To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Jaswal & Akhtar provide several quotes ostensibly from people with autism but obtained via the discredited techniques of Facilitated Communication and the Rapid Prompting Method, and they do not acknowledge the use of these techniques. As a result, their argument is substantially less convincing than they assert, and the article lacks transparency.
Objectives: To describe multivariate base rates (MBRs) of low scores and reliable change (decline) scores on Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) in college athletes at baseline, as well as to assess MBR differences among demographic and medical history subpopulations. Methods: Data were reported on 15,909 participants (46.5% female) from the NCAA/DoD CARE Consortium. MBRs of ImPACT composite scores were derived using published CARE normative data and reliability metrics. MBRs of sex-corrected low scores were reported at <25th percentile (Low Average), <10th percentile (Borderline), and ≤2nd percentile (Impaired). MBRs of reliable decline scores were reported at the 75%, 90%, 95%, and 99% confidence intervals. We analyzed subgroups by sex, race, attention-deficit/hyperactivity disorder and/or learning disability (ADHD/LD), anxiety/depression, and concussion history using chi-square analyses. Results: Base rates of low scores and reliable decline scores on individual composites approximated the normative distribution. Athletes obtained ≥1 low score with frequencies of 63.4% (Low Average), 32.0% (Borderline), and 9.1% (Impaired). Athletes obtained ≥1 reliable decline score with frequencies of 66.8%, 32.2%, 18%, and 3.8%, respectively. Comparatively few athletes had low scores or reliable decline on ≥2 composite scores. Black/African American athletes and athletes with ADHD/LD had higher rates of low scores, while greater concussion history was associated with lower MBRs (p < .01). MBRs of reliable decline were not associated with demographic or medical factors. Conclusions: Clinical interpretation of low scores and reliable decline on ImPACT depends on the strictness of the low score cutoff, the reliable change criterion, and the number of scores exceeding these cutoffs. Race and ADHD influence the frequency of low scores at all cutoffs cross-sectionally.
Due to concerns over increasing fluoroquinolone (FQ) resistance among gram-negative organisms, our stewardship program implemented a preauthorization use policy. The goal of this study was to assess the relationship between hospital FQ use and antibiotic resistance.
Large academic medical center.
We performed a retrospective analysis of FQ susceptibility of hospital isolates for 5 common gram-negative bacteria: Acinetobacter spp., Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Primary endpoint was the change of FQ susceptibility. A Poisson regression model was used to calculate the rate of change between the preintervention period (1998–2005) and the postimplementation period (2006–2016).
Large rates of decline of FQ susceptibility began in 1998, particularly among P. aeruginosa, Acinetobacter spp., and E. cloacae. Our FQ restriction policy improved FQ use from 173 days of therapy (DOT) per 1,000 patient days to <60 DOT per 1,000 patient days. Fluoroquinolone susceptibility increased for Acinetobacter spp. (rate ratio [RR], 1.038; 95% confidence interval [CI], 1.005–1.072), E. cloacae (RR, 1.028; 95% CI, 1.013–1.044), and P. aeruginosa (RR, 1.013; 95% CI, 1.006–1.020). No significant change in susceptibility was detected for K. pneumoniae (RR, 1.002; 95% CI, 0.996–1.008), and the susceptibility for E. coli continued to decline, although the decline was not as steep (RR, 0.981; 95% CI, 0.975–0.987).
A stewardship-driven FQ restriction program stopped overall declining FQ susceptibility rates for all species except E. coli. For 3 species (ie, Acinetobacter spp, E. cloacae, and P. aeruginosa), susceptibility rates improved after implementation, and this improvement has been sustained over a 10-year period.
