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To test the hypothesis that long-term care facility (LTCF) residents with Clostridium difficile infection (CDI) or asymptomatic carriage of toxigenic strains are an important source of transmission in the LTCF and in the hospital during acute-care admissions.
A 6-month cohort study with identification of transmission events was conducted based on tracking of patient movement combined with restriction endonuclease analysis (REA) and whole-genome sequencing (WGS).
Veterans Affairs hospital and affiliated LTCF.
The study included 29 LTCF residents identified as asymptomatic carriers of toxigenic C. difficile based on every other week perirectal screening and 37 healthcare facility-associated CDI cases (ie, diagnosis >3 days after admission or within 4 weeks of discharge to the community), including 26 hospital-associated and 11 LTCF-associated cases.
Of the 37 CDI cases, 7 (18·9%) were linked to LTCF residents with LTCF-associated CDI or asymptomatic carriage, including 3 of 26 hospital-associated CDI cases (11·5%) and 4 of 11 LTCF-associated cases (36·4%). Of the 7 transmissions linked to LTCF residents, 5 (71·4%) were linked to asymptomatic carriers versus 2 (28·6%) to CDI cases, and all involved transmission of epidemic BI/NAP1/027 strains. No incident hospital-associated CDI cases were linked to other hospital-associated CDI cases.
Our findings suggest that LTCF residents with asymptomatic carriage of C. difficile or CDI contribute to transmission both in the LTCF and in the affiliated hospital during acute-care admissions. Greater emphasis on infection control measures and antimicrobial stewardship in LTCFs is needed, and these efforts should focus on LTCF residents during hospital admissions.
Research on the cities of the Classical Greek world has traditionally focused on mapping the organisation of urban space and studying major civic or religious buildings. More recently, newer techniques such as field survey and geophysical survey have facilitated exploration of the extent and character of larger areas within urban settlements, raising questions about economic processes. At the same time, detailed analysis of residential buildings has also supported a change of emphasis towards understanding some of the functional and social aspects of the built environment as well as purely formal ones. This article argues for the advantages of analysing Greek cities using a multidisciplinary, multi-scalar framework which encompasses all of these various approaches and adds to them other analytical techniques (particularly micro-archaeology). We suggest that this strategy can lead towards a more holistic view of a city, not only as a physical place, but also as a dynamic community, revealing its origins, development and patterns of social and economic activity. Our argument is made with reference to the research design, methodology and results of the first three seasons of fieldwork at the city of Olynthos, carried out by the Olynthos Project.
The study aims to assess whether supplementation with the probiotic Lactobacillus rhamnosus HN001 (HN001) can reduce the prevalence of gestational diabetes mellitus (GDM). A double-blind, randomised, placebo-controlled parallel trial was conducted in New Zealand (NZ) (Wellington and Auckland). Pregnant women with a personal or partner history of atopic disease were randomised at 14–16 weeks’ gestation to receive HN001 (6×109 colony-forming units) (n 212) or placebo (n 211) daily. GDM at 24–30 weeks was assessed using the definition of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) (fasting plasma glucose ≥5·1 mmol/l, or 1 h post 75 g glucose level at ≥10 mmol/l or at 2 h ≥8·5 mmol/l) and NZ definition (fasting plasma glucose ≥5·5 mmol/l or 2 h post 75 g glucose at ≥9 mmol/l). All analyses were intention-to-treat. A total of 184 (87 %) women took HN001 and 189 (90 %) women took placebo. There was a trend towards lower relative rates (RR) of GDM (IADPSG definition) in the HN001 group, 0·59 (95 % CI 0·32, 1·08) (P=0·08). HN001 was associated with lower rates of GDM in women aged ≥35 years (RR 0·31; 95 % CI 0·12, 0·81, P=0·009) and women with a history of GDM (RR 0·00; 95 % CI 0·00, 0·66, P=0·004). These rates did not differ significantly from those of women without these characteristics. Using the NZ definition, GDM prevalence was significantly lower in the HN001 group, 2·1 % (95 % CI 0·6, 5·2), v. 6·5 % (95 % CI 3·5, 10·9) in the placebo group (P=0·03). HN001 supplementation from 14 to 16 weeks’ gestation may reduce GDM prevalence, particularly among older women and those with previous GDM.
