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Among the most widely distributed species globally, common reed [Phragmites australis (Cav.) Trin. ex Steud.] has generated extensive interest in invasive plant science and management because its introduced strains are highly invasive and often form monocultures that alter ecosystem properties. In desert wetlands in Las Vegas, NV, USA, where management goals included reducing hazardous P. australis fuels and increasing native plant diversity, we assessed variation in P. australis cover, the degree of native plant colonization, and soil seedbanks after P. australis management treatments (cutting, glyphosate–imazapyr herbicide) and wildfires across gradients in soil properties. Based on change in P. australis cover during six measurement events over 24 mo, 24 study sites formed three groups: (1) decreasing cover, where initially high P. australis cover (60% to 85%) decreased to <5% following multiple cutting or herbicide treatments; (2) sustaining low cover, where wildfire or clearing was associated with initially low P. australis cover which remained low (<30%) after multiple herbicide applications; and (3) sustaining high cover (45% to 100% initially and remaining at 30% to 100%), including sites unmanaged or treated/burned only once. High soil salinity correlated with low postmanagement P. australis cover. No native plants were detected in the sustaining high P. australis cover group, despite natives occurring in the seedbank. Where management reduced P. australis cover, minimal native plant colonization did occur. Secondary invasion by other non-native plants was nearly absent. Our results suggest that if P. australis can be initially cleared, multiple herbicide applications can persistently keep cover low, especially on drier, saline soils. Slow native plant colonization suggests that a phased approach may be useful to initially reduce P. australis cover, keep it low via repeated treatments, and actively revegetate sites with native species tailored to the moisture–salinity gradient across P. australis–invaded habitats.
One of the greatest global threats to mental health and wellbeing is the already discernible impact of climate change on local communities, particularly those living in the most vulnerable places on the planet, as well as the predicted impacts globally over the next 25–50 years (Romanello et al., 2021). Impacts have already been reported in those communities which have been devastated, often repeatedly, by extreme weather events (floods, cyclones, drought, bushfires, etc.) (Obradovich et al., 2018). These include massive social dislocation, loss of social connections and breakdowns in education, employment, economic and housing security – all factors known to increase the risk of common mental health conditions including anxiety, depression and other mood disorders.
The most basic distinction between depressive (and other mood) disorders and other major mental disorders is the notion that they are primarily mood or affective disorders and not fundamentally perturbations of other cognitive, perceptual, motor, communication, impulse, sleep−wake, fear-response, arousal, developmental or personality functions. The primacy of mood or affective state is captured in the ‘core’ criteria for major depression (depressed mood or loss of pleasure) and the other major mood disorders (e.g., for dysthymia – prolonged depressed mood) (American Psychiatric Association, 2013). For bipolar disorder, while the presence of manic features (with increased motor activity) (Scott et al., 2017) is the core element, the depressive phase is described in similar terms, with the emphasis on the same shared features of major depression (i.e., depressed mood or loss of pleasure).
The needs of young people attending mental healthcare can be complex and often span multiple domains (e.g., social, emotional and physical health factors). These factors often complicate treatment approaches and contribute to poorer outcomes in youth mental health. We aimed to identify how these factors interact over time by modelling the temporal dependencies between these transdiagnostic social, emotional and physical health factors among young people presenting for youth mental healthcare.
Methods
Dynamic Bayesian networks were used to examine the relationship between mental health factors across multiple domains (social and occupational function, self-harm and suicidality, alcohol and substance use, physical health and psychiatric syndromes) in a longitudinal cohort of 2663 young people accessing youth mental health services. Two networks were developed: (1) ‘initial network’, that shows the conditional dependencies between factors at first presentation, and a (2) ‘transition network’, how factors are dependent longitudinally.
Results
The ‘initial network’ identified that childhood disorders tend to precede adolescent depression which itself was associated with three distinct pathways or illness trajectories; (1) anxiety disorder; (2) bipolar disorder, manic-like experiences, circadian disturbances and psychosis-like experiences; (3) self-harm and suicidality to alcohol and substance use or functioning. The ‘transition network’ identified that over time social and occupational function had the largest effect on self-harm and suicidality, with direct effects on ideation (relative risk [RR], 1.79; CI, 1.59–1.99) and self-harm (RR, 1.32; CI, 1.22–1.41), and an indirect effect on attempts (RR, 2.10; CI, 1.69–2.50). Suicide ideation had a direct effect on future suicide attempts (RR, 4.37; CI, 3.28–5.43) and self-harm (RR, 2.78; CI, 2.55–3.01). Alcohol and substance use, physical health and psychiatric syndromes (e.g., depression and anxiety, at-risk mental states) were independent domains whereby all direct effects remained within each domain over time.
