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The Wisconsin Twin Project comprises multiple longitudinal studies that span infancy to early adulthood. We summarize recent papers that show how twin designs with deep phenotyping, including biological measures, can inform questions about phenotypic structure, etiology, comorbidity, heterogeneity, and gene–environment interplay of temperamental constructs and mental and physical health conditions of children and adolescents. The general framework for investigations begins with rich characterization of early temperament and follows with study of experiences and exposures across childhood and adolescence. Many studies incorporate neuroimaging and hormone assays.
Introduction: Access block (AB) is the most important indicator of Emergency Department (ED) crowding, but the impact of AB on consultation time has not been described. Our objectives were to determine if ED AB affects inpatient service consultation time, and operational and patient outcomes. Methods: We conducted a health records review of all ED patients referred and admitted at a university-affiliated tertiary care hospital over 60-days. A computational algorithm determined hourly ED AB at the time of consultation request, and observational cohorts were determined based on ED AB high (>35% ED bed capacity occupied by admitted patients) or low (<35%). The outcomes included total consultation time (TCT), ED physician initial assessment (PIA) time, ED length of stay (LOS), transfer time to inpatient bed (TTB), hospital LOS, return to ED (RTED) within 30 days, and 30-day mortality. Results: We included 2,871 patients (48% male; M = 63 years, IQR 45–78), and the low AB cohort were higher acuity (N = 1,692; 50.4% CTAS 1–2) than the high AB cohort (N = 1,179; 47.1% CTAS 1–2). Median TCT was not significantly different (low = 209min, high = 212min; p = 0.09), and there was no difference in consults completed within the 3-hour institutional time target (low = 41.1%, high = 40.9%; p = 0.89). Median ED PIA time was not significantly different (low = 66min, high = 68min; p = 0.08), however, patients seen within the funding-associated provincial ED PIA time target was significantly less during high AB (high = 82.2%, low = 89.2%; p < 0.001). Median ED LOS was significantly longer during high AB (high = 12.1hr, low = 11.1hr; p = 0.009), but median hospital LOS was not different (high = 109.5hr, low = 112.4hr; p = 0.44). Median TTB was significantly longer during high AB (high = 8.0hr, low = 5.9hr; p = 0.0004). There was no difference in RTED visits (high = 12.4%, low = 10.6%; p = 0.15) or 30-day mortality (high = 8.4%, low = 9.2%; p = 0.51). Conclusion: In conclusion, consultation time is not affected by AB. However, boarding admitted patients in the ED impairs our ability to meet funding-associated performance metrics. Reducing boarding time should be an ED and hospital-wide priority, as it negatively impacts funding and delays patient care.
The problem treated here is an abstract version of the Cauchy problem for an equation of mixed type in the hyperbolic region with initial data on the parabolic line (cf. 2, 3, 5, 11, 13, 14, 15, 16, 21, 27). A more complete bibliography may be found in (3, 5, 18). We begin with the equation (6)
Sugarbeet, grown for biofuel, is being considered as an alternate cool-season crop in the southeastern United States. Previous research identified ethofumesate PRE and phenmedipham + desmedipham POST as herbicides that controlled troublesome cool-season weeds in the region, specifically cutleaf evening-primrose. Research trials were conducted from 2014 through 2016 to evaluate an integrated system of sweep cultivation and reduced rates of ethofumesate PRE and/or phenmedipham+desmedipham POST for weed control in sugarbeet grown for biofuel. There were no interactions between the main effects of cultivation and herbicides for control of cutleaf evening-primrose and other cool-season species in two out of three years. Cultivation improved control of cool-season weeds, but the effect was largely independent of control provided by herbicides. Of the herbicide combinations evaluated, the best overall cool-season weed control was from systems that included either a 1/2X or 1X rate of phenmedipham+desmedipham POST. Either rate of ethofumesate PRE was less effective than phenmedipham+desmedipham POST. Despite improved cool-season weed control, sugarbeet yield was not affected by cultivation each year of the study. Sugarbeet yields were greater when treated with any herbicide combination that included either a 1/2X or 1X rate of phenmedipham+desmedipham POST compared with either rate of ethofumesate PRE alone or the nontreated control. These results indicate that cultivation has a very limited role in sugarbeet grown for biofuel. The premise of effective weed control based on an integration of cultivation and reduced herbicide rates does not appear to be viable for sugarbeet grown for biofuel.
