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Herbivory is a common ecological function among extant lepidosaurs, but little is known about the origin of this feeding strategy within Lepidosauria. Here we describe a sphenodontian (Lepidosauria) from the Late Triassic of western North America, Trullidens purgatorii n. gen. n. sp., that reveals new aspects of the earliest radiation of herbivorous lepidosaurs. This taxon is represented by an isolated lower jaw with robust structure bearing transversely widened dentition and extensive wear facets, suggesting a masticatory apparatus specialized for herbivory. An unusual ‘incisor-like’ tooth is present at the anterior end of the jaw; a unique feature among lepidosaurs, this tooth is convergent with the incisors of extant rodents and lagomorphs. Phylogenetic analyses support the placement of this taxon within opisthodontian sphenodontians, a group sharing derived cranio-dental morphologies specialized for herbivory. The new taxon was recovered in a recently discovered and unnamed series of Upper Triassic strata in southeastern Colorado, USA, exposed in Canyons incised by the Purgatoire River and its tributaries. These strata comprise a dominantly red-bed sequence of conglomerates, sandstones, and siltstones deposited in a fluvio-lacustrine setting, preserving a Late Triassic biota of invertebrate and vertebrate ichnofossils, plant macrofossils, bony fish, temnospondyl amphibians, and reptiles. We use aetosaur osteoderms as biostratigraphic links to the nearby Chinle Formation of Arizona, USA, establishing a middle Norian age for these strata. The presence of an opisthodontian from western equatorial Pangaea in the Norian Stage reveals a near-global radiation of this clade across the Pangaean supercontinent during the Late Triassic.
Background: The burden of C. difficile infection (CDI) on healthcare facilities is well recognized. However, studies focusing on inpatient settings, in addition to ascertainment bias in general, have led to a paucity of data on the true burden of CDI across whole healthcare economies. Methods: Sites testing both inpatient and community samples were recruited from 12 European countries (1 site per 3 million population). On 2 selected days, all diarrheal fecal samples (regardless of tests requested) were sent to the European Coordinating Laboratory (ECL) for C. difficile toxin testing and culture. The CDI results and tests not requested at each submitting site were compared with the ECL results to determine the number of missed CDIs. Contemporaneous C. difficile isolates from food and animal sources were collected. All isolates underwent PCR ribotyping and toxinotyping; prevalences of ribotypes among regions of Europe and reservoir settings were compared. Results: Overall, 3,163 diarrheal fecal samples were received from 119 sites. The burden of CDI varied by country (positivity rates, 0–15.8%) and by European region; the highest positivity rate in Eastern Europe was 13.1%. The testing and positivity rates in community samples were 29.6% and 1.4% vs 74.9% and 5.0% in hospital samples; 16% and 55% of samples positive for CDI at ECL were not diagnosed in hospitals and the community. The most common C. difficile ribotypes from hospital samples were 027 (11%), 181 (12%), and 014 (8%), although prevalence varied by country. The highest prevalence of toxinotype IIIb (ribotypes 027, 181, and 176) was seen in Eastern Europe (55% of all isolates), which also had the lowest testing rate. For hospital samples, the proportion of toxinotype IIIb was inversely related to the testing rate (r = −0.79) (Fig. 1). The most common ribotypes from food sources were 078 (23%) and 126 (13%) (toxinotype V), and most common ribotypes from community samples were 078 (9%) and 039 (9%). Overall, 106 different ribotypes were identified: 25 in both the hospital and community and 16 in the hospital, community, and food chain. Conclusions: The diagnosed burden of CDI varies markedly among countries in both hospital and community settings. Reduced sampling/testing in Eastern Europe is inversely related to the proportion of toxinotype IIIb strains identified, suggesting that lack of suspicion leads to underdiagnosis and outbreaks of infection. The proportion of missed CDIs in the community was ~3.5× higher than in hospitals, indicating major underrecognition in the former setting. There were marked differences in ribotypes in different reservoir settings, emphasizing the complex epidemiology of C. difficile.
Funding: Proprietary organization: COMBACTE-CDI is an EU funded (Horizon2020) consortium of academic and EFPIA partners (bioMerieux, GSK, Sanofi Pasteur, Astra Zeneca, Pfizer, Da Volterra) with additional Funding: from the EFPIA partners.