Conclusions
This study identified probable temporal dependencies between domains, which has causal interpretations, and therefore can provide insight into their differential role over the course of illness. This work identified social, emotional and physical health factors that may be important early intervention and prevention targets. Improving social and occupational function may be a critical target due to its impacts longitudinally on self-harm and suicidality. The conditional independence of alcohol and substance use supports the need for specific interventions to target these comorbidities.
CHD care is resource-intensive. Unwarranted variation in care may increase cost and result in poorer health outcomes. We hypothesise that process variation exists within the pre-operative evaluation and planning process for children undergoing repair of atrial septal defect or ventricular septal defect and that substantial variation occurs in a small number of care points.
Methods:
From interviews with staff of an integrated congenital heart centre, an initial process map was constructed. A retrospective chart review of patients with isolated surgical atrial septal defect and ventricular septal defect repair from 7/1/2018 through 11/1/2020 informed revisions of the process map. The map was assessed for points of consistency and variability.
Results:
Thirty-two surgical atrial septal defect/ventricular septal defect repair patients were identified. Ten (31%) were reviewed by interventional cardiology before surgical review. Of these, 6(60%) had a failed catheter-based closure and 4 (40%) were deemed inappropriate for catheter-based closure. Thirty (94%) were reviewed in case conference, all attended surgical clinic, and none were admitted prior to surgery. The process map from interviews alone identified surgery rescheduling as a point of major variability; however, chart review revealed this was not as prominent a source of variability as pre-operative interventional cardiology review.
Conclusions:
Significant variation in the pre-operative evaluation and planning process for surgical atrial septal defect/ventricular septal defect patients was identified. If such process variation is widespread through CHD care, it may contribute to variations in outcome and cost previously documented within CHD surgery. Future research will focus on determining whether the variation is warranted or unwarranted, associated health outcomes and cost variation attributed to these variations in care processes.
Background: Healthcare facilities have experienced many challenges during the COVID-19 pandemic, including limited personal protective equipment (PPE) supplies. Healthcare personnel (HCP) rely on PPE, vaccines, and other infection control measures to prevent SARS-CoV-2 infections. We describe PPE concerns reported by HCP who had close contact with COVID-19 patients in the workplace and tested positive for SARS-CoV-2. Method: The CDC collaborated with Emerging Infections Program (EIP) sites in 10 states to conduct surveillance for SARS-CoV-2 infections in HCP. EIP staff interviewed HCP with positive SARS-CoV-2 viral tests (ie, cases) to collect data on demographics, healthcare roles, exposures, PPE use, and concerns about their PPE use during COVID-19 patient care in the 14 days before the HCP’s SARS-CoV-2 positive test. PPE concerns were qualitatively coded as being related to supply (eg, low quality, shortages); use (eg, extended use, reuse, lack of fit test); or facility policy (eg, lack of guidance). We calculated and compared the percentages of cases reporting each concern type during the initial phase of the pandemic (April–May 2020), during the first US peak of daily COVID-19 cases (June–August 2020), and during the second US peak (September 2020–January 2021). We compared percentages using mid-P or Fisher exact tests (α = 0.05). Results: Among 1,998 HCP cases occurring during April 2020–January 2021 who had close contact with COVID-19 patients, 613 (30.7%) reported ≥1 PPE concern (Table 1). The percentage of cases reporting supply or use concerns was higher during the first peak period than the second peak period (supply concerns: 12.5% vs 7.5%; use concerns: 25.5% vs 18.2%; p Conclusions: Although lower percentages of HCP cases overall reported PPE concerns after the first US peak, our results highlight the importance of developing capacity to produce and distribute PPE during times of increased demand. The difference we observed among selected groups of cases may indicate that PPE access and use were more challenging for some, such as nonphysicians and nursing home HCP. These findings underscore the need to ensure that PPE is accessible and used correctly by HCP for whom use is recommended.