Graphene possesses exceptional mechanical, electrical, and thermal properties that stand out for numerous applications in materials and energy-related areas. The growing demand to produce high-quality large-scale graphene films inexpensively remains a challenge. The work presented in this paper emphasizes a straightforward method of producing high-quality graphene films using cellulose as the starting materials. We demonstrate the synthesis of defect-free graphene films (as thin as ∼10 layers) on substrates up to 7 cm2 in area. Graphitic films were characterized using Infrared Raman, energy-dispersive X-ray spectroscopy, X-ray diffraction (XRD), scanning electron microcopy SEM, and high-resolution transmission electron microscopy (HRTEM). Our XRD, Raman, and HRTEM studies indicated that the synthetic temperature was critical in the synthesis of high-quality graphene films using cellulose as the carbon source material. Systematic studies revealed that defect-free large area graphitic films were produced at a synthetic temperature of ∼900 °C. The Raman D band peak intensity decreased for the samples synthesized at higher temperature but was absent for the samples prepared at 900 °C. Both the HRTEM and selected area electron diffraction confirm the highly ordered arrangement of carbon atoms in the sample matrix. The measured distance between lattice fringes was 0.335 nm, which matches with the literature reported fringe distance for the high-quality graphene. The XRD spectrum of the thin graphitic samples synthesized at 900 °C displayed a sharp diffraction peak 2θ–26.5° characteristic of highly crystalline defect-free graphene. Functional photodetector and photovoltaic (PV) devices were fabricated using graphitic films. The graphitic films were used as one of the electrodes for the PV devices yielded a power conversion efficiency of ∼1%. Our synthetic method can be potentially used for producing high-quality free-standing graphene films inexpensively at large-scale.
Adult schistosomes live in the blood vessels and cannot easily be sampled from humans, so archived miracidia larvae hatched from eggs expelled in feces or urine are commonly used for population genetic studies. Large collections of archived miracidia on FTA cards are now available through the Schistosomiasis Collection at the Natural History Museum (SCAN). Here we describe protocols for whole genome amplification of Schistosoma mansoni and Schistosome haematobium miracidia from these cards, as well as real time PCR quantification of amplified schistosome DNA. We used microgram quantities of DNA obtained for exome capture and sequencing of single miracidia, generating dense polymorphism data across the exome. These methods will facilitate the transition from population genetics, using limited numbers of markers to population genomics using genome-wide marker information, maximising the value of collections such as SCAN.
Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.
To evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.
Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.
A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97).
The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.
Declaration of interest
Drs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
PRE and POST herbicide options were evaluated to control perilla mint, a potentially deadly plant for livestock. The germination requirements of seed from weedy populations were also investigated to better understand and predict emergence timing. POST applications of aminocyclopyrachlor blends, glyphosate, picloram+2,4-D, aminopyralid+2,4-D, and 2,4-D alone provided superior control of perilla mint when applied in the early reproductive growth stage. Picloram+2,4-D and aminocyclopyrachlor+chlorsulfuron also provided soil residual activity and the most effective PRE control followed by pendimethalin and aminopyralid+2,4-D. Seed from weedy populations tend to germinate in a range of night/day soil temperatures from 10–15 C to 25–30 C. Therefore, application and activation of the most effective PRE treatments should be made before these temperatures occur in areas where weedy perilla mint populations are found.
Characterisation of genetic diversity in a large number of European pig populations has been undertaken with EC support. The populations sampled included local (rare) breeds, national varieties of the major international breeds, commercial lines and the Chinese Meishan breed. A second phase of the project will sample a further 50 Chinese breeds. Neutral genetic markers (AFLP and microsatellites), with individual or bulk typing, were used and compared.
DNA from 59 European pig populations was extracted on samples of about 50 individuals per population. Individuals were typed for 50 microsatellites and for 148 AFLP bands. A subset of 25 populations was typed for 20 microsatellites on pools of DNA. Allele frequencies were estimated by direct allele counting for the co-dominant markers. Frequencies of AFLP negative alleles (absent bands) were obtained by taking the square root of absent band frequencies. Within-breed variability was summarised using standard statistics: expected and observed heterozygosity, mean observed and effective numbers of alleles, and F statistics. Between-breed diversity analysis was based on a bootstrapped Neighbor-Joining (NJ) tree derived from Reynolds distances (DR). The standard distance of Nei (DS) was also calculated.
