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Recently, oral vancomycin prophylaxis (OVP) has been suggested for the prevention of Clostridium difficile infection (CDI). We conducted a systematic review and meta-analysis to investigate the efficacy and safety of this approach.
Systematic review and meta-analysis.
We conducted a computerized search of MEDLINE, EMBASE, and Cochrane databases from inception to March 2019 for publications investigating OVP for CDI prevention. Results were screened for eligibility. Relevant data were extracted and analyzed. Publication bias was assessed using the Egger test.
Ultimately, 8 retrospective studies and 1 prospective study examining 2174 patients, published between 2016 and 2019 were included in the review. OVP was associated with decreased CDI (odds ratio, 0.263; 95% confidence interval, 0.13–0.52) with considerable heterogeneity (I2 = 61%). Meta-regression showed that total daily dose of OVP correlated with CDI, explaining 100% of heterogeneity between studies. Furthermore, 3 studies evaluated the risk of vancomycin-resistant enterococci (VRE) infection after OVP and found no significant increase.
Our results suggest that OVP might decrease CDI rates in at-risk populations, although this conclusion should be interpreted with caution. Higher daily doses of OVP might increase CDI. Although the use of OVP in high-risk patients may reduce CDI, this suggestion has yet to be validated by prospective blinded randomized controlled trials.
This trial compared weight loss outcomes over 14 weeks in women showing low- or high-satiety responsiveness (low- or high-satiety phenotype (LSP, HSP)) measured by a standardised protocol. Food preferences and energy intake (EI) after low and high energy-density (LED, HED) meals were also assessed. Ninety-six women (n 52 analysed; 41·24 (SD 12·54) years; 34·02 (sd 3·58) kg/m2) engaged in one of two weight loss programmes underwent LED and HED laboratory test days during weeks 3 and 12. Preferences for LED and HED food (Leeds Food Preference Questionnaire) and ad libitum evening meal and snack EI were assessed in response to equienergetic LED and HED breakfasts and lunches. Weekly questionnaires assessed control over eating and ease of adherence to the programme. Satiety quotients based on subjective fullness ratings post LED and HED breakfasts determined LSP (n 26) and HSP (n 26) by tertile splits. Results showed that the LSP lost less weight and had smaller reductions in waist circumference compared with HSP. The LSP showed greater preferences for HED foods, and under HED conditions, consumed more snacks (kJ) compared with HSP. Snack EI did not differ under LED conditions. LSP reported less control over eating and reported more difficulty with programme adherence. In conclusion, low-satiety responsiveness is detrimental for weight loss. LED meals can improve self-regulation of EI in the LSP, which may be beneficial for longer-term weight control.
Peter Hill, one of the leading British pianists and musicologists of his generation.,
Thalia Myers, association with the music of Howard Skempton dates from 1995, when she commissioned Cantilena for the first Spectrum (for the ABRSM, the Associated Board of the Royal Schools of Music).,
John Tilbury, Polish government scholarship where he studied with Zbigniew Drzewiecki and co-founded the Warsaw Music Workshop group with Zygmunt Krause.,
James Weeks, published by University of York Music Press.,
Howard Skempton, none
This chapter captures the voices of some leading performers of Howard Skempton's music: Peter Hill (PH), Thalia Myers (TM), John Tilbury (JT), James Weeks (JW), interviewed by Cavett (EC) and collated by Head. The chapter concludes with a few words from Skempton (HS). For details of Skempton pieces see the Authorized Worklist (Appendix One). For information about recordings, see the Discography (Appendix Two). Author-date references in the transcripts below are to items in the select bibliography, unless they are further annotated ‘Discography’.
