treatment, ≥90% control of the HPPD-RW was achieved with PRE-applied mesotrione/atrazine/S-metolachlor+acetochlor, pyroxasulfone (180 and 270 g ai ha−1), pyroxasulfone/fluthiacet-methyl/atrazine, and pyroxasulfone+saflufenacil+atrazine. Among POST-only herbicide programs, glyphosate, a premix of mesotrione/atrazine tank-mixed with diflufenzopyr/dicamba, or metribuzin, or glufosinate provided ≥92% HPPD-RW control. Herbicide combinations of different effective sites of action in mixtures provided ≥86% HPPD-RW control in PRE followed by POST herbicide programs. It is concluded that the suspected waterhemp biotype is resistant to HPPD-inhibiting herbicides and alternative herbicide programs are available for effective control in corn. The occurrence of HPPD-RW in Nebraska is significant because it limits the effectiveness of HPPD-inhibiting herbicides.
Several authors have claimed that radiocarbon dates in the Ancient Near East are too early. Herein, a hypothesis that might explain this is presented. Marine degassing of “old” carbon (i.e. 14C-deficient C), induced by upwelling of old subsurface water, has been observed, in modern times, to cause century-scale 14C ages in the surface atmosphere. A review of the Mediterranean Sea post-ice-age circulation concludes that the subsurface waters became very old, primarily due to millennia-long stagnation. It is hypothesized that as the stagnation ended, subsurface waters were brought towards the surface, where they degassed old carbon. Additionally, Anatolian dendrochronology is shown to not contradict the hypothesis.
HST ultra-violet and ground-based optical spectroscopy are presented for DI 1388, an early-type star in the Magellanic Bridge. These data have been supplemented with H I radio mapping of its environment. The spectroscopy shows interstellar components at LSR velocities of 0, 90 and 200 km s−1 – corresponding to the local ISM, a high velocity cloud and the Magellanic Bridge ISM, respectively. The last is the first absorption line detection of this material and shows the presence of both low (e.g., N I) and high (Si IV) ionization material. Further optical and HST UV observations of DI 1338 and another Bridge star, DGIK 975, are scheduled to investigate the chemical homogeneity and star formation history of the Bridge.
The 2s21S0–2s2p 3P1 intercombination line at 1218.34 Å of Be-like O V has been observed in IUE spectra of gaseous nebulae such as RR Tel (Doschek & Feibelman 1993). However, the forbidden line at 1213 Å has not been detected to date in any astrophysical object, with the possible exception of the Sun, where Sandlin, Brueckner & Tousey (1977) very tentatively identify the line at 1213.90 Å in an off-limb spectrum.
We report on results from the Solar Eclipse Coronal Imaging System (SECIS), an instrument using fast CCD cameras designed to search for short-period modulations in visible-light emission from the corona during an eclipse or with a coronagraph. The instrument was successfully used during the total eclipse of 1999 August 11 from a site in Bulgaria. This paper summarizes both the instrument and preliminary results.
Electronic health records (EHRs) may contain infomarkers that identify patients near the end of life for whom it would be appropriate to shift care goals to palliative care. Discovery and use of such infomarkers could be used to conduct effectiveness research that ultimately could help to reduce the monumental cost of caring for the dying. The aim of our study was to identify changes in the plans of care that represent infomarkers, which signal a transition of care goals from nonpalliative care ones to those consistent with palliative care.
Using an existing electronic health record database generated during a two-year longitudinal study of nine diverse medical–surgical units from four Midwest hospitals and a known group approach, we evaluated patient care episodes for 901 patients who died (mean age = 74.5 ± 14.6 years). We used ANOVA and Tukey's post-hoc tests to compare patient groups.
We identified 11 diagnoses, including Death Anxiety and Anticipatory Grieving, whose addition to the care plan, some of which also occurred with removal of nonpalliative care diagnoses, represent infomarkers of transition to palliative care goals. There were four categories of patients, those who had: no infomarkers on plans (n = 507), infomarkers added on the admission plan (n = 194), infomarkers added on a post-admission plan (minor transitions, n = 109), and infomarkers added and nonpalliative care diagnoses removed on a post-admission plan (major transition, n = 91). Age, length of stay, and pain outcomes differed significantly for these four categories of patients.
Significance of Results:
EHRs contain pertinent infomarkers that if confirmed in future studies could be used for timely referral to palliative care for improved focus on comfort outcomes and to identify palliative care subjects from data repositories in order to conduct big-data research, comparative effectiveness studies, and health-services research.
Our recent estimates of galaxy counts and the luminosity density in the near-infrared (Keenan et al. 2010, 2012) indicated that the local universe may be under-dense on radial scales of several hundred megaparsecs. Such a large-scale local under-density could introduce significant biases in the measurement and interpretation of cosmological observables, such as the inferred effects of dark energy on the rate of expansion. In Keenan et al. (2013), we measured the K-band luminosity density as a function of distance from us to test for such a local under-density. We made this measurement over the redshift range 0.01 < z < 0.2 (radial distances D ~ 50 - 800 h70−1 Mpc). We found that the shape of the K-band luminosity function is relatively constant as a function of distance and environment. We derive a local (z < 0.07, D < 300 h70−1 Mpc) K-band luminosity density that agrees well with previously published studies. At z > 0.07, we measure an increasing luminosity density that by z ~ 0.1 rises to a value of ~ 1.5 times higher than that measured locally. This implies that the stellar mass density follows a similar trend. Assuming that the underlying dark matter distribution is traced by this luminous matter, this suggests that the local mass density may be lower than the global mass density of the universe at an amplitude and on a scale that is sufficient to introduce significant biases into the measurement of basic cosmological observables. At least one study has shown that an under-density of roughly this amplitude and scale could resolve the apparent tension between direct local measurements of the Hubble constant and those inferred by Planck team. Other theoretical studies have concluded that such an under-density could account for what looks like an accelerating expansion, even when no dark energy is present.