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Clostridioides difficile infection (CDI) can be prevented through infection prevention practices and antibiotic stewardship. Diagnostic stewardship (ie, strategies to improve use of microbiological testing) can also improve antibiotic use. However, little is known about the use of such practices in US hospitals, especially after multidisciplinary stewardship programs became a requirement for US hospital accreditation in 2017. Thus, we surveyed US hospitals to assess antibiotic stewardship program composition, practices related to CDI, and diagnostic stewardship.
Surveys were mailed to infection preventionists at 900 randomly sampled US hospitals between May and October 2017. Hospitals were surveyed on antibiotic stewardship programs; CDI prevention, treatment, and testing practices; and diagnostic stewardship strategies. Responses were compared by hospital bed size using weighted logistic regression.
Overall, 528 surveys were completed (59% response rate). Almost all (95%) responding hospitals had an antibiotic stewardship program. Smaller hospitals were less likely to have stewardship team members with infectious diseases (ID) training, and only 41% of hospitals met The Joint Commission accreditation standards for multidisciplinary teams. Guideline-recommended CDI prevention practices were common. Smaller hospitals were less likely to use high-tech disinfection devices, fecal microbiota transplantation, or diagnostic stewardship strategies.
Following changes in accreditation standards, nearly all US hospitals now have an antibiotic stewardship program. However, many hospitals, especially smaller hospitals, appear to struggle with access to ID expertise and with deploying diagnostic stewardship strategies. CDI prevention could be enhanced through diagnostic stewardship and by emphasizing the role of non–ID-trained pharmacists and clinicians in antibiotic stewardship.
This article presents the Illinois Work and Well-Being Model as a framework that can be applied to facilitate the career development of people with diabetes mellitus. The model emphasizes the interaction of contextual and career development domains to improve participation in the areas of work, society, community, and home. This article provides a brief discussion of the potential implications of vocational rehabilitation research, service, and policy, with the overall goal of reinforcing career development as the foundation of vocational rehabilitation services for adults with diabetes mellitus and other chronic health conditions.
Upper Ordovician (Katian) strata of the Lake Simcoe region of Ontario record a spectacularly diverse and abundant echinoderm fauna known as the Brechin Lagerstätte. Despite recognition as the most taxonomically diverse Katian crinoid paleocommunity, the Brechin Lagerstätte has received relatively little taxonomic study since Frank Springer published his classic monograph on the “Kirkfield fauna” in 1911.
Using a new collection of exceptionally preserved material, we evaluate all dicyclic inadunate crinoids occurring in the Brechin Lagerstätte, which is predominantly comprised of cladids (Eucladida and Flexibilia). We document 15 species across 11 genera, including descriptions of two new genera and four new species. New taxa include Konieckicrinus brechinensis n. gen. n. sp., K. josephi n. gen. n. sp., Simcoecrinus mahalaki n. gen. n. sp., and Dendrocrinus simcoensis n. sp.
Although cladids are not commonly considered major components of the Early Paleozoic Crinoid Macroevolutionary Fauna, which is traditionally conceived as dominated by disparids and diplobathrid camerates, they are the most diverse major lineage of crinoids occurring in the Brechin Lagerstätte. This unexpected result highlights the important roles of specimen-based taxonomy and systematic revisions in the study of large-scale diversity patterns.
Functional neurological disorder (FND) is a condition at the intersection of neurology and psychiatry. Individuals with FND exhibit corticolimbic abnormalities, yet little is known about the role of white matter tracts in the pathophysiology of FND. This study characterized between-group differences in microstructural integrity, and correlated fiber bundle integrity with symptom severity, physical disability, and illness duration.
A diffusion tensor imaging (DTI) study was performed in 32 patients with mixed FND compared to 36 healthy controls. Diffusion-weighted magnetic resonance images were collected along with patient-reported symptom severity, physical disability (Short Form Health Survey-36), and illness duration data. Weighted-degree and link-level graph theory and probabilistic tractography analyses characterized fractional anisotropy (FA) values across cortico-subcortical connections. Results were corrected for multiple comparisons.
Compared to controls, FND patients showed reduced FA in the stria terminalis/fornix, medial forebrain bundle, extreme capsule, uncinate fasciculus, cingulum bundle, corpus callosum, and striatal-postcentral gyrus projections. Except for the stria terminalis/fornix, these differences remained significant adjusting for depression and anxiety. In within-group analyses, physical disability inversely correlated with stria terminalis/fornix and medial forebrain bundle FA values; illness duration negatively correlated with stria terminalis/fornix white matter integrity. A FND symptom severity composite score did not correlate with FA in patients.