“SIMPLICITY ABOUT HIM”: FIRST ENCOUNTERS WITH SKEMPTON
PH: I got to know Howard in the early 1970s through my sister who worked at Faber Music, as did Howard. The first time we met was at a supper party for my sister's colleagues and for composers associated with Faber. Howard at once impressed me as a person of complete artistic integrity, and when he talked about his music he had a sincerity that made a refreshing change from the relentlessly competitive and over-professionalized ambience of the Royal College of Music where I was then a student. He was engaged in writing miniatures, many of them for piano, each of which was a distillation of weeks or even months of thought. Indeed, Howard told me he liked the mundane office work he did at Faber since it left his mind free to concentrate on his music. I had the impression of someone who thought very deeply about very simple things, and he explained that for him composition involved paring his ideas down to their essentials. The appeal of his music to me was that it embodied the principle of “less is more,” in which every sound mattered, instead of being lost in a maze of complexity. Although his manner was serious, Howard was not solemn. I can still recall from that evening that he amused us all with a lengthy saga of the accumulated mishaps that had befallen him on a trip to the launderette – making us laugh through his ability to look at the everyday in a quirky way that brought out the unexpected in things we take for granted.
What Howard was writing at that time was so at odds with the world of contemporary music, as it then was, that one didn't think of him as a “career” composer.
Successful organic farming requires crop varieties that are resilient to environmental variability. Assessing variety performance across the range of conditions represented on working farms is vital to developing such varieties; however, data collected from on-farm, participatory trials can be difficult to both collect and interpret. To assess the utility of data arising from participatory trialing efforts, we examined the performance of butternut squash (Cucurbita moschata L.), broccoli (Brassica oleracea L.) and carrot (Daucus carota L.) varieties grown in diverse organic production environments in participatory trials in Oregon, Washington, Wisconsin and New York using adaptability analysis (regression of variety means on environmental index). Patterns of adaptation varied across varieties, with some demonstrating broad adaptation and others showing specific adaptation to low- or high-yielding environments. Selection of varieties with broad vs specific adaptation should be guided by farmers’ risk tolerance and on-farm environmental variation. Adaptability analysis was appropriate for continuous variables (e.g., yield traits), but less so for ordinal variables and quality traits such as flavor and appearance, which can be vitally important in organic vegetable crop variety selection. The relative advantages of adaptability analysis and additive main effects and multiplicative interactions are also discussed in relation to on-farm trial networks. This work demonstrated the unique challenges presented by extensive participatory vegetable trialing efforts, which, as compared to grain crops, require novel approaches to facilitating farmer participation as well as data collection and analysis. Efficient, precise and reliable methods for evaluating quality related traits in these crops would allow researchers to assess stability and adaptation across a wider range of traits, providing advantages for effective plant breeding and trialing activities within the organic sector.
The current study advanced research on the link between community violence exposure and aggression by comparing the effects of violence exposure on different functions of aggression and by testing four potential (i.e., callous–unemotional traits, consideration of others, impulse control, and anxiety) mediators of this relationship. Analyses were conducted in an ethnically/racially diverse sample of 1,216 male first-time juvenile offenders (M = 15.30 years, SD = 1.29). Our results indicated that violence exposure had direct effects on both proactive and reactive aggression 18 months later. The predictive link of violence exposure to proactive aggression was no longer significant after controlling for proactive aggression at baseline and the overlap with reactive aggression. In contrast, violence exposure predicted later reactive aggression even after controlling for baseline reactive aggression and the overlap with proactive aggression. Mediation analyses of the association between violence exposure and reactive aggression indicated indirect effects through all potential mediators, but the strongest indirect effect was through impulse control. The findings help to advance knowledge on the consequences of community violence exposure on justice-involved youth.
Hemorrhage remains the major cause of preventable death after trauma. Recent data suggest that earlier blood product administration may improve outcomes. The purpose of this study was to determine whether opportunities exist for blood product transfusion by ground Emergency Medical Services (EMS).
This was a single EMS agency retrospective study of ground and helicopter responses from January 1, 2011 through December 31, 2015 for adult trauma patients transported from the scene of injury who met predetermined hemodynamic (HD) parameters for potential transfusion (heart rate [HR]≥120 and/or systolic blood pressure [SBP]≤90).
A total of 7,900 scene trauma ground transports occurred during the study period. Of 420 patients meeting HD criteria for transfusion, 53 (12.6%) had a significant mechanism of injury (MOI). Outcome data were available for 51 patients; 17 received blood products during their emergency department (ED) resuscitation. The percentage of patients receiving blood products based upon HD criteria ranged from 1.0% (HR) to 5.9% (SBP) to 38.1% (HR+SBP). In all, 74 Helicopter EMS (HEMS) transports met HD criteria for blood transfusion, of which, 28 patients received prehospital blood transfusion. Statistically significant total patient care time differences were noted for both the HR and the SBP cohorts, with HEMS having longer time intervals; no statistically significant difference in mean total patient care time was noted in the HR+SBP cohort.