Systems of management of beef cows in the hills and uplands seek to make use of the cow's ability to utilise body tissue to maintain production during periods of undernutrition in winter and to replenish body reserves from relatively inexpensive summer grazing.
In spring-calving cows, the periods of winter undernutrition occur during late pregnancy and the early months of lactation. On upland farms, cows with adequate body reserves (condition score 3.5) at the beginning of winter, fed less than 50 MJ ME per day during the final 3 months of gestation and 70 MJ ME per day during the first 2 months of lactation, will lose about 1.5 units of body condition but such a regime will not necessarily result in biologically significant production penalties. Fertilised ryegrass swards maintained at 8 cm sward surface height during the grazing season will support levels of milk production of around 11 kg per day, calf growth rates of the order of 1.2 kg per day and allow full recovery of cow body weight and condition. In hill herds, the magnitude of losses in weight and condition over winter must be restricted to the extent of the recovery which the quality of summer grazing will support.
Similar considerations apply in autumn-calving herds, where the greater part or all of lactation coincides with the period of winter feeding. Cows calving at a body condition score of 3.0 can be fed 75 MJ ME per day from before to one month after mating without prejudicing reproductive performance, and 60-65 MJ ME per day from then until turnout. Where good quality pasture is available, milk production will increase from around 5 to more than 9 kg per day following turnout, calf performance will be enhanced by delaying weaning and cows will recover in full the weight and condition lost during winter. In the hill situation, calves may require to be weaned at turnout if full cow recovery is to be achieved.
Studies on the nutrition of the weaned suckled calf indicate that a policy of feeding weaned calves inexpensively during winter to gain between 0.3 and 0.5 kg per day may constitute a viable alternative to the traditional practice of selling calves in the autumn. Such animals will achieve significantly higher growth rates at pasture in the following summer than calves fed more generously and gaining weight more rapidly during winter.
On some hill farms where opportunities for the conservation of winter fodder are limited but where there is plentiful summer grazing, a system of June calving followed by a short lactation, and in which calves are only very moderately fed over winter, merits consideration.
The areas in which further research is most urgently required to effect significant improvements in efficiency are those concerned with the relationship between nutrition and reproductive efficiency and the induction of twinning in cows.
The shallow subsurface of Groningen, the Netherlands, is heterogeneous due to its formation in a Holocene tidal coastal setting on a periglacially and glacially inherited landscape with strong lateral variation in subsurface architecture. Soft sediments with low, small-strain shear wave velocities (VS30 around 200 m s−1) are known to amplify earthquake motions. Knowledge of the architecture and properties of the subsurface and the combined effect on the propagation of earthquake waves is imperative for the prediction of geohazards of ground shaking and liquefaction at the surface. In order to provide information for the seismic hazard and risk analysis, two geological models were constructed. The first is the ‘Geological model for Site response in Groningen’ (GSG model) and is based on the detailed 3D GeoTOP voxel model containing lithostratigraphy and lithoclass attributes. The GeoTOP model was combined with information from boreholes, cone penetration tests, regional digital geological and geohydrological models to cover the full range from the surface down to the base of the North Sea Supergroup (base Paleogene) at ~800 m depth. The GSG model consists of a microzonation based on geology and a stack of soil stratigraphy for each of the 140,000 grid cells (100 m × 100 m) to which properties (VS and parameters relevant for nonlinear soil behaviour) were assigned. The GSG model serves as input to the site response calculations that feed into the Ground Motion Model. The second model is the ‘Geological model for Liquefaction sensitivity in Groningen’ (GLG). Generally, loosely packed sands might be susceptible to liquefaction upon earthquake shaking. In order to delineate zones of loosely packed sand in the first 40 m below the surface, GeoTOP was combined with relative densities inferred from a large cone penetration test database. The marine Naaldwijk and Eem Formations have the highest proportion of loosely packed sand (31% and 38%, respectively) and thus are considered to be the most vulnerable to liquefaction; other units contain 5–17% loosely packed sand. The GLG model serves as one of the inputs for further research on the liquefaction potential in Groningen, such as the development of region-specific magnitude scaling factors (MSF) and depth–stress reduction relationships (rd).