We have begun a project to produce self-consistent 2-D MHD simulations of the generation and collimation of mass outflows from star forming regions. We describe our code development work, and present preliminary results.
We report on preliminary numerical MHD simulations of magnetic disk accretion surrounding a compact protostar in which the disk and the hydromagnetic wind interact self-consistently. We show that an outflow is indeed produced, but that its properties are sensitive to the assumed initial poloidal magnetic field structure. In particular, we reconcile the apparently disparate models of Pudritz and Norman (1983,1986) and Uchida and Shibata (1985) concerning the mass ejection mechanism.
The ALFA mission is designed to map the entire sky at frequencies between approximately 0.3 and 30 MHz with angular resolution limited by interstellar and interplanetary scattering. Most of this region of the spectrum is inaccessible from the ground because of absorption and refraction by the Earth’s ionosphere. A wide range of astrophysical questions concerning solar system, galactic, and extragalactic objects could be answered with high resolution images at low frequencies, where absorption effects and coherent emission processes become important and the synchrotron lifetimes of electrons are comparable to the age of the universe.
Common beans (Phaseolus vulgaris L.) are a nutrient-dense, low glycemic index food that supports healthy weight management in people and was examined for dogs. The objectives of this study were to evaluate the apparent total tract digestibility (ATTD) and nutrient utilisation of navy (NB) and black (BB) bean-based diets in overweight or obese companion dogs undergoing a weight loss intervention. A nutritionally complete, dry extruded dog food was used as the control (CON) diet and two isocaloric, nutrient matched bean diets, containing either 25% w/w cooked BB or NB powder formed the test diets. Diets were fed to adult, overweight companion dogs for either four weeks (short-term study, n = 30) or for twenty-six weeks (long-term study, n = 15) at 60% of maintenance calories for ideal weight. Apparent weight loss increased over time in both the short- and long-term studies (p < 0.001) but was not different between the three study groups: apparent weight loss was between 4.05% – 6.14% for the short-term study and 14.0% – 17.9% in the long-term study. The ATTD was within expected ranges for all groups, whereby total dry matter and crude protein ATTD was 7–8% higher in the BB diet compared to CON (P < 0.05), crude fat ATTD was similar across all diets, and nitrogen free extract ATTD was 5–6% higher in both BB and NB compared to CON (P < 0.05). Metabolisable energy was similar for all diets, and ranged from 3,434–3,632 kcal/kg. At the end of each study period, dogs had haemoglobin levels ≥12 g/dl, packed cell volume ≥36%, albumin ≥2.4 g/dl, ALP ≤ 300 IU/l and all median values for each group were within defined limits for nutritional adequacy. This investigation demonstrated that BB and NB diets were safe, digestible, and supported weight loss in calorically restricted, overweight or obese, adult companion dogs.
Using new high resolution VLA and VLBA data and existing MERLIN data of 3C 67 and 3C 190, we find both sources have a complex spectral structure similar to larger Fanaroff-Riley type II sources. Our analysis of 3C 190 predicts either an unusually steep injection index of −0.8 and a young age, or a superposition of different age spectral components.
The third High Energy Astronomical Observatory, HEAO-3 was launched on the 20th Sept., 1979 into a 496 km, 43.6° orbit, and has since been successfully returning data from all three experiments on board. One of these experiments, that intended to study the heavy and ultra heavy nuclei in the cosmic radiation, is described here.
Complementing a multitude of activities around the International Year of Crystallography, we report here on a few resources that are helpful for integrating basic crystallography into interdisciplinary college education. We concentrate on four resources with which we are directly involved. The Crystallography Open Database (COD) features currently more than 295,000 entries and has over the last decade developed into the world’s premier open-access source for the structures of small molecules and small to medium sized unit cell crystals. ‘Educational offshoots’ of the COD with approximately a thousand entries combined provide structural information on small molecules, selected macromolecules, crystal structures, grain boundaries, and crystal morphologies in the well documented Crystallographic Information Framework (CIF) file format. This information can be displayed interactively on the website http://nanocrystallography.research.pdx.edu and freely downloaded. Files that allow for the printing of selected database entries on any 3D printer have been added to this site and are also freely downloadable. These files were created with the programs Cif2VRML and WinXMorph that convert CIF files directly into 3D printing files. Interested college educators are invited to visit our open access crystallography resource portal and suggest other resources that should receive wider exposure over this portal.