In this first DTI study of mixed FND, microstructural differences were observed in limbic and associative tracts implicated in salience, defensive behaviors, and emotion regulation. These findings advance our understanding of neurocircuit pathways in the pathophysiology of FND.
The separation dimension of a graph G is the minimum positive integer d for which there is an embedding of G into ℝd, such that every pair of disjoint edges are separated by some axis-parallel hyperplane. We prove a conjecture of Alon et al. [SIAM J. Discrete Math. 2015] by showing that every graph with maximum degree Δ has separation dimension less than 20Δ, which is best possible up to a constant factor. We also prove that graphs with separation dimension 3 have bounded average degree and bounded chromatic number, partially resolving an open problem by Alon et al. [J. Graph Theory 2018].
At §194 of the Philosophical Investigations, Wittgenstein writes the following about what tends to happen in philosophy: “When we do philosophy, we are like savages, primitive people, who hear the way in which civilized people talk, put a false interpretation on it, and then draw the oddest conclusions from this.”1 With just a bit of tweaking, Wittgenstein’s remark might be taken to be applicable to readers of his work: When we read Wittgenstein, we are like savages, primitive people, and so forth. At least, that is how some readers of his work must appear to other readers, given how polarized readings of his philosophy can be. Although Wittgenstein’s life extended only six years into the period of philosophy covered by this volume (as he died in 1951), his shadow – much like that of Nietzsche’s Buddha in The Gay Science – nonetheless looms over its entirety. One measure of this is the vast scholarship devoted to Wittgenstein’s work in the form of articles, anthologies, and monographs, which has grown so large as to be practically unsurveyable.2
We developed a tilt sensor for studying ice deformation and installed our tilt sensor systems in two boreholes drilled close to the shear margin of Jarvis Glacier, Alaska to obtain kinematic measurements of streaming ice. We used the collected tilt data to calculate borehole deformation by tracking the orientation of the sensors over time. The sensors' tilts generally trended down-glacier, with an element of cross-glacier flow in the borehole closer to the shear margin. We also evaluated our results against flow dynamic parameters derived from Glen's exponential flow law and explored the parameter space of the stress exponent n and enhancement factor E. Comparison with values from ice deformation experiments shows that the ice on Jarvis is characterized by higher n values than that is expected in regions of low stress, particularly at the shear margin (~3.4). The higher n values could be attributed to the observed high total strains coupled with potential dynamic recrystallization, causing anisotropic development and consequently sped up ice flow. Jarvis' n values place the creep regime of the ice between basal slip and dislocation creep. Tuning E towards a theoretical upper limit of 10 for anisotropic ice with single-maximum fabric reduces the n values by 0.2.
Identification of individuals with clinically significant aggressive behavior is critical for the prevention and management of human aggressive behavior. A previous population-based taxometric study reported that the Diagnostic and Statistical Manual of Mental Disorders-4th Edition (DSM-IV) intermittent explosive disorder (IED) belongs to its own discrete class (taxon) rather than existing along a continuum.
This study sought to extend previous population-based findings in a clinical research sample of adults with DSM-5 IED (n = 346), adults with non-aggressive DSM-5 disorders (n = 293), and adults without any DSM-5 disorder (n = 174), using standardized assessments of DSM-5 diagnoses, aggression, and other related measures not available in past studies.
Analyses revealed a taxonic latent structure that overlapped with the DSM-5 diagnosis of IED. Within the sample, taxon group members had higher scores on a variety of measures of psychopathology than did the complement members of the sample. Comorbidity of other diagnoses with IED did not affect these results.
These findings support the proposition that DSM-5 IED represents a distinct behavioral disorder rather than the severe end of an aggressive behavior continuum.