The opioid crisis in the USA requires immediate action through clinical and translational research. Already built network infrastructure through funding by the National Institute on Drug Abuse (NIDA) and National Center for Advancing Translational Sciences (NCATS) provides a major advantage to implement opioid-focused research which together could address this crisis. NIDA supports training grants and clinical trial networks; NCATS funds the Clinical and Translational Science Award (CTSA) Program with over 50 NCATS academic research hubs for regional clinical and translational research. Together, there is unique capacity for clinical research, bioinformatics, data science, community engagement, regulatory science, institutional partnerships, training and career development, and other key translational elements. The CTSA hubs provide unprecedented and timely response to local, regional, and national health crises to address research gaps [Clinical and Translational Science Awards Program, Center for Leading Innovation and Collaboration, Synergy paper request for applications]. This paper describes opportunities for collaborative opioid research at CTSA hubs and NIDA–NCATS opportunities that build capacity for best practices as this crisis evolves. Results of a Landscape Survey (among 63 hubs) are provided with descriptions of best practices and ideas for collaborations, with research conducted by hubs also involved in premier NIDA initiatives. Such collaborations could provide a rapid response to the opioid epidemic while advancing science in multiple disciplinary areas.
To assess the impact of a newly developed Central-Line Insertion Site Assessment (CLISA) score on the incidence of local inflammation or infection for CLABSI prevention.
Design:
A pre- and postintervention, quasi-experimental quality improvement study.
Setting and participants:
Adult inpatients with central venous catheters (CVCs) hospitalized in an intensive care unit or oncology ward at a large academic medical center.
Methods:
We evaluated CLISA score impact on insertion site inflammation and infection (CLISA score of 2 or 3) incidence in the baseline period (June 2014–January 2015) and the intervention period (April 2015–October 2017) using interrupted times series and generalized linear mixed-effects multivariable analyses. These were run separately for days-to-line removal from identification of a CLISA score of 2 or 3. CLISA score interrater reliability and photo quiz results were evaluated.
Results:
Among 6,957 CVCs assessed 40,846 times, percentage of lines with CLISA score of 2 or 3 in the baseline and intervention periods decreased by 78.2% (from 22.0% to 4.7%), with a significant immediate decrease in the time-series analysis (P < .001). According to the multivariable regression, the intervention was associated with lower percentage of lines with a CLISA score of 2 or 3, after adjusting for age, gender, CVC body location, and hospital unit (odds ratio, 0.15; 95% confidence interval, 0.06–0.34; P < .001). According to the multivariate regression, days to removal of lines with CLISA score of 2 or 3 was 3.19 days faster after the intervention (P < .001). Also, line dwell time decreased 37.1% from a mean of 14 days (standard deviation [SD], 10.6) to 8.8 days (SD, 9.0) (P < .001). Device utilization ratios decreased 9% from 0.64 (SD, 0.08) to 0.58 (SD, 0.06) (P = .039).
Conclusions:
The CLISA score creates a common language for assessing line infection risk and successfully promotes high compliance with best practices in timely line removal.
Little information is available on the prevalence of Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 eating disorders in adolescence, and eating disorders remain unique in the DSM for not systematically including a criterion for clinical significance. This study aimed to provide the first prevalence report of the full suite of DSM-5 eating disorders in adolescence, and to examine the impact of applying a criterion for clinical significance.
Methods
In total, 5191 (participation rate: 70%) Australian adolescents completed a survey measuring 1-month prevalence of eating disorder symptoms for all criterial, ‘other specified’ and unspecified eating disorders, as well as health-related quality of life and psychological distress.
Results
The point prevalence of any eating disorder was 22.2% (12.8% in boys, 32.9% in girls), and ‘other specified’ disorders (11.2%) were more common than full criterial disorders (6.2%). Probable bulimia nervosa and binge eating disorder, but not anorexia nervosa (AN), were more likely to be experienced by older adolescents. Most disorders were associated with an increased odds for being at a higher weight. The prevalence of eating disorders was reduced by 40% (to 13.6%) when a criterion for clinical significance was applied.
Conclusions
Eating disorders, particularly ‘other specified’ syndromes, are common in adolescence, and are experienced across age, weight, socioeconomic and migrant status. The merit of adding a criterion for clinical significance to the eating disorders, similar to other DSM-5 disorders, warrants consideration. At the least, screening tools should measure distress and impairment associated with eating disorder symptoms in order to capture adolescents in greatest need for intervention.
