The use of binomial coefficients in place of factorials to shorten the calculation of exact probabilities for 2 × 2 and 2 × r contingency tables is discussed. A useful set of inequalities for estimating the cumulative probabilities in the tail of the distribution from the probability of a single table is given. A table of binomial coefficients with four significant places and n through 60 is provided.

Background: The Streptococcal pneumoniae urine antigen (SPUA) test was developed to increase microbiologic diagnosis of pneumonia. Concerns have been raised about the test’s low sensitivity and failure to alter outcomes by de-escalating antibiotics (PMID:31956656). However, the cost-effectiveness and real-world clinical utility of the test remain unclear. Methods: From June 1, 2022 - May 31, 2023, all patients with a SPUA test in the MUSC Health System were identified via Epic SlicerDicer. Those with a positive test underwent chart review. Antibiotics were classified as a “broad” or “targeted” regimen for S. pneumoniae. Targeted regimens included penicillins without beta-lactamase inhibitors, 1st-3rd generation cephalosporins, doxycycline, levofloxacin or moxifloxacin (with or without azithromycin), as well as azithromycin monotherapy. Broad regimens included 4th generation or higher cephalosporins, carbapenems, penicillins with beta-lactamase inhibitors, and vancomycin. Results: In one year, 1,518 patients had a SPUA test ordered. 62 (4%) patients had a positive test. Of those 62 patients, 14 patients were discharged before the test resulted (Table). The average turnaround time for the test was 2.2 days. When comparing antibiotic therapy on the day before the SPUA test resulted to two days after the test resulted, only 7 additional patients were switched to a targeted regimen (Figure). Conclusion: Of 1,518 SPUA tests ordered in a year, most (1,456 or 96%) were negative, with minimal changes to antibiotic therapy based on positive Results: These results are similar to other real-world studies, which showed a positive test prevalence between 4-8% (PMID:30265290) with 15-30% of patients changed to targeted antibiotics following a positive result (PMID:23111919, PMID: 28053969). The SPUA test cost approximately $44,022 (based on $29 test price) but has limited utility in a real-world setting.

Disclosure: Krutika Hornback: Speaker’s Bureau - Cepheid Diagnostics

In postwar France a proliferation of thinkers sought to move away from the dialectic of negation and synthesis. Two such writers turned to Jean-Jacques Rousseau as the source of a non-dualistic reflection. In 1962, Claude Lévi-Strauss laid claim to him as the “founder of the sciences of man,” and, inspired in part by his contact with Buddhism, he created a non-dualist version of the philosophe as a foil to Sartre. In 1989, Monique Wittig would also take up Rousseau, but in order to challenge Lévi-Strauss's notion of the exchange of women. In her hands, Rousseau also became a non-dualist through whom she could formalize the insights of gay and lesbian community life as a theory of sex abolition: “the science of the oppressed.” With archival materials, close readings, and historical contextualization, this article explores the genesis and interactions of both interpretations and situates them on the broader horizon of postwar thought.

Nematode spicules play a vital role in the reproductive activity of species that possess them. Our primary objective was to compare the lengths of spicules of the laboratory mouse (Mus musculus) – maintained isolate H. bakeri – with those of H. polygyrus from naturally infected wood mice (Apodemus sylvaticus). On a more limited scale, we also included H. glareoli from bank voles (Myodes glareolus), a species reputed to possess longer spicules than either of the 2 former species. In total, we measured 1264 spicules (H. bakeri, n = 614; H. polygyrus n = 582; and H. glareoli, n = 68). There was a highly significant difference between the spicule lengths of the Nottingham-maintained H. bakeri (mean = 0.518 mm) and H. polygyrus (0.598 mm) from 11 different localities across the British Isles. A comparison of the spicules of H. bakeri maintained in 4 different laboratories in 3 continents revealed a range in the mean values from 0.518 to 0.540 mm, while those of worms from Australian wild house mice were shorter (0.480 mm). Mean values for H. polygyrus from wood mice from the British Isles ranged from 0.564 to 0.635 mm, although isolates of this species from Norway had longer spicules (0.670 mm). In agreement with the literature, the spicules of H. glareoli were considerably longer (1.098 mm). Since spicules play a vital role in the reproduction of nematode species that possess them, the difference in spicule lengths between H. bakeri and H. polygyrus adds to the growing evidence that these 2 are quite distinct species and likely reproductively isolated.

