A pharmacist-driven protocol for methicillin-resistant Staphylococcus aureus nares screening and empiric vancomycin discontinuation was instituted in a community healthcare system utilizing a tele-antimicrobial stewardship program to reduce inappropriate use of vancomycin. The protocol and associated intervention resulted in a significant decrease in both vancomycin utilization and the rate of acute kidney injury.

The personalised oncology paradigm remains challenging to deliver despite technological advances in genomics-based identification of actionable variants combined with the increasing focus of drug development on these specific targets. To ensure we continue to build concerted momentum to improve outcomes across all cancer types, financial, technological and operational barriers need to be addressed. For example, complete integration and certification of the ‘molecular tumour board’ into ‘standard of care’ ensures a unified clinical decision pathway that both counteracts fragmentation and is the cornerstone of evidence-based delivery inside and outside of a research setting. Generally, integrated delivery has been restricted to specific (common) cancer types either within major cancer centres or small regional networks. Here, we focus on solutions in real-world integration of genomics, pathology, surgery, oncological treatments, data from clinical source systems and analysis of whole-body imaging as digital data that can facilitate cost-effectiveness analysis, clinical trial recruitment, and outcome assessment. This urgent imperative for cancer also extends across the early diagnosis and adjuvant treatment interventions, individualised cancer vaccines, immune cell therapies, personalised synthetic lethal therapeutics and cancer screening and prevention. Oncology care systems worldwide require proactive step-changes in solutions that include inter-operative digital working that can solve patient centred challenges to ensure inclusive, quality, sustainable, fair and cost-effective adoption and efficient delivery. Here we highlight workforce, technical, clinical, regulatory and economic challenges that prevent the implementation of precision oncology at scale, and offer a systematic roadmap of integrated solutions for standard of care based on minimal essential digital tools. These include unified decision support tools, quality control, data flows within an ethical and legal data framework, training and certification, monitoring and feedback. Bridging the technical, operational, regulatory and economic gaps demands the joint actions from public and industry stakeholders across national and global boundaries.

We detected no correlation between standardized antimicrobial administration ratios (SAARs) and healthcare facility-onset Clostridioides difficile infection (HO-CDI) rates in 102 acute-care Veterans Affairs medical centers over 16 months. SAARs may be useful for investigating trends in local antimicrobial use, but no ratio threshold demarcated HO-CDI risk.

Sealings recovered from the Omo M10 temple, a provincial center of the Andean Tiwanaku state (AD 500–1100), and from the Muru Ut Pata neighborhood of the Tiwanaku capital, as well as a signet ring from the Akapana East complex of Tiwanaku's highland capital, shed light on the hitherto undocumented use of seals and sealings in Central Andean complex society. The identification of Tiwanaku sealings related to the signet ring seal has implications for understanding the transmission of identity, authority, and authenticity over time and distance in early Andean states.

The Subglacial Antarctic Lakes Scientific Access (SALSA) Project accessed Mercer Subglacial Lake using environmentally clean hot-water drilling to examine interactions among ice, water, sediment, rock, microbes and carbon reservoirs within the lake water column and underlying sediments. A ~0.4 m diameter borehole was melted through 1087 m of ice and maintained over ~10 days, allowing observation of ice properties and collection of water and sediment with various tools. Over this period, SALSA collected: 60 L of lake water and 10 L of deep borehole water; microbes >0.2 μm in diameter from in situ filtration of ~100 L of lake water; 10 multicores 0.32–0.49 m long; 1.0 and 1.76 m long gravity cores; three conductivity–temperature–depth profiles of borehole and lake water; five discrete depth current meter measurements in the lake and images of ice, the lake water–ice interface and lake sediments. Temperature and conductivity data showed the hydrodynamic character of water mixing between the borehole and lake after entry. Models simulating melting of the ~6 m thick basal accreted ice layer imply that debris fall-out through the ~15 m water column to the lake sediments from borehole melting had little effect on the stratigraphy of surficial sediment cores.