Excavations at Tell Brak in 2006–7 explored two key episodes in Mesopotamian political and social history, developing early social complexity in the fifth to fourth millennia BC and the shift from territorial state to early empire in the second millennium BC. Late Chalcolithic complexity is represented in Area TW on the main mound and at the outlying sub-mound of Tell Majnuna, while investigation of the Old Babylonian to Mitanni state-to-empire transition involved excavation in Areas HH and HN (Fig. 1). Both sets of excavations tie into our exploration of larger issues of the creation and maturation of past urban landscapes, for which Tell Brak provides a great depth of data.
We would like once again to express our warmest gratitude to Dr Bassam Jamous, Director General of Antiquities and Museums, to Dr Michel Al-Maqdissi, Director of Excavations, to all their staff in Damascus, and to Sd Abdul Messih Baghdo, Director of the Antiquities Office in Hasseke, for their constant and friendly support. Financial support for the excavations was generously provided by the British School of Archaeology in Iraq, the McDonald Institute for Archaeological Research, Cambridge, the National Geographic Committee for Research and Exploration (2006), the Society of Antiquaries of London (2007), Newnham College, Cambridge and the University of Cambridge. We are extremely grateful to all those who have made this research possible.
The majority of people at ultra high risk (UHR) of psychosis also present with co-morbid affective disorders such as depression or anxiety. The neuroanatomical and clinical impact of UHR co-morbidity is unknown.
We investigated group differences in grey matter volume using baseline magnetic resonance images from 121 participants in four groups: UHR with depressive or anxiety co-morbidity; UHR alone; major depressive disorder; and healthy controls. The impact of grey matter volume on baseline and longitudinal clinical/functional data was assessed with regression analyses.
The UHR-co-morbidity group had lower grey matter volume in the anterior cingulate cortex than the UHR-alone group, with an intermediate effect between controls and patients with major depressive disorder. In the UHR-co-morbidity group, baseline anterior cingulate volume was negatively correlated with baseline suicidality/self-harm and obsessive–compulsive disorder symptoms.
Co-morbid depression and anxiety disorders contributed distinctive grey matter volume reductions of the anterior cingulate cortex in people at UHR of psychosis. These volumetric deficits were correlated with baseline measures of depression and anxiety, suggesting that co-morbid depressive and anxiety diagnoses should be carefully considered in future clinical and imaging studies of the psychosis high-risk state.
Cannabis use is associated with an increased risk of developing a psychotic disorder but the temporal relationship between cannabis use and onset of illness is unclear. The objective of this study was to assess prospectively the influence of cannabis use on transition to psychosis in people at ultra-high risk (UHR) for the disorder.
Lifetime and continued cannabis use was assessed in a consecutively ascertained sample of 182 people (104 male, 78 female) at UHR for psychosis. Individuals were then followed clinically for 2 years to determine their clinical outcomes.
Lifetime cannabis use was reported by 134 individuals (73.6%). However, most of these individuals had stopped using cannabis before clinical presentation (n = 98, 73.1%), usually because of adverse effects. Among lifetime users, frequent use, early-onset use and continued use after presentation were all associated with an increase in transition to psychosis. Transition to psychosis was highest among those who started using cannabis before the age of 15 years and went on to use frequently (frequent early-onset use: 25%; infrequent or late-onset use: 5%; χ21 = 10.971, p = 0.001). However, within the whole sample, cannabis users were no more likely to develop psychosis than those who had never used cannabis (cannabis use: 12.7%; no use: 18.8%; χ21 = 1.061, p = 0.303).
In people at UHR for psychosis, lifetime cannabis use was common but not related to outcome. Among cannabis users, frequent use, early-onset use and continued use after clinical presentation were associated with transition to psychosis.