The History, Electrocardiogram (ECG), Age, Risk Factors, and Troponin (HEART) score is a decision aid designed to risk stratify emergency department (ED) patients with acute chest pain. It has been validated for ED use, but it has yet to be evaluated in a prehospital setting.
A prehospital modified HEART score can predict major adverse cardiac events (MACE) among undifferentiated chest pain patients transported to the ED.
A retrospective cohort study of patients with chest pain transported by two county-based Emergency Medical Service (EMS) agencies to a tertiary care center was conducted. Adults without ST-elevation myocardial infarction (STEMI) were included. Inter-facility transfers and those without a prehospital 12-lead ECG or an ED troponin measurement were excluded. Modified HEART scores were calculated by study investigators using a standardized data collection tool for each patient. All MACE (death, myocardial infarction [MI], or coronary revascularization) were determined by record review at 30 days. The sensitivity and negative predictive values (NPVs) for MACE at 30 days were calculated.
Over the study period, 794 patients met inclusion criteria. A MACE at 30 days was present in 10.7% (85/794) of patients with 12 deaths (1.5%), 66 MIs (8.3%), and 12 coronary revascularizations without MI (1.5%). The modified HEART score identified 33.2% (264/794) of patients as low risk. Among low-risk patients, 1.9% (5/264) had MACE (two MIs and three revascularizations without MI). The sensitivity and NPV for 30-day MACE was 94.1% (95% CI, 86.8-98.1) and 98.1% (95% CI, 95.6-99.4), respectively.
Prehospital modified HEART scores have a high NPV for MACE at 30 days. A study in which prehospital providers prospectively apply this decision aid is warranted.
Unidentified depression in primary care is a public health concern, globally. There is a need for brief, valid and easily administered tools in primary care.
To estimate reliability and validity of the newly developed Primary care Screening Questionnaire for Depression (PSQ4D), a four-item tool, with ‘yes’ or ‘no’ options.
PSQ4D was administered verbally (time required, <1 min) by primary care physicians to adult outpatients (n=827) in six primary care settings in Kerala, India. A psychiatrist evaluated each patient on the same day, using ICD-10 Diagnostic Criteria for Research, based on unstructured clinical interview.
The Cronbach's alpha for internal consistency reliability was 0.80; kappa coefficient for test-retest reliability was 0.9 and that for interrater reliability was 0.72. At a score ≥2, sensitivity was 0.96, specificity was 0.87, positive predictive value was 0.74, negative predictive value was 0.98, positive likelihood ratio was 7.4 and negative likelihood ratio was 0.05.
When physician administered, PSQ4D has good reliability. At a cut-off score of ≥2, it has high sensitivity and specificity to identify depressive disorder in primary care.