The magnetic resonance imaging (MRI) appearance of the brain and spinal cord in humans with neuroangiostrongyliasis (NA) due to Angiostrongylus cantonensis infection has been well reported. Equivalent studies in animals are lacking. This case series describes clinical and MRI findings in 11 dogs with presumptively or definitively diagnosed NA. MRI of the brain and/or spinal cord was performed using high-field (1.5 T) or low-field (0.25 T) scanners using various combinations of transverse, sagittal, dorsal and three-dimensional (3D) T1-weighted (T1W), transverse, sagittal and dorsal T2-weighted (T2W), T2W fluid-attenuated inversion recovery (FLAIR) and T2*-weighted (T2*W) gradient echo (GRE), dorsal T2W short tau inversion recovery (STIR) and post-gadolinium transverse, sagittal, dorsal and 3D T1W and transverse T2W FLAIR sequences. In 4/6 cases where the brain was imaged, changes consistent with diffuse meningoencephalitis were observed. Evidence of meningeal involvement was evident even when not clinically apparent. The spinal cord was imaged in 9 dogs, with evidence of meningitis and myelitis detected in regions consistent with the observed neuroanatomical localization. Pathognomonic changes of neural larva migrans, as described in some human patients with NA, were not detected. NA should be considered in the differential diagnosis of dogs with MRI evidence of focal or diffuse meningitis, myelitis and/or encephalitis, especially in areas where A. cantonensis is endemic. If not precluded by imaging findings suggestive of brain herniation, cerebrospinal fluid (CSF) collection for cytology, fluid analysis, real-time polymerase chain reaction (qPCR) and enzyme-linked immunosorbent assay (ELISA) testing should be considered mandatory in such cases after the MRI studies.

We distributed a 16-question survey concerning noxious weed abundance, impacts, and management to livestock producers grazing on privately owned or leased grazing lands in Montana. The noxious weeds most commonly reported as being present on respondents’ grazing units were Canada thistle [Cirsium arvense (L.) Scop.] (64% of grazing units) and leafy spurge (Euphorbia esula L.) (45% of grazing units), and these species also reportedly caused the greatest reductions in livestock forage. Houndstongue (Cynoglossum officinale L.) was more prevalent than either spotted knapweed (Centaurea stoebe L.) or diffuse knapweed (Centaurea diffusa Lam.) (39% vs. 32% and 10%, respectively, of grazing units), but collectively C. stoebe and C. diffusa were reported to cause greater forage reductions than C. officinale. The top three strategies used to manage noxious weeds were chemical control, grazing, and biological control. Combining survey responses with forage-loss models derived from field data for C. stoebe and E. esula, we estimated the combined cost of noxious weed management and forage losses on privately owned rangeland to be $3.54 ha−1 yr−1, or $7,243 annually for an average size grazing unit (i.e., 2,046 ha [5,055 ac]). Our estimates of economic losses are lower than many estimates from previous studies, possibly because we focused only on direct costs related to private grazing land, while other studies often consider indirect impacts. Nonetheless, our estimates are substantial; for example, our estimated loss equates to 24% of the average per-hectare lease rate for Montana grazing land.