In this study population, HD parameters alone did not predict need for ED blood product administration. Despite longer transport times, only one-third of HEMS patients meeting HD criteria for blood administration received prehospital transfusion. While one-third of ground Advanced Life Support (ALS) transport patients manifesting HD compromise received blood products in the ED, this represented 0.2% of total trauma transports over the study period. Given complex logistical issues involved in prehospital blood product administration, opportunities for ground administration appear limited within the described system.
MixFM, ZielinskiMD, MyersLA, BernsKS, LukeA, StubbsJR, ZietlowSP, JenkinsDH, SztajnkrycerMD. Prehospital Blood Product Administration Opportunities in Ground Transport ALS EMS – A Descriptive Study. Prehosp Disaster Med. 2018;33(3):230–236.
Except for the addition of modern material remains, the archaeological record is a finite resource, which means that, at some point in the future, there will be nothing left to find. In this paper, we model trends in archaeological discovery based on the growth of the field and the probability of site discovery. We compare this model to seven diverse datasets of archaeological discovery trends: (1) all sites from the state of Wyoming, USA; (2) high-altitude archaeological sites from the state of Colorado, USA; (3) mostly complete Neandertal crania; (4) monumental sites of the Maya Classic period; (5) proboscidean kill/scavenge sites globally; (6) Upper Paleolithic sites from Europe; and (7) a compilation of shipwreck discoveries. We forecast discovery trends over the current century. We show that, for all datasets, rates of discovery are in decline, and some segments of the record are near depletion.
The number of pediatric antimicrobial stewardship programs (ASPs) is increasing and program evaluation is a key component to improve efficiency and enhance stewardship strategies.
To determine the antimicrobials and diagnoses most strongly associated with a recommendation provided by a well-established pediatric ASP.
DESIGN AND SETTING
Retrospective cohort study from March 3, 2008, to March 2, 2013, of all ASP reviews performed at a free-standing pediatric hospital.
ASP recommendations were classified as follows: stop therapy, modify therapy, optimize therapy, or consult infectious diseases. A multinomial distribution model to determine the probability of each ASP recommendation category was performed on the basis of the specific antimicrobial agent or disease category. A logistic model was used to determine the odds of recommendation disagreement by the prescribing clinician.
The ASP made 2,317 recommendations: stop therapy (45%), modify therapy (26%), optimize therapy (19%), or consult infectious diseases (10%). Third-generation cephalosporins (0.20) were the antimicrobials with the highest predictive probability of an ASP recommendation whereas linezolid (0.05) had the lowest probability. Community-acquired pneumonia (0.26) was the diagnosis with the highest predictive probability of an ASP recommendation whereas fever/neutropenia (0.04) had the lowest probability. Disagreement with ASP recommendations by the prescribing clinician occurred 22% of the time, most commonly involving community-acquired pneumonia and ear/nose/throat infections.
Evaluation of our pediatric ASP identified specific clinical diagnoses and antimicrobials associated with an increased likelihood of an ASP recommendation. Focused interventions targeting these high-yield areas may result in increased program efficiency and efficacy.
High-current-density cathodes are required for the development of high-power mm-wave and upper mm-wave devices, as well as for other electron beam applications. To address this need, a current amplifier stage is being developed that will multiply a primary electron-beam current (via the secondary-electron multiplication process) and then emit the amplified beam so as to achieve a current gain of 50-100. Diamond is a particularly promising current amplification source due to the negative electron affinity present at stable hydrogenated surfaces. As such, we are fabricating current amplifiers using single-crystal CVD diamond grown at NRL, with our growth effort focused on reducing the impurity concentration in the epitaxial diamond and on fabricating microns-thick freestanding films. The current amplification characteristics of the diamond films are examined using secondary-electron-emission measurements in both reflection and transmission configurations. In our initial study of an 8.3-µm-thick CVD diamond film, the single-crystal diamond is shown to have superior transport and emission properties compared to similar polycrystalline material. While transmission gains have been obtained under field-free conditions from the unbiased diamond film, we are striving to increase the gain by increasing the transport efficiency in a biased amplifier structure. Towards this end, recent efforts have focused on optimizing the bonding and metallization processes as needed to establish and control the internal electric field. In addition, Monte Carlo simulations are being used to predict the optimal material and device parameters needed to achieve high amplifier gain and low energy spread.
