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Clostridioides difficile infection (CDI) can be prevented through infection prevention practices and antibiotic stewardship. Diagnostic stewardship (ie, strategies to improve use of microbiological testing) can also improve antibiotic use. However, little is known about the use of such practices in US hospitals, especially after multidisciplinary stewardship programs became a requirement for US hospital accreditation in 2017. Thus, we surveyed US hospitals to assess antibiotic stewardship program composition, practices related to CDI, and diagnostic stewardship.
Surveys were mailed to infection preventionists at 900 randomly sampled US hospitals between May and October 2017. Hospitals were surveyed on antibiotic stewardship programs; CDI prevention, treatment, and testing practices; and diagnostic stewardship strategies. Responses were compared by hospital bed size using weighted logistic regression.
Overall, 528 surveys were completed (59% response rate). Almost all (95%) responding hospitals had an antibiotic stewardship program. Smaller hospitals were less likely to have stewardship team members with infectious diseases (ID) training, and only 41% of hospitals met The Joint Commission accreditation standards for multidisciplinary teams. Guideline-recommended CDI prevention practices were common. Smaller hospitals were less likely to use high-tech disinfection devices, fecal microbiota transplantation, or diagnostic stewardship strategies.
Following changes in accreditation standards, nearly all US hospitals now have an antibiotic stewardship program. However, many hospitals, especially smaller hospitals, appear to struggle with access to ID expertise and with deploying diagnostic stewardship strategies. CDI prevention could be enhanced through diagnostic stewardship and by emphasizing the role of non–ID-trained pharmacists and clinicians in antibiotic stewardship.
Dicamba and 2,4-D exposure to sensitive crops, such as dry bean, is of great concern with the recent registrations of dicamba- and 2,4-D- resistant soybean. In 2017 and 2018, field experiments were conducted at two Michigan locations to understand how multiple factors, including dry bean market class, herbicide rate, and application timing influence dry bean response to dicamba and 2,4-D. Dicamba and 2,4-D at rates of 0.1, 1 and 10% of the field use rate for dicamba and 2,4-D choline were applied to V2 and V8 black and navy bean. Field use rates for dicamba and 2,4-D choline were 560 and 1120 g ae ha-1, respectively. There were few differences between market classes or application timings when dry bean were exposed to dicamba or 2,4-D. Estimated rates to cause 20% dry bean injury 14 DAT were 4.5 and 107.5 g ae ha-1 for dicamba and 2,4-D, respectively. When dicamba was applied at 56 g ae ha-1 light interception was reduced up to 51% and maturity was delayed up to 16 days. Even though both herbicides caused high levels of injury to dry bean, yield reductions were not consistently observed. At four site-years, 2,4-D did not reduce dry bean yield or seed weight with any rate tested. However, when averaged over site-years dicamba rates of 3.7, 9.8 and 17.9 g ae ha-1 were estimated to cause 5, 10 and 15% yield loss, respectively. Dicamba also reduced seed weight by 10% when 56 g ae ha-1 was applied. However, the germination of harvested seed was not affected by dicamba or 2,4-D. Long delays in dry bean maturity from dicamba injury can also indirectly increase losses in yield and quality due to harvestability issues. This work further stresses the need for caution when using dicamba or 2,4-D herbicides near sensitive crops.
This chapter reviews key findings from analyses of spectral reflectance measurements of Mercury taken by the MESSENGER mission. Mercury’s crust lacks the 1-µm crystal field absorption due to ferrous iron that is common on other silicate bodies, yet is unusually low in reflectance. The most likely darkening phase is carbon as graphite. Variations in reflectance and color reveal that volcanic plains averaging >5 km in thickness overlie graphite-rich low-reflectance material, which may have originated as a graphite flotation crust from a magma ocean. The one unambiguous absorption due to an oxidized transition metal, an ultraviolet oxygen–metal charge transfer band in bright, pyroclastic deposits, may originate by oxidation of carbon and sulfides, reducing 0.3–1 wt.% ferrous iron in silicates to a metallic state, unsaturating the very strong oxygen–metal charge transfer band.