Causes of falls in older adults are common, multifactorial, and can lead to significant injury. This before-and-after study evaluated the benefits of a Fall Prevention Mobile Clinic (FPMC) in reducing the risk of falling in older adults in British Columbia, Canada. Four hundred seventy-six participants (average age of 83.6 years) enrolled in the study and were followed for 12 months after attending the FPMC. At 12-month follow-up, the mean percentage uptake of fall prevention recommendations was 48.8 per cent (SD = 25.7%), the Timed Up and Go mobility measure improved from a median of 19.04 seconds to 17.45 seconds and the number of participants falling decreased from 64.8 per cent (in the 12 months before attending the clinic) to 55.6 per cent (in the 12 months after attending the clinic) (p = .012). After attending the FPMC, participants acted on recommendations, improved mobility and decreased their risk of future falls.
Objectives: To evaluate prospective and retrospective memory abilities in Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans with and without a self-reported history of blast-related mild traumatic brain injury (mTBI). Methods: Sixty-one OEF/OIF/OND Veterans, including Veterans with a self-reported history of blast-related mTBI (mTBI group; n=42) and Veterans without a self-reported history of TBI (control group; n=19) completed the Memory for Intentions Test, a measure of prospective memory (PM), and two measures of retrospective memory (RM), the California Verbal Learning Test-II and the Brief Visuospatial Memory Test-Revised. Results: Veterans in the mTBI group exhibited significantly lower PM performance than the control group, but the groups did not differ in their performance on RM measures. Further analysis revealed that Veterans in the mTBI group with current PTSD (mTBI/PTSD+) demonstrated significantly lower performance on the PM measure than Veterans in the control group. PM performance by Veterans in the mTBI group without current PTSD (mTBI/PTSD-) was intermediate between the mTBI/PTSD+ and control groups, and results for the mTBI/PTSD- group were not significantly different from either of the other two groups. Conclusions: Results suggest that PM performance may be a sensitive marker of cognitive dysfunction among OEF/OIF/OND Veterans with a history of self-reported blast-related mTBI and comorbid PTSD. Reduced PM may account, in part, for complaints of cognitive difficulties in this Veteran cohort, even years post-injury. (JINS, 2018, 24, 324–334)
Prestige, authority and power: what is the significance of these three terms for the study of late-medieval manuscripts and texts? This collection of essays, by leading scholars from Britain and North America, answers this question in various ways: by discussing manuscripts as prestigious de luxe objects; by showing how the layout of texts was used to confer different kinds of authority; and by locating manuscripts and texts more dynamically in what Foucault calls 'power's net-like organisation'. All of the essays in the volume embed the manuscripts they discuss in particular sets of personal relationships, conducted in specific social environments - in the schoolroom or the monastery, at court, in the gentry household and the city, or mediating between these. The essays address, among others, issues of gender, patronage, status, self-authorization, and gentry and urban sociability, in studies ranging from the twelfth to the sixteenth centuries. Professor FELICITY RIDDY teaches in the Centre for Medieval Studies and the Department of English at the University of York. Contributors: SUZANNE REYNOLDS, KANTIK GHOSH, KATE HARRIS, KATHLEEN L. SCOTT, JOHN THOMPSON, CAROL M. MEALE, ANNE M. DUTTON, JAMES P. CARLEY, DAVID R. CARLSON
Laboratory assays were conducted to determine the sensitivity of tomato and tobacco cell suspension cultures and tomato and pepper cotyledons to clomazone. A comparison of fresh weight and carotenoid content indicated up to a three-fold difference between the clomazone-tolerant tobacco and clomazone-susceptible tomato cell suspension cultures. In contrast, an approximate 60-fold difference between the tolerant pepper and susceptible tomato cotyledons was observed when total chlorophyll and carotenoid contents were measured. The effect of clomazone and its possible metabolites on in vivo and in vitro extractable IPP isomerase (EC 5.3.3.2) and prenyltransferase (EC 2.5.1.29) activity was investigated. There was no clear inhibitory effect of clomazone or possible clomazone metabolites upon enzyme activity in tomato or tobacco cell suspension cultures or on light or dark grown tomato or pepper cotyledons. No specific enzymatic target site of clomazone was identified in correlation with the reduction in total chlorophyll or carotenoid content.