Epitaxial graphene (EG) grown on the carbon-face of SiC has been shown to exhibit higher carrier mobilities in comparison to other growth techniques amenable to wafer-scale graphene fabrication. The transfer of large area (>mm2) graphene films to substrates amenable for specific applications is desirable. We demonstrate the dry transfer of EG from the C-face of 4H-SiC onto SiO2, GaN and Al2O3 substrates via two approaches using either 1) thermal release tape or 2) a spin-on, chemically-etchable dielectric. Van der Pauw devices fabricated from C-face EG transferred to SiO2 gave similar mobility values and up to three fold reductions in carrier density in comparison to devices fabricated on as-grown material.
We began to work on this book in late 2006. At the time, we felt that the problem of petrodollars was not receiving sufficient attention, a short presentation by Saleh Nsouli of the International Monetary Fund (IMF) on “petrodollar recycling and global imbalances” in March 2006 notwithstanding. Discussion of global trade and financial imbalances and the sustainability of the Dollar-centered international financial system were still mainly concerned with accumulated reserves in Asia, especially China. As we show in this book, both groups who thought that the system was sustainable for another decade and those who thought that it wasn't seemed to ignore the role of petrodollars in accelerating systemic instability.
As we started to work on the book project, we discovered a bigger problem yet: the literatures on energy markets, financial markets, and Middle-East geopolitics were highly compartmentalized, with few notable exceptions that are cited in this book. Our focus therefore turned to integrating all three domains of investigation and showing that all three spheres integrate to perpetuate, and potentially to amplify, a cycle that we were witnessing for the second time in our own lifetimes. We were both struck by the remarkable similarities between the events that we were observing in 2006–7 and those that we had earlier witnessed in 1979–80, and reached the conclusion that we are likely to see a steep spike in oil prices followed by a crash and severe global recession.
With the start of the twenty-first century, all three factors in our story – financial markets, energy economics, and Middle-East geopolitics – have become major players on the global scene. In this chapter, we study how contagion and spillovers have grown substantially between different financial markets, markets for different sources of energy, and previously region-specific geopolitical conflicts. In the process, as each of the three factors has become more globalized, the interactions among the three factors – which constitute the core focus of this book – have also grown in importance, leading to what we have called the globalized curse of black gold.
We begin by reviewing some of the major developments that have led to this globalization of Middle-East dynamics. The first development has been the rise in structured finance, which facilitated the creation of derivative financial vehicles that have, in turn, allowed investment and fund-flow patterns that were not previously possible. The second closely related development has been the increasingly important role of hedge funds and sovereign wealth funds. The former are unregulated market participants that have been able to use derivative securities to play the role previously reserved for highly regulated banks, and the latter a new gargantuan phenomenon which continues to mystify much of the financial world.
Concurrent with those novel developments in the financial world, improvements in information technology have amplified the role, steadily increasing in importance, of developing countries both as sources of capital and as homes for inviting “emerging markets” for investment opportunities.
During the four decades covered in this book, we have witnessed two full phases of the cycle. We began writing this book (and rewriting various chapters, as the pace of change accelerated) in late 2006, when we noticed that the surge in petrodollars was left out of the Bretton Woods II sustainability debate. As it turns out, the crash of 2008–9 did not usher in the end of that system, in large part because U.S. creditors have recognized the “balance of financial terrors” problem and therefore have continued to invest substantially in Dollar-denominated assets, albeit more nervously and more vocally about that nervousness. In other words, cooperation and coordination of investment policies have allowed the international financial system to remain intact through its latest crisis.
Moreover, although signs of increasing protectionism have been evident, including among G20 countries that have repeatedly warned against it, the early signs suggest that 1930s-style collapse of international trade and finance is unlikely: A recent World Bank Trade Note warned that despite signing a pact in November 2008 to avoid protectionism, seventeen out of the G20 countries had in fact implemented some protectionist policies, forty-seven in all, by March 2009.