A novel approach to fabricate CuIn(S,Se)2 (CIS) thin films through ultrasonically spraying a hydrazine-based precursor solution onto a heated substrate is reported. The effects of the composition of the precursor solutions and the deposition temperature on the CIS film properties were investigated by comparing thin films fabricated using aqueous metal salt solution, anhydrous hydrazine solution, and hydrazine hydrate solution at various deposition temperatures. Crystallite size and texture coefficient in the preferred (112) orientation in the sprayed films increased when the aqueous solution was replaced by hydrazine-based solutions. Additionally, the hydrazine-based precursor solutions resulted in films with better surface smoothness and compositional uniformity than those fabricated using water-based solutions and the hydrazine hydrate solution resulting in the smoothest, most uniform films. The sprayed films were used to fabricate preliminary solar cells that demonstrated a modest photovoltaic response. With optimization, the synthesis of high-quality CIS films by spray pyrolysis from a hydrazine hydrate solution could demonstrate the potential for a low-cost, high-throughput manufacturing process.
Smoking is highly prevalent in people diagnosed with schizophrenia, but the reason for this co-morbidity is currently unclear. One possible explanation is that a common abnormality underpins the development of psychosis and independently enhances the incentive motivational properties of drugs and their associated cues. This study aimed to investigate whether incentive salience attribution towards smoking cues, as assessed by attentional bias, is heightened in schizophrenia and associated with delusions and hallucinations.
Twenty-two smokers diagnosed with schizophrenia and 23 control smokers were assessed for smoking-related attentional bias using a modified Stroop task. Craving, nicotine dependence, smoking behaviour and positive and negative symptoms of schizophrenia were also recorded.
Both groups showed similar craving scores and smoking behaviour according to self-report and expired carbon monoxide (CO), although the patient group had higher nicotine dependence scores. Attentional bias, as evidenced by significant interference from smoking-related words on the modified Stroop task, was similar in both groups and correlated with CO levels. Attentional bias was positively related to severity of delusions but not hallucinations or other symptoms in the schizophrenia group.
This study supports the hypothesis that the development of delusions and the incentive motivational aspects of smoking may share a common biological substrate. These findings may offer some explanation for the elevated rates of smoking and other drug use in people with psychotic illness.
Cannabis use has been reported to be associated with an earlier onset of symptoms in patients with first-episode psychosis, and a worse outcome in those who continue to take cannabis. In general, studies have concentrated on symptoms of psychosis rather than mania. In this study, using a longitudinal design in a large naturalistic cohort of patients with first-episode psychosis, we investigated the relationship between cannabis use, age of presentation to services, daily functioning, and positive, negative and manic symptoms.
Clinical data on 502 patients with first-episode psychosis were collected using the MiData audit database from seven London-based Early Intervention in psychosis teams. Individuals were assessed at two time points – at entry to the service and after 1 year. On each occasion, the Positive and Negative Syndrome Scale, Young Mania Rating Scale and Global Assessment of Functioning Scale disability subscale were rated. At both time points, the use of cannabis and other drugs of abuse in the 6 months preceding each assessment was recorded.
Level of cannabis use was associated with a younger age at presentation, and manic symptoms and conceptual disorganization, but not with delusions, hallucinations, negative symptoms or daily functioning. Cannabis users who reduced or stopped their use following contact with services had the greatest improvement in symptoms at 1 year compared with continued users and non-users. Continued users remained more symptomatic than non-users at follow-up.
Effective interventions for reducing cannabis use may yield significant health benefits for patients with first-episode psychosis.
We present experimental results supporting physics-based ejecta model development, where our main assumption is that ejecta form as a special limiting case of a Richtmyer–Meshkov (RM) instability at a metal–vacuum interface. From this assumption, we test established theory of unstable spike and bubble growth rates, rates that link to the wavelength and amplitudes of surface perturbations. We evaluate the rate theory through novel application of modern laser Doppler velocimetry (LDV) techniques, where we coincidentally measure bubble and spike velocities from explosively shocked solid and liquid metals with a single LDV probe. We also explore the relationship of ejecta formation from a solid material to the plastic flow stress it experiences at high-strain rates () and high strains (700 %) as the fundamental link to the onset of ejecta formation. Our experimental observations allow us to approximate the strength of Cu at high strains and strain rates, revealing a unique diagnostic method for use at these extreme conditions.