In this editorial we, as members of the 2022 NICE Guideline Committee, highlight and discuss what, in our view, are the key guideline recommendations (generated through evidence synthesis and consensus) for mental health professionals when caring for people after self-harm, and we consider some of the implementation challenges.

We present observations of the Mopra carbon monoxide (CO) survey of the Southern Galactic Plane, covering Galactic longitudes spanning $l = 250^{\circ}$ ($-110^{\circ}$) to $l = 355^{\circ}$ ($-5^{\circ}$), with a latitudinal coverage of at least $|b|<1^\circ$, totalling an area of $>$210 deg$^{2}$. These data have been taken at 0.6 arcmin spatial resolution and 0.1 km s$^{-1}$ spectral resolution, providing an unprecedented view of the molecular gas clouds of the Southern Galactic Plane in the 109–115 GHz $J = 1-0$ transitions of $^{12}$CO, $^{13}$CO, C$^{18}$O, and C$^{17}$O.

Background: Our aim was to develop a National Quality Indicators Set for the Care of Adults Hospitalized for Neurological Problems, to serve as a foundation to build regional or national quality initiatives in Canadian neurology centres. Methods: We used a national eDelphi process to develop a suite of quality indicators and a parallel process of surveys and patient focus groups to identify patient priorities. Canadian content and methodology experts were invited to participate. To be included, >70% of participants had to rate items as critical and <15% had to rate it as not important. Two rounds of surveys and consensus meetings were used identify and rank indicators, followed by national consultation with members of the Canadian Neurological Society. Results: 38 neurologists and methodologists and 56 patients/caregivers participated in this project. An initial list of 91 possible quality indicators was narrowed to 40 indicators across multiple categories of neurological conditions. 21 patient priorities were identified. Conclusions: This quality indicators suite can be used regionally or nationally to drive improvement initiatives for inpatient neurology care. In addition, we identified multiple opportunities for further research where evidence was lacking or patient and provider priorities did not align.

Preferences for nest box size and position were tested in two groups of common marmoset, Callithrix jacchus jacchus. In a pre-test phase two, new, wooden nest boxes were introduced to each group alongside their old metal one, so that the animals could become familiar with them, and so that any pre-existing preference could be identified. In successive experiments: i) the old metal nest box was closed so that the marmosets had to choose a preferred box from the two new nest boxes; ii) the size of the preferred nest box was systematically reduced; and iii) in one of the groups the reduced nest box was restored to full size, but its position interchanged with the non-preferred box. In a further experiment, the position of the preferred, and then of the non-preferred box was raised to the highest point in the cage. The marmosets showed strong positional preferences which could not have been predicted without performing the tests. One of the groups also showed a strong preference for the high nest box. It was concluded that marmosets may exhibit preferences for their cage furniture, the basis of which may not be clear to us. These preferences should, however, be taken into account when designing cages to maximize the welfare of the animals.

The herbicides that inhibit 4-hydroxyphenylpyruvate dioxygenase (HPPD) are primarily used for weed control in corn, barley, oat, rice, sorghum, sugarcane, and wheat production fields in the United States. The objectives of this review were to summarize 1) the history of HPPD-inhibitor herbicides and their use in the United States; 2) HPPD-inhibitor resistant weeds, their mechanism of resistance, and management; 3) interaction of HPPD-inhibitor herbicides with other herbicides; and 4) the future of HPPD-inhibitor-resistant crops. As of 2022, three broadleaf weeds (Palmer amaranth, waterhemp, and wild radish) have evolved resistance to the HPPD inhibitor. The predominance of metabolic resistance to HPPD inhibitor was found in aforementioned three weed species. Management of HPPD-inhibitor-resistant weeds can be accomplished using alternate herbicides such as glyphosate, glufosinate, 2,4-D, or dicamba; however, metabolic resistance poses a serious challenge, because the weeds may be cross-resistant to other herbicide sites of action, leading to limited herbicide options. An HPPD-inhibitor herbicide is commonly applied with a photosystem II (PS II) inhibitor to increase efficacy and weed control spectrum. The synergism with an HPPD inhibitor arises from depletion of plastoquinones, which allows increased binding of a PS II inhibitor to the D1 protein. New HPPD inhibitors from the azole carboxamides class are in development and expected to be available in the near future. HPPD-inhibitor-resistant crops have been developed through overexpression of a resistant bacterial HPPD enzyme in plants and the overexpression of transgenes for HPPD and a microbial gene that enhances the production of the HPPD substrate. Isoxaflutole-resistant soybean is commercially available, and it is expected that soybean resistant to other HPPD inhibitor herbicides such as mesotrione, stacked with resistance to other herbicides, will be available in the near future.