The World Bank note suggested steps that should be taken by the World Trade Organization (WTO) and G20 to avoid further escalation of protectionist policies worldwide. So far, despite significant reduction in global trade because of the severe global recession, and despite the isolated incidents discussed in this World Bank note, cooperation and coordination, including protection of a relatively strong Dollar, have prevented, the death of globalization empowered by trade and foreign direct investment.
The coincidence of oil and financial crises can be traced back historically to the time of the industrial revolution. Our story begins, more modestly, with the dramatic increase in crude-oil prices in 1973 – an episode that continues to live as a vivid memory in Western and Middle-Eastern imaginations alike. For the former, this memory serves as a constant reminder of Western economies' vulnerability to market and geopolitical forces, especially in the Middle East. For the latter, it feeds nostalgic yearning for the moment when the Organization of Petroleum Exporting Countries (OPEC) cartel's market and political power reached its zenith.
As the world continues to struggle with the task of containing the economic, financial, and geopolitical ramifications of the financial crisis of 2007–9, it is important to recognize this and the previous 1970s crisis, as well as a number of others, as phases of a larger ongoing cycle. To paraphrase Mark Twain, rumors of the death of the business cycle – as well as the energy-price cycle, the financial boom-and-bust cycle, and the cycle of Middle-East geopolitical turmoil – have all been greatly exaggerated. In this book, we study the interaction of the global business cycle with these closely related energy-price, financial, and geopolitical cycles. We show that this super cycle is endogenous and self-perpetuating.
Like the human ego, this cycle is most dangerous when we assume that we have tamed or killed it.
The mid-1990s ushered in new and fundamental transformations in the global landscape on all three dimensions of our analysis: energy economics, Middle-East geopolitics, and financial crises. Middle-East geopolitical transformations were perhaps the most obvious, with the globalization of militant Islamism and the direct United States military intervention in Iraq. Ongoing financial transformation became more obvious in the aftermath of the Asian financial crisis, as contagion spread from Asia to Latin America and Eastern Europe at unprecedented speeds. We discuss the mechanics of globalized finance and their effect on petrodollar flows and economic cycles in Chapter 4. The current chapter is focused on the energy economics and Middle-East geopolitical components of the analysis.
A New Era of Higher Oil Prices
On the front of energy economics, the early 1990s witnessed the restoration of Kuwait's oil production and renewed Organization of Petroleum Exporting Countries (OPEC)-member infighting on market shares and production quotas, which culminated in a virtual price war. The lack of discipline in OPEC combined with the recessionary effects of the Asian financial crisis of the mid-1990s to bring about the collapse of oil prices in 1998. This collapse, in turn, taught noncooperative OPEC members a valuable lesson, and made it possible for OPEC to reorganize its production strategy in time for global economic recovery at the turn of the new millennium.
Renewed OPEC discipline combined with increasing demand for energy to shrink spare production capacity, resulting in substantial price increases and contributing to increased U.S. debt and a weakening Dollar.
Hyman Minsky wrote during the late twentieth century, explaining why political rhetoric has masked the financial forces that have caused significant amplification of economic cycles since the collapse of the Bretton-Woods system. The primary target of his attack was the (still) dominant neoclassical school of economic thought, which has continued to deny many of the economic dimensions of the financial crisis that started during 2008 as “myths.” In criticizing this neoclassical school's adoption of “real business cycle” models that abstract from cycles driven by financial markets, Minsky wrote:
A theory that denies what is happening can happen, sees unfavorable events as the work of evil outside forces (such as the oil crisis) rather than as the result of characteristics of the economic mechanism, may satisfy politicians' need for a villain or scapegoat, but such a theory offers no useful guide to a solution of the problem. …
The economic instability so evident since the late 1960s is the result of the fragile financial system that emerged from cumulative changes in financial relations and institutions of the years following World War II.
In writing this book, we have at times focused on Minsky's favorite link between economic activity and financial market structure and regulation. However, we have also suggested, perhaps in the same spirit, that understanding the overall cycle, and the potential for severe crises if the cycle was not regulated properly, would require understanding the links to resource economics, especially energy markets, and geopolitical developments in the part of the world where most of those resources are located.