Visible to short-wave infrared (VSWIR, 0.4–5.0 µm) reflectance spectroscopy is a powerful tool to identify and map mineral groups on the martian surface. The Mars Express/OMEGA and Mars Reconnaissance Orbiter/CRISM instruments have characterized more than 30 mineral groups, revolutionizing previous understanding of martian crustal composition and the role of water in altering it. Analyses of these spectral images revealed the primary structure of the crust to be dominated by basalt, over a deep layer of segregated pyroxene- and olivine-rich plutons, with sparse feldspar-rich, differentiated intrusions. Martian volatile-bearing environments have evolved through four phases: the pre-Noachian to early Noachian period when alteration by liquid water occurred near the surface and deep in the subsurface, in chemically neutral to alkaline environments that formed hydrous silicates and carbonates; the middle to late Noachian period when liquid water was widely present at the surface forming valley networks, lacustrine deposits, and clay-rich pedogenic horizons; the early Hesperian to early Amazonian period during which water became increasingly acidic and saline, forming deposits rich in sulfate salts, chlorides, and hydrated silica; and the Amazonian period when surface water has existed predominantly as ice, with only localized reaction with regolith and briny flow on the surface.
Viral pneumonia is an important cause of death and morbidity among infants worldwide. Transmission of non-influenza respiratory viruses in households can inform preventative interventions and has not been well-characterised in South Asia. From April 2011 to April 2012, household members of pregnant women enrolled in a randomised trial of influenza vaccine in rural Nepal were surveyed weekly for respiratory illness until 180 days after birth. Nasal swabs were tested by polymerase chain reaction for respiratory viruses in symptomatic individuals. A transmission event was defined as a secondary case of the same virus within 14 days of initial infection within a household. From 555 households, 825 initial viral illness episodes occurred, resulting in 79 transmission events. The overall incidence of transmission was 1.14 events per 100 person-weeks. Risk of transmission incidence was associated with an index case age 1–4 years (incidence rate ratio (IRR) 2.35; 95% confidence interval (CI) 1.40–3.96), coinfection as initial infection (IRR 1.94; 95% CI 1.05–3.61) and no electricity in household (IRR 2.70; 95% CI 1.41–5.00). Preventive interventions targeting preschool-age children in households in resource-limited settings may decrease the risk of transmission to vulnerable household members, such as young infants.
Little is known about the neural substrates of suicide risk in mood disorders. Improving the identification of biomarkers of suicide risk, as indicated by a history of suicide-related behavior (SB), could lead to more targeted treatments to reduce risk.
Participants were 18 young adults with a mood disorder with a history of SB (as indicated by endorsing a past suicide attempt), 60 with a mood disorder with a history of suicidal ideation (SI) but not SB, 52 with a mood disorder with no history of SI or SB (MD), and 82 healthy comparison participants (HC). Resting-state functional connectivity within and between intrinsic neural networks, including cognitive control network (CCN), salience and emotion network (SEN), and default mode network (DMN), was compared between groups.
Several fronto-parietal regions (k > 57, p < 0.005) were identified in which individuals with SB demonstrated distinct patterns of connectivity within (in the CCN) and across networks (CCN-SEN and CCN-DMN). Connectivity with some of these same regions also distinguished the SB group when participants were re-scanned after 1–4 months. Extracted data defined SB group membership with good accuracy, sensitivity, and specificity (79–88%).
These results suggest that individuals with a history of SB in the context of mood disorders may show reliably distinct patterns of intrinsic network connectivity, even when compared to those with mood disorders without SB. Resting-state fMRI is a promising tool for identifying subtypes of patients with mood disorders who may be at risk for suicidal behavior.