Disclosures: Submitter: Kerrie Davies; the work presented is funded via the EU and EFPIA (commercial) partners in a consortium.
In classical approaches to regime taxonomy, classifying a particular order within a typology of regimes turns on identifying the particular mix of its most important institutions and their associated purposes. Baogang He and Mark Warren’s past work has unsettled this familiar approach through a combination of innovative theorizing and empirical research. In this chapter, they extend their approach to recent arguments that Confucian ideals of meritocracy have been a significant factor driving China’s astonishing economic growth in recent decades. Beyond contesting the claim that China’s current regime is meritocratic, they reject altogether the view that “political meritocracy” is a regime type that can be coherently contrasted with “democracy.” Distinctions between regime types turn on how power is conferred on officeholders, whereas “meritocracy” refers to the qualities that officeholders possess. “Meritocracy” should be understood as an adjectival modifier of the two core regime types, authoritarianism and democracy. He and Warren draw on empirical research to argue that the current Chinese regime is a hybrid form, “authoritarian meritocracy with democratic characteristics,” that has emerged through innovative combinations of institutional forms. In practice, Chinese innovations sacrificed both democratic and meritocratic features of these institutions to the temptations of authoritarian rule.
Explaining genuine moral disagreement is a challenge for metaethical theories. For expressivists, this challenge comes from the plausibility of agents making seemingly univocal claims while expressing incongruent conative attitudes. I argue that metaethical inferentialism – a deflationary cousin to expressivism, which locates meaning in the inferential import of our moral assertions rather than the attitudes they express – offers a unique solution to this problem. Because inferentialism doesn’t locate the source of moral disagreements in a clash between attitudes, but instead in conflicts between the inferential import of ethical assertions, the traditional problem for expressivism can be avoided. After considering two forms of inferentialism that lead to revenge versions of the problem, I conclude by recommending that we understand the semantics of moral disagreements pragmatically: the source of univocity does not come from moral or semantic facts waiting to be described, but instead from the needs that ethical and semantic discourses answer – a solution to the problems of what we are to do and how we are to talk about it.
Objectives: Glioblastoma is a lethal disease in the elderly population. We aimed to evaluate disease and treatment outcomes in the oldest-old patients. Methods: Patients >80 years old with histologically confirmed glioblastoma treated between 2004 and 2009 were identified. We included patients managed with best supportive care (BSC), temozolomide (TMZ) alone, radiotherapy (RT) alone, or concomitantly with TMZ (CRT). Survival outcomes were analyzed using the Kaplan–Meier method. Results: Ultimately, 48 patients were analyzed. Median age and Eastern Cooperative Oncology Group (ECOG) Performance Status were 82 years and 2, respectively. The median Age-Adjusted Charlson Index (AAC) was 6. Gross total and subtotal resections were performed in 16.7% and 18.8% of patients, respectively. Biopsy followed by RT alone was the treatment modality for 23/48 (47.9%), while 17/48 (35.4%) received surgery followed by RT alone or CRT. A total of 8 (16.7%) were managed with BSC after biopsy. Median overall survival (OS) and progression-free survival (PFS) were 4.1 (95% confidence interval [95% CI] 3.3-4.9) and 2.7 (95% CI 1.5-3.9) months, respectively. Improved median OS was observed in those treated with surgical resection followed by RT alone or CRT (7.1 months), compared to biopsy followed by RT alone (4.2 months) or BSC (2.0 months; p=0.002). Surgical resection, age≤85, and AAC<6 were associated with better OS (p=0.032, p=0.031, and p=0.02, respectively). Cause of death was neurological progression in 56% of cases. RT was well-tolerated. Conclusions: PFS and OS outcomes remain poor in the oldest-old patients (>80 years old). Younger age, lower AAC, surgical resection, and adjuvant treatment were associated with improved OS.