The Taipan galaxy survey (hereafter simply ‘Taipan’) is a multi-object spectroscopic survey starting in 2017 that will cover 2π steradians over the southern sky (δ ≲ 10°, |b| ≳ 10°), and obtain optical spectra for about two million galaxies out to z < 0.4. Taipan will use the newly refurbished 1.2-m UK Schmidt Telescope at Siding Spring Observatory with the new TAIPAN instrument, which includes an innovative ‘Starbugs’ positioning system capable of rapidly and simultaneously deploying up to 150 spectroscopic fibres (and up to 300 with a proposed upgrade) over the 6° diameter focal plane, and a purpose-built spectrograph operating in the range from 370 to 870 nm with resolving power R ≳ 2000. The main scientific goals of Taipan are (i) to measure the distance scale of the Universe (primarily governed by the local expansion rate, H0) to 1% precision, and the growth rate of structure to 5%; (ii) to make the most extensive map yet constructed of the total mass distribution and motions in the local Universe, using peculiar velocities based on improved Fundamental Plane distances, which will enable sensitive tests of gravitational physics; and (iii) to deliver a legacy sample of low-redshift galaxies as a unique laboratory for studying galaxy evolution as a function of dark matter halo and stellar mass and environment. The final survey, which will be completed within 5 yrs, will consist of a complete magnitude-limited sample (i ⩽ 17) of about 1.2 × 106 galaxies supplemented by an extension to higher redshifts and fainter magnitudes (i ⩽ 18.1) of a luminous red galaxy sample of about 0.8 × 106 galaxies. Observations and data processing will be carried out remotely and in a fully automated way, using a purpose-built automated ‘virtual observer’ software and an automated data reduction pipeline. The Taipan survey is deliberately designed to maximise its legacy value by complementing and enhancing current and planned surveys of the southern sky at wavelengths from the optical to the radio; it will become the primary redshift and optical spectroscopic reference catalogue for the local extragalactic Universe in the southern sky for the coming decade.

Fall-applied residual and spring preplant burn-down herbicide applications are typically used to control winter annual weeds and may also provide early-season residual control of summer annual weed species such as giant ragweed. Field experiments were conducted from 2006 to 2008 in southern Illinois to (1) assess the emergence pattern of giant ragweed, (2) evaluate the efficacy of several herbicides commonly used for soil-residual control of giant ragweed, and (3) investigate the optimal application timing of soil-residual herbicides for control of giant ragweed. Six herbicide treatments were applied at four application timings: early fall, late fall, early spring, and late spring. Giant ragweed first emerged in mid- and late-March in 2007 and 2008, respectively. The duration of emergence varied by year, with 95% of emergence complete in late May of 2008, but not until early July in 2007. Giant ragweed emergence occurred more quickly in plots that received a fall application of glyphosate + 2,4-D compared with the nontreated. Fall-applied residual herbicides did not reduce giant ragweed emergence in 2007 when compared with the nontreated, with the exception of chlorimuron + tribenuron applied in late fall. Giant ragweed control from early- and late-spring herbicide applications was variable by year. In 2007, saflufenacil (50 and 100 g ai ha−1) and simazine applied in early spring reduced giant ragweed densities by 95% or greater through mid-May; however, in 2008, early-spring applications failed to reduce giant ragweed emergence in mid-April. The only treatments that reduced giant ragweed densities by > 80% through early July were late-spring applications of chlorimuron + tribenuron or saflufenacil at 100 g ha−1. Thus, the emergence patterns of giant ragweed in southern Illinois dictates that best management with herbicides would include late-spring applications of soil-residual herbicides just before crop planting and most likely requires subsequent control with foliar or soil-residual herbicides after crop emergence.

Laguna de la Leche, north coastal Cuba, is a shallow (≤ 3 m), oligohaline (∼ 2.0–4.5‰) coastal lake surrounded by mangroves and cattail stands. A 227-cm core was studied using loss-on-ignition, pollen, calcareous microfossils, and plant macrofossils. From ∼6200 to ∼ 4800 cal yr BP, the area was an oligohaline lake. The period from ∼ 4800 to ∼ 4200 cal yr BP saw higher water levels and a freshened system; these changes are indicated by an increase in the regional pollen rain, as well as by the presence of charophyte oogonia and an increase in freshwater gastropods (Hydrobiidae). By ∼ 4000 cal yr BP, an open mesohaline lagoon had formed; an increase in salt-tolerant foraminifers suggests that water level increase was driven by relative sea level rise. The initiation of Laguna de la Leche correlates with a shift to wetter conditions as indicated in pollen records from the southeastern United States (e.g., Lake Tulane). This synchronicity suggests that sea level rise caused middle Holocene environmental change region-wide. Two other cores sampled from mangrove swamps in the vicinity of Laguna de la Leche indicate that a major expansion of mangroves was underway by ∼ 1700 cal yr BP.