Weeds can cause significant yield loss in watermelon production systems. Commercially acceptable weed control is difficult to achieve, even with heavy reliance on herbicides. A study was conducted to evaluate a spring-seeded cereal rye cover crop with different herbicide application timings for weed management between row middles in watermelon production systems. Common lambsquarters and pigweed species (namely, Palmer amaranth and smooth pigweed) densities and biomasses were often lower with cereal rye compared with no cereal rye, regardless of herbicide treatment. The presence of cereal rye did not negatively influence the number of marketable watermelon fruit, but average marketable fruit weight in cereal rye versus no cereal rye treatments varied by location. These results demonstrate that a spring-seeded cereal rye cover crop can help reduce weed density and weed biomass, and potentially enhance overall weed control. Cereal rye alone did not provide full-season weed control, so additional research is needed to determine the best methods to integrate spring cover cropping with other weed management tactics in watermelon for effective, full-season control.
Research participants want to receive results from studies in which they participate. However, health researchers rarely share the results of their studies beyond scientific publication. Little is known about the barriers researchers face in returning study results to participants.
Using a mixed-methods design, health researchers (N = 414) from more than 40 US universities were asked about barriers to providing results to participants. Respondents were recruited from universities with Clinical and Translational Science Award programs and Prevention Research Centers.
Respondents reported the percent of their research where they experienced each of the four barriers to disseminating results to participants: logistical/methodological, financial, systems, and regulatory. A fifth barrier, investigator capacity, emerged from data analysis. Training for research faculty and staff, promotion and tenure incentives, and funding agencies supporting dissemination of results to participants were solutions offered to overcoming barriers.
Study findings add to literature on research dissemination by documenting health researchers’ perceived barriers to sharing study results with participants. Implications for policy and practice suggest that additional resources and training could help reduce dissemination barriers and increase the return of results to participants.
The occurrence of herbicide tank contamination with dicamba or 2,4-D will likely increase with the recent commercialization of dicamba- and 2,4-D-resistant soybean. High-value sensitive crops, including dry bean, will be at higher risks for exposure. In 2017 and 2018, two separate field experiments were conducted in Michigan to understand how multiple factors may influence dry bean response to dicamba and 2,4-D herbicides, including 1) the interaction between herbicides applied POST to dry bean and dicamba or 2,4-D, and 2) the impact of low rates of glyphosate with dicamba or 2,4-D. Dry bean injury was 20% and 2% from POST applications of dicamba (5.6 h ae ha−1) and 2,4-D (11.2 g ae ha−1), respectively, 14 days after treatment (DAT). The addition of glyphosate (8.4 g ae ha−1) did not increase dry bean injury from dicamba or 2,4-D. Over 2 site-years the addition of dry bean herbicides to dicamba or dicamba + glyphosate (8.4 g ae ha−1) increased dry bean injury and reduced yield by 6% to 10% more than when dicamba or dicamba + glyphosate was applied alone. The interaction between 2,4-D (11.2 g ae ha−1) and dry bean herbicides was determined to be synergistic. However, 2,4-D (11.2 g ae ha−1) had little effect on dry bean with or without the addition of a dry bean herbicide program. These studies document that synergy also occurs between dicamba and dicamba + glyphosate and both common dry bean herbicide programs tested: 1) imazamox (35 g ha−1) + bentazon (560 g ha−1), and 2) fomesafen (280 g ha−1). The synergy between dry bean herbicide and dicamba and dicamba + glyphosate can increase plant injury, delay maturity, and reduce yield to a greater extent than dicamba or dicamba + glyphosate alone. This work emphasizes the need to properly clean out sprayers after applications of dicamba to reduce the risk of exposure to other crops.