Objectives: This study examined whether children with distinct brain disorders show different profiles of strengths and weaknesses in executive functions, and differ from children without brain disorder. Methods: Participants were children with traumatic brain injury (N=82; 8–13 years of age), arterial ischemic stroke (N=36; 6–16 years of age), and brain tumor (N=74; 9–18 years of age), each with a corresponding matched comparison group consisting of children with orthopedic injury (N=61), asthma (N=15), and classmates without medical illness (N=68), respectively. Shifting, inhibition, and working memory were assessed, respectively, using three Test of Everyday Attention: Children’s Version (TEA-Ch) subtests: Creature Counting, Walk-Don’t-Walk, and Code Transmission. Comparison groups did not differ in TEA-Ch performance and were merged into a single control group. Profile analysis was used to examine group differences in TEA-Ch subtest scaled scores after controlling for maternal education and age. Results: As a whole, children with brain disorder performed more poorly than controls on measures of executive function. Relative to controls, the three brain injury groups showed significantly different profiles of executive functions. Importantly, post hoc tests revealed that performance on TEA-Ch subtests differed among the brain disorder groups. Conclusions: Results suggest that different childhood brain disorders result in distinct patterns of executive function deficits that differ from children without brain disorder. Implications for clinical practice and future research are discussed. (JINS, 2017, 23, 529–538)
Over the last few decades, democratic theory has grown dramatically in its power and sophistication, fueled by debates among models of democracy. But these debates are increasingly unproductive. Model-based strategies encourage theorists to overgeneralize the place and functions of ideal typical features of democracy, such as deliberation or elections. Here I sketch an alternative strategy based on the question: What kinds of problems does a political system need to solve to count as “democratic”? I suggest three general kinds: it should empower inclusions, form collective agendas and wills, and have capacities to make collective decisions. We can view common practices such as voting and deliberating as means for addressing these problems, and theorize institutional mixes of practices that would maximize a political system's democratic problem-solving capacities. The resulting theories will be both normatively robust and sufficiently fine-grained to frame democratic problems, possibilities, and deficits in complex polities.
Pre-registration teaching of radiotherapy planning in a non-clinical setting should allow students the opportunity to develop clinical decision-making skills. Students frequently struggle with their ability to prioritise and optimise multiple objectives when producing a clinically acceptable plan. Emerging software applications providing quantitative assessment of plan quality are designed for clinical use but may have value for teaching these skills. This project aimed to evaluate the potential value of automated feedback to second year BSc (Hons) Radiotherapy students.
Materials and methods
All 26 students studying a pre-registration radiotherapy planning module were provided with automated prediction of relative feasibility for left lung tumour planning targets by planning metrics software. Students were also provided with interim quantitative reports during the development of their plan. Student perceptions of the software were gathered using an anonymous questionnaire. Independent blinded marking of plans was performed after module completion and analysed for correlation with software-assigned marks.
In total, 25 plans were utilised for marking comparison and 16 students submitted feedback relating to the software. Overall, student feedback was positive regarding the software. A ‘strong’ Spearman’s rank-order correlation (rs=0·7165) was evident between human and computer marks (p=0·000055).
Automated software is capable of providing useful feedback to students as a teaching aid, in particular with regard to relative feasibility of goals. The strong correlation between human and computer marks suggests a role in benchmarking or moderation; however, the narrow scope of assessment parameters suggests value as an adjunct and not a replacement to human marking.
Increasing usage of magnetic resonance imaging (MRI) in radiotherapy (RT) and the advent of MRI-based image-guided radiotherapy (IGRT) suggests a need for additional training within the RT profession. This critical review aimed to identify potential gaps in knowledge by evaluating the current skill base in MRI among therapeutic radiographers as evidenced by published research.
Papers related to MRI usage were retrieved. Topic areas included outlining, planning and IGRT; diagnosis, follow-up and staging-related papers were excluded. After selection and further text analysis, papers were grouped by tumour site and year of publication.
The literature search and filtering resulted in a total of 123 papers, of which 66 were related to ‘outlining’, 37 to ‘planning’ and 20 to ‘IGRT’. The main sites of existing MRI expertise in RT were brain, central nervous system, prostate, and head and neck tumours. Expertise was clearly related to regions where MRI offered improved soft-tissue contrast. MRI studies within RT have been published from 2007 onwards at a steadily increasing rate.