Aminocyclopyrachlor, a newly discovered synthetic auxin herbicide, and its methyl ester, appear to control a number of perennial broadleaf weeds. The potential volatility of this new herbicide and its methyl ester were determined under laboratory conditions and were also compared to dicamba and aminopyralid with the use of enclosed chamber and open-air plant bioassays. Bioassays consisting of visual estimates of epinastic responses and kidney bean and soybean leaf-width measurements were developed to measure vapor release from glass and plastic. Vapor release of aminocyclopyrachlor from glass surfaces was undetectable under laboratory conditions, and no phytotoxic responses were observed when plants were exposed to vapors emanating from various surfaces. Results were similar to those of aminopyralid, indicating the risk of plant injury from vapor movement of aminocyclopyrachlor and aminopyralid was very low. When combined with 1% methylated seed oil, vapor release of aminocyclopyrachlor-methyl ester reached 86% 192 h after application to glass surfaces. Phytotoxic responses of plants exposed to vapors emanating from various surfaces treated with aminocyclopyrachlor-methyl ester were similar to responses to dicamba under enclosed incubation conditions, but were less in outdoor, open-air environments. Studies are needed to understand better the risk of injury to nontarget plants due to vapor movement of aminocyclopyrachlor-methyl ester under field applications.
Analysis of a buried deposit in the Diamond Valley of southern California has revealed well-preserved pollen, wood, and diatom remains. Accelerator mass spectrometry dates of 41,200±2100 and 41,490±1380 14C yr B.P. place this deposit in marine isotope stage 3. Diatoms suggest a shallow lacustrine environment. Pollen data suggest that several plant communities were present near the site, with grassland, scrub, chaparral, forest, and riparian communities represented. Comparison with modern pollen suggests similarities with montane forests in the nearby San Bernardino and San Jacinto ranges, indicating vegetation lowering by at least 900 m elevation and temperatures 4°–5°C cooler than today. An increase in high-elevation conifer pollen documents climatic cooling near the profile top. Early-profile diatoms are typical of warm water with high alkalinity and conductivity, whereas later diatoms suggest a higher flow regime and input of cooler water into the system. We suggest that the sequence is part of the cooling phase of an interstadial Dansgaard–Oeschger cycle. Records of the middle Wisconsin period are rare in southern California, but the Diamond Valley site is similar to records from Tulare Lake in the San Joaquin Valley and the ODP Site 893A record from Santa Barbara Basin. It is probable that the Diamond Valley assemblage is a local expression of a vegetation type widespread in the ranges and basins of southwestern California during the middle Wisconsin.
Foraminiferal analyses of 404 contiguous samples, supported by diatom, lithologic, geochronologic and seismic data, reveal both rapid and gradual Holocene paleoenvironmental changes in an 8.21-m vibracore taken from southern Pamlico Sound, North Carolina. Data record initial flooding of a latest Pleistocene river drainage and the formation of an estuary 9000 yr ago. Estuarine conditions were punctuated by two intervals of marine influence from approximately 4100 to 3700 and 1150 to 500 cal yr BP. Foraminiferal assemblages in the muddy sand facies that accumulated during these intervals contain many well-preserved benthic foraminiferal species, which occur today in open marine settings as deep as the mid shelf, and significant numbers of well-preserved planktonic foraminifera, some typical of Gulf Stream waters. We postulate that these marine-influenced units resulted from temporary destruction of the southern Outer Banks barrier islands by hurricanes. The second increase in marine influence is coeval with increased rate of sea-level rise and a peak in Atlantic tropical cyclone activity during the Medieval Climate Anomaly. This high-resolution analysis demonstrates the range of environmental variability and the rapidity of coastal change that can result from the interplay of changing climate, sea level and geomorphology in an estuarine setting.
The court of Common Pleas was one of the most important courts in the English legal system for more than 600 years, until its abolition by Act of Parliament in 1873. The cases heard before this royal court were civil disputes between the king’s subjects, often relating to land, inheritance and debts. The purpose of this paper is to introduce readers to the ornament and imagery that appeared on the headings of the main records of the court of Common Pleas between 1422 and 1509 and to explore the origins and contemporary context of the images and representations employed by the clerk-artists who wrote and decorated these headings. The decoration they chose ranged from simple ornament to representations of plants, birds, animals and people. Great emphasis was placed on the role of the sovereign as the fount of justice, and this emphasis was reinforced by the incorporation of words and phrases, acclamations and verses from the Psalms chosen to underline the majesty and power of successive monarchs. The illustrations provide an important insight into the art, history and politics of late fifteenth-century England.