Total vegetation control (TVC) is an essential management practice to eliminate all vegetation for the purpose of protecting infrastructure, people, or natural resources on sites where vegetation poses major fire, visibility, and infrastructure risks. TVC is implemented on sites such as railroads, power substations, airports, roadsides, and oil and gas facilities. Current research has identified that tank-mixing two effective mechanisms of action is a superior resistance management strategy compared to rotating mechanisms of action; however, effective tank mixes for TVC have not been thoroughly evaluated. A field experiment was conducted from 2013 to 2014 at five sites in Colorado to compare 32 treatment combinations to two industry standards for TVC. Research objectives were (1) to identify herbicide tank-mix combinations for TVC with multiple effective mechanisms of action for resistance management, (2) to evaluate lower use rate alternatives to minimize nontarget impacts, and (3) to determine the efficacy of fall versus spring application timings. Seven treatments were identified as top-ranking treatments, averaging 96% bare-ground (BG) across five sites and two application timings. Four out of the seven top-ranked treatments included aminocyclopyrachlor, chlorsulfuron, and indaziflam. The industry standard diuron plus imazapyr was in the top ranking, whereas the other industry standard bromacil plus diuron performed inconsistently across sites. Probability modeling was used to predict the probability of achieving 97% or 100% BG with various treatment combinations. The combination of aminocyclopyrachlor, chlorsulfuron, indaziflam, and imazapyr had the highest predicted BG probability, with 88% predicted probability of achieving 100% BG, compared to 67% and 52% predicted probabilities for the industry standards diuron plus imazapyr and bromacil plus diuron, respectively. In three of the five sites, fall applications outperformed the same treatments applied in the spring. Several top-ranking treatments represent newer, lower use rate herbicide combinations that provide multiple mechanisms of action to manage herbicide-resistant weeds and minimize nontarget impacts.
Invasive winter annual grass infestations on rangeland accumulate large quantities of litter on the soil surface, as plants senesce yearly and decompose slowly. It has been speculated that winter annual grass litter can adsorb soil-active herbicides and reduce overall performance. Three experiments were conducted from 2017 to 2018 at the Colorado State University Weed Research Laboratory to evaluate interception and subsequent desorption of herbicides applied to litter from three invasive winter annual grass species with simulated rainfall. Imazapic, rimsulfuron, and indaziflam were applied to medusahead [Taeniatherum caput-medusae (L.) Nevski], ventenata [Ventenata dubia (Leers) Coss.], and downy brome (Bromus tectorum L.) litter at two amounts (equivalent to 1,300 and 2,600 kg ha−1). Rainfall was simulated at 3, 6, 12, and 24 mm at 0, 1, and 7 d after herbicide application. Herbicide concentration from the collected rainfall was measured using liquid chromatography–tandem mass spectrometry. At 2,600 kg ha−1, B. tectorum herbicide interception was 84.3%, while V. dubia and T. caput-medusae averaged 76% herbicide interception. There were no differences in desorption among the three litter types. Simulated rainfall at 0 d after application recovered 100% of the intercepted rimsulfuron and imazapic from B. tectorum litter, while recovery decreased to 65% with rainfall at 1 or 7 d after application. Only 54% of indaziflam could be recovered at 0 d, and recovery decreased to 33% when rainfall was applied at 1 or 7 d after application. Applying soil-active herbicides before forecasted rain or tank mixing with a POST herbicide to provide initial control could potentially increase the amount of herbicide reaching the soil and provide more consistent invasive winter annual grass control.
To describe an outbreak of bacteremia caused by vancomycin-sensitive Enterococcus faecalis (VSEfe).
An investigation by retrospective case control and molecular typing by whole-genome sequencing (WGS).
A tertiary-care neonatal unit in Melbourne, Australia.
Risk factors for 30 consecutive neonates with VSEfe bacteremia from June 2011 to December 2014 were analyzed using a case control study. Controls were neonates matched for gestational age, birth weight, and year of birth. Isolates were typed using WGS, and multilocus sequence typing (MLST) was determined.
Bacteremia for case patients occurred at a median time after delivery of 23.5 days (interquartile range, 14.9–35.8). Previous described risk factors for nosocomial bacteremia did not contribute to excess risk for VSEfe. WGS typing results designated 43% ST179 as well as 14 other sequence types, indicating a polyclonal outbreak. A multimodal intervention that included education, insertion checklists, guidelines on maintenance and access of central lines, adjustments to the late onset sepsis antibiotic treatment, and the introduction of diaper bags for disposal of soiled diapers after being handled inside the bed, led to termination of the outbreak.
Typing using WGS identified this outbreak as predominately nonclonal and therefore not due to cross transmission. A multimodal approach was then sought to reduce the incidence of VSEfe bacteremia.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.