Current use of MRI in RT is mainly restricted to sites where MRI offers a considerable imaging advantage over computed tomography. Given the changing use of MRI for image guidance, emerging therapeutic radiographers will require training in MRI interpretation across a wider range of anatomical regions.
To demonstrate the feasibility of applying the Healthy Eating Index-2010 (HEI-2010) to the hunger relief setting, specifically by assessing the nutritional quality of foods ordered by food shelves (front-line food provider) from food banks (warehouse of foods).
This Healthy FOOD (Feedback On Ordering Decisions) observational study used electronic invoices detailing orders made by 269 food shelves in 2013 and analysed in 2015 from two large Minnesota, USA food banks to generate HEI-2010 scores. Initial development and processing procedures are described.
The average total HEI-2010 score for the 269 food shelves was 62·7 out of 100 with a range from 28 to 82. Mean component scores for total protein foods, total vegetables, fatty acids, and seafood and plant proteins were the highest. Mean component score for whole grains was the lowest followed by dairy, total fruits, refined grains and sodium. Food shelves located in micropolitan areas and the largest food shelves had the highest HEI-2010 scores. Town/rural and smaller food shelves had the lowest scores. Monthly and seasonal differences in scores were detected. Limitations to this approach are identified.
Calculating HEI-2010 for food shelves using electronic invoice data is novel and feasible, albeit with limitations. HEI-2010 scores for 2013 identify room for improvement in nearly all food shelves, especially the smallest agencies. The utility of providing HEI-2010 scores to decision makers in the hunger relief setting is an issue requiring urgent study.
This study used a prospective longitudinal design to examine the early developmental pathways that underlie language growth in infants at high risk (n = 50) and low risk (n = 34) for autism spectrum disorder in the first 18 months of life. While motor imitation and responding to joint attention (RJA) have both been found to predict expressive language in children with autism spectrum disorder and those with typical development, the longitudinal relation between these capacities has not yet been identified. As hypothesized, results revealed that 15-month RJA mediated the association between 12-month motor imitation and 18-month expressive vocabulary, even after controlling for earlier levels of RJA and vocabulary. These results provide new information about the developmental sequencing of skills relevant to language growth that may inform future intervention efforts for children at risk for language delay or other developmental challenges.
The Whillans Ice Stream Subglacial Access Research Drilling (WISSARD) project will test the overarching hypothesis that an active hydrological system exists beneath a West Antarctic ice stream that exerts a major control on ice dynamics, and the metabolic and phylogenetic diversity of the microbial community in subglacial water and sediment. WISSARD will explore Subglacial Lake Whillans (SLW, unofficial name) and its outflow toward the grounding line where it is thought to enter the Ross Ice Shelf seawater cavity. Introducing microbial contamination to the subglacial environment during drilling operations could compromise environmental stewardship and the science objectives of the project, consequently we developed a set of tools and procedures to directly address these issues. WISSARD hot water drilling efforts will include a custom water treatment system designed to remove micron and sub-micron sized particles (biotic and abiotic), irradiate the drilling water with germicidal ultraviolet (UV) radiation, and pasteurize the water to reduce the viability of persisting microbial contamination. Our clean access protocols also include methods to reduce microbial contamination on the surfaces of cables/hoses and down-borehole equipment using germicidal UV exposure and chemical disinfection. This paper presents experimental data showing that our protocols will meet expectations established by international agreement between participating Antarctic nations.
Both the plight of African American young people and their feelings and thoughts about this plight are major issues of concern in U.S. politics. In 2003, the Black Youth Project was launched, with funding by the Ford Foundation and the Robert Wood Johnson Foundation, to promote both social scientific analysis and public understanding of these issues (the project has an innovative and engaging Website that can be accessed at http://www.blackyouthproject.com/). Cathy J. Cohen is the principal investigator of the project and, in Democracy Remixed, she draws upon a new national survey of black youth to offer a mixed-method empirical description and theoretical analysis of “black youth and the future of American politics.” In this symposium, a diverse group of political and social scientists have been asked to critically assess the book's account and to comment more broadly on the importance of black youth to the future of American politics.—Jeffrey C. Isaac, Editor