Control of noxious weeds such as cogongrass depend heavily on chemical treatment, but success is limited unless integrated with other practices. Utilization of cover crops in the system is ideal to avoid the use of excess herbicide and replace vegetation that will resist cogongrass reinvasion. Greenhouse studies were conducted from 2013 through 2015 at Mississippi State University with the objective to evaluate ‘AG4934’ RR/STS soybean, Korean lespedeza, crimson clover and ‘Durana’ white clover tolerance to soil-applied imazapyr at selected rates and various planting times after application. Plastic containers filled with a mixture of 2:1 sand:topsoil were treated with imazapyr at 0, 70, 140 and 280 g ae ha–1. Legume species were planted 0, 1, 3 and 6 months after treatment (MAT). The factorial experimental design included legume species, imazapyr rate and planting time. At 6 weeks after each planting, the number of seedlings, average plant height and shoot biomass were measured. Statistical analysis revealed the imazapyr rate x planting time interaction was significant with respect to number of emerged seedlings, average height and shoot biomass per plant for each species. It was observed that the legumes planted at 0 MAT of imazapyr at 70 g ae ha–1 or higher reduced emerged seedlings, average height and biomass production. In general, seeds planted 1 MAT or later in combination with these same herbicide rates, showed less growth reductions than treatments seeded 0 MAT. In conclusion, sites treated with imazapyr rates from 70 to 280 g ae ha–1 for weed control, should not be seeded with legume ground covers less than 1 month after treatment to reduce emergence failure, plant height and biomass production.
We have previously shown that the minor alleles of vascular endothelial growth factor A (VEGFA) single-nucleotide polymorphism rs833069 and superoxide dismutase 2 (SOD2) single-nucleotide polymorphism rs2758331 are both associated with improved transplant-free survival after surgery for CHD in infants, but the underlying mechanisms are unknown. We hypothesised that one or both of these minor alleles are associated with better systemic ventricular function, resulting in improved survival.
This study is a follow-up analysis of 422 non-syndromic CHD patients who underwent neonatal cardiac surgery with cardiopulmonary bypass. Echocardiographic reports were reviewed. Systemic ventricular function was subjectively categorised as normal, or as mildly, moderately, or severely depressed. The change in function was calculated as the change from the preoperative study to the last available study. Stepwise linear regression, adjusting for covariates, was performed for the outcome of change in ventricular function. Model comparison was performed using Akaike’s information criterion. Only variables that improved the model prediction of change in systemic ventricular function were retained in the final model.
Genetic and echocardiographic data were available for 335/422 subjects (79%). Of them, 33 (9.9%) developed worse systemic ventricular function during a mean follow-up period of 13.5 years. After covariate adjustment, the presence of the VEGFA minor allele was associated with preserved ventricular function (p=0.011).
These data support the hypothesis that the mechanism by which the VEGFA single-nucleotide polymorphism rs833069 minor allele improves survival may be the preservation of ventricular function. Further studies are needed to validate this genotype–phenotype association and to determine whether this mechanism is related to increased vascular endothelial growth factor production.
We have used ground-penetrating radar (GPR) to observe englacial structural control upon the development of an esker formed during a high-magnitude outburst flood (jökulhlaup). The surge-type Skeiðarárjökull, an outlet glacier of the Vatnajökull ice cap, Iceland, is a frequent source of jökulhlaups. The rising-stage waters of the November 1996 jökulhlaup travelled through a dense network of interconnected fractures that perforated the margin of the glacier. Subsequent discharge focused upon a small number of conduit outlets. Recent ice-marginal retreat has exposed a large englacial esker associated with one of these outlets. We investigated structural controls on esker genesis in April 2006, by collecting >2.5km of GPR profiles on the glacier surface up-glacier of where the esker ridge has been exposed by meltout. In lines closest to the exposed esker ridge, we interpret areas of englacial horizons up to ~30m wide and ~10–15m high as an up-glacier continuation of the esker sediments. High-amplitude, dipping horizons define the base of esker materials across many lines. Similar dipping surfaces deeper in the profiles suggest that: (1) the dipping surfaces beneath the esker are englacial tephera bands; (2) floodwaters were initially discharged along structurally controlled englacial surfaces (tephra bands); (3) the rapid increase in discharge resulted in hydrofracturing; (4) establishment of preferential flow paths resulted in conduit development along the tephra bands due to localized excavation of surrounding glacier ice; and (5) sedimentation took place within the new accommodation space to form the englacial structure melting out to produce the esker.