To examine neonatal risk factors associated with recurrent Staphylococcus aureus colonization and to determine the genetic relatedness of S. aureus strains cultured from neonates before and after decolonization.
Single-center retrospective cohort study of neonates admitted to the neonatal intensive care unit (NICU) from April 2013 to December 2015, during which weekly nasal cultures from hospitalized NICU patients were routinely obtained for S. aureus surveillance.
Johns Hopkins Hospital’s 45-bed level IV NICU in Baltimore, Maryland.
Demographics and clinical data were collected on all neonates admitted to the NICU with S. aureus nasal colonization who underwent mupirocin-based decolonization during the study period. A decolonized neonate was defined as a neonate with ≥1 negative culture after intranasal mupirocin treatment. Pulsed-field gel electrophoresis was used for strain typing.
Of 2,060 infants screened for S. aureus, 271 (13%) were colonized, and 203 of these 271 (75%) received intranasal mupirocin. Of those treated, 162 (80%) had follow-up surveillance cultures, and 63 of these 162 infants (39%) developed recurrent colonization after treatment. The S. aureus strains were often genetically similar before and after decolonization. The presence of an endotracheal tube or nasal cannula/mask was associated with an increased risk of recurrent S. aureus colonization (hazard ratio [HR], 2.65; 95% confidence interval [CI], 1.19–5.90; and HR, 2.21; 95% CI, 1.02–4.75, respectively).
Strains identified before and after decolonization were often genetically similar, and the presence of invasive respiratory devices increased the risk of recurrent S. aureus nasal colonization in neonates. To improve decolonization efficacy, alternative strategies may be needed.
The ideal sampling method and benefit of qualitative versus quantitative culture for carbapenem-resistant Enterobacteriaceae (CRE) recovery in hospitalized patient rooms and bathrooms is unknown. Although the use of nylon-flocked swabs improved overall gram-negative organism recovery compared with cellulose sponges, they were similar for CRE recovery. Quantitative culture was inferior and unrevealing beyond the qualitative results.
Sugarbeet, grown for biofuel, is being considered as an alternate cool-season crop in the southeastern U.S. coastal plain. Typically, the crop would be seeded in the autumn, then grow through the winter and be harvested the following spring. Labels for herbicides registered for use on sugarbeet grown in the traditional sugarbeet production regions do not list any of the cool-season weeds common in the southeastern United States. Field trials were initiated near Ty Ty, GA, to evaluate all possible combinations of ethofumesate applied PRE, phenmedipham+desmedipham applied POST, clopyralid POST, and triflusulfuron POST for cool-season weed control in sugarbeet. Phenmedipham+desmedipham alone and in combination with clopyralid and/or triflusulfuron effectively controlled cutleaf eveningprimrose, lesser swinecress, henbit, and corn spurry when applied to seedling weeds. Ethofumesate PRE alone was not as effective in controlling cool-season weeds compared to treatments containing phenmedipham+desmedipham POST. However, ethofumesate PRE applied sequentially with phenmedipham+desmedipham POST improved weed control consistency. Clopyralid and/or triflusulfuron alone did not adequately control cutleaf eveningprimrose. Triflusulfuron alone effectively controlled wild radish. In the 2013–2014 and 2014–2015 seasons, December-applied POST herbicides did not injure sugarbeet. However, in the 2015–2016 season POST herbicides were applied in late October. On the day of treatment, the maximum temperature was 25.4 C, which exceeded the established upper temperature limit of 22 C for safe application of phenmedipham+desmedipham, and sugarbeet plants were severely injured. In the southeastern United States, temperatures frequently exceed 22 C in early autumn, which may limit phenmedipham+desmedipham use for controlling troublesome cool-season weeds of sugarbeet in the region. Weed control options need to be expanded to compensate for this limitation.
The fourth edition of Gender and Elections offers a systematic, lively, multi-faceted account of the role of gender in the electoral process through the 2016 elections. This timely, yet enduring, volume strikes a balance between highlighting the most important development for women as voters and candidates in the 2016 elections and providing a more long-term, in-depth analysis of the ways in which gender has helped shape the contours and outcomes of electoral politics in the United States. Individual chapters demonstrate the importance of gender in understanding and interpreting presidential elections, presidential and vice-presidential candidacies, voter participation and turnout, voting choices, congressional elections, the political involvement of Latinas, the participation of African American women, the support of political parties and women's organizations, candidate communications with voters, and state elections. Without question, Gender and Elections is the most comprehensive, reliable, and trustworthy resource on the role of gender in electoral politics.