Nematode spicules vary in shape and size even between closely related species and, therefore, constitute key characters in nematode taxonomy for distinguishing between species. Spicules are seldom measured on fresh specimens, but rather at some time after extraction from culled hosts and after a period of preservation of the worms in chemical fixatives or by freezing. We carried out two experiments to assess the effects of freezing in Hanks’ balanced salt solution, 70% or 80% ethanol and 10% formalin (both of the latter at room temperature and after storage at −80°C) on spicule length of Heligmosomoides bakeri at two time intervals after extraction from mice (Experiment 1, one and four weeks; Experiment 2, one and four months). In Experiment 1, no significant differences were detected, although there was some variation between treatments and over time. In Experiment 2, spicule length varied significantly between treatments and over time, the greatest shrinkage being in 80% ethanol and the least in 10% formalin. However, overall variation in spicule length was very limited, accounting for no more than 5.03% change in length over time and 4.95% between treatments at any of the periods of assessment. Therefore, while whole nematodes can shrivel and shrink in preservatives, making many measurements unreliable, our data indicated that spicule lengths are very little changed by preservation techniques over time, and so spicule length remains as a reliable taxonomic character.

Delirium is reported to be one of the manifestations of coronavirus infectious disease 2019 (COVID-19) infection. COVID-19 hospitalized patients are at a higher risk of delirium. Pathophysiology behind the association of delirium and COVID-19 is uncertain. We analyzed the association of delirium occurrence with outcomes in hospitalized COVID-19 patients, across all age groups, at Mayo Clinic hospitals.

A retrospective study of all hospitalized COVID-19 patients at Mayo Clinic between March 1, 2020 and December 31, 2020 was performed. Occurrence of delirium and outcomes of mortality, length of stay, readmission, and 30-day mortality after hospital discharge were measured. Chi-square test, student t-test, survival analysis, and logistic regression analysis were performed to measure and compare outcomes of delirium group adjusted for age, sex, Charlson comorbidity score, and COVID-19 severity with no-delirium group.

A total of 4351 COVID-19 patients were included in the study. Delirium occurrence in the overall study population was noted to be 22.4%. The highest occurrence of delirium was also noted in patients with critical COVID-19 illness severity. A statistically significant OR 4.35 (3.27–5.83) for in-hospital mortality and an OR 4.54 (3.25–6.38) for 30-day mortality after discharge in the delirium group were noted. Increased hospital length of stay, 30-day readmission, and need for skilled nursing facility on discharge were noted in the delirium group. Delirium in hospitalized COVID-19 patients is a marker for increased mortality and morbidity. In this group, outcomes appear to be much worse when patients are older and have a critical severity of COVID-19 illness.

The discovery of wake bistability has generated an upsurge in experimental investigations into the wakes of simplified vehicle geometries. Particular focus has centred on the probabilistic switching between two asymmetrical bistable wake states of a square-back Ahmed body; however, the majority of this research has been undertaken in wind tunnels with turbulence intensities of less than $1\,\%$, considerably lower than typical atmospheric levels. To better simulate bistability under on-road conditions, in which turbulence intensities can easily reach levels of $10\,\%$ or more, this experimental study investigates the effects of free-stream turbulence on the bistability characteristics of the square-back Ahmed body. Through passive generation and quantification of the free-stream turbulent conditions, a monotonic correlation was found between the switching rate and free-stream turbulence intensity.

The spicules of male parasitic nematodes are key morphological features, which vary between species in shape and length and are used often for species identification. However, little is known about spicules and particularly if/how their length varies during growth. We first assessed the degree of variation in spicule length of male Heligmosomoides bakeri 21 days post infection (PI), and then in two follow-up experiments measured spicule lengths at half daily/daily intervals between days 6 and 14 PI. Mean spicule length in 21-day worms was 0.518 mm with a range of 94 μm, and variation between the two spicules of individual worms from 2 to 32 μm. Spicules were first detectable on day 6–6.5, after which their lengths increased until day 7 PI (mean = 0.61 and 0.59). This was followed by significant contraction, initially relatively quickly over the following 48 h and then more slowly over a longer period, stabilizing by days 10–14, with only minor further reduction in length. We conclude that the length of spicules varies significantly over the first few days after they have formed, and, consequently, the age of worms is an important factor for consideration when spicule lengths are measured for experimental/diagnostic or taxonomical purposes.