New δ13Ccarb and microfacies data from Hereford–Worcestershire and the West Midlands allow for a detailed examination of variations in the Homerian carbon isotope excursion (Silurian) and depositional environment within the Much Wenlock Limestone Formation of the Midland Platform (Avalonia), UK. These comparisons have been aided by a detailed sequence-stratigraphic and bentonite correlation framework. Microfacies analysis has identified regional differences in relative sea-level change and indicates an overall shallowing of the carbonate platform interior from Hereford–Worcestershire to the West Midlands. Based upon the maximum δ13Ccarb values for the lower and upper peaks of the Homerian carbon isotope excursion (CIE), the shallower depositional setting of the West Midlands is associated with values that are 0.7 ‰ and 0.8 ‰ higher than in Hereford–Worcestershire. At the scale of parasequences the effect of depositional environment upon δ13Ccarb values can also be observed, with a conspicuous offset in the position of the trough in δ13Ccarb values between the peaks of the Homerian CIE. This offset can be accounted for by differences in relative sea-level change and carbonate production rates. While such differences complicate the use of CIEs as a means of high-resolution correlation, and caution against correlations based purely upon the isotopic signature, it is clear that a careful analysis of the depositional environment can account for such differences and thereby improve the use of carbon isotopic curves as a means of correlation.
Early behaviors that differentiate later biomarkers for psychopathology can guide preventive efforts while also facilitating pathophysiological research. We tested whether error-related negativity (ERN) moderates the link between early behavior and later psychopathology in two early childhood phenotypes: behavioral inhibition and irritability. From ages 2 to 7 years, children (n = 291) were assessed longitudinally for behavioral inhibition (BI) and irritability. Behavioral inhibition was assessed via maternal report and behavioral responses to novelty. Childhood irritability was assessed using the Child Behavior Checklist. At age 12, an electroencephalogram (EEG) was recorded while children performed a flanker task to measure ERN, a neural indicator of error monitoring. Clinical assessments of anxiety and irritability were conducted using questionnaires (i.e., Screen for Child Anxiety Related Disorders and Affective Reactivity Index) and clinical interviews. Error monitoring interacted with early BI and early irritability to predict later psychopathology. Among children with high BI, an enhanced ERN predicted greater social anxiety at age 12. In contrast, children with high childhood irritability and blunted ERN predicted greater irritability at age 12. This converges with previous work and provides novel insight into the specificity of pathways associated with psychopathology.
The philosophy of Gilles Deleuze has become popular in recent moves to embed approaches such as the new materialist and the posthuman in environmental education. Certainly, a newfound respect for the material universe, including the comprehension of the human place in it, and the tendency to a posthuman theoretical position, are both important given the contemporary environmental crisis, named as the Anthropocene. However, this article will argue that both these philosophies do not go far enough. This is because they must retain a political, social and critical edge if they are to be effective, and this edge can be too easily disregarded in the pursuit of increased engagement with the material and everything not human. In contrast, this article will put forward a Deleuzian approach to environmental education, based on the intellectual quadrant of Spinoza-Marx-Nietzsche-Bergson (Figure 1). It will be argued that only by fully connecting these often conflicting and disparate philosophies that a workable new synthesis for environmental education and a cartography for learning can be achieved. The Deleuzian approach to environmental education will be exemplified through an analysis of current environmental practises in schools as assemblage.
Field studies were conducted from 2009 through 2011 at the Sustainable Agriculture Research and Extension Center near Lingle, Wyoming, to evaluate great northern bean response to PRE flumioxazin mixed with either trifluralin, pendimethalin, or ethalfluralin. Seven treatments were arranged in a randomized complete block with three or four replicates y−1. The soil texture of the study site was loam in 2009 and 2011, and sandy loam in 2010. Soil organic matter ranged from 1.4% to 1.8%. Treatments included flumioxazin plus trifluralin, flumioxazin plus pendimethalin, flumioxazin plus ethalfluralin, ethalfluralin plus EPTC, imazamox plus bentazon (POST), hand-weeded control, and nontreated control. Dry bean density 4 wk after planting differed among herbicide treatments (P < 0.001). Treatments that included flumioxazin reduced dry bean density 54% compared with treatments without flumioxazin. Dry bean yield was influenced by dry bean density; on average, yield in flumioxazin-containing herbicide treatments was 30% less than treatments not containing flumioxazin, even though weed control was generally greater in flumioxazin treatments.
A new fossil site in a previously unexplored part of western Madagascar (the Beanka Protected Area) has yielded remains of many recently extinct vertebrates, including giant lemurs (Babakotia radofilai, Palaeopropithecus kelyus, Pachylemur sp., and Archaeolemur edwardsi), carnivores (Cryptoprocta spelea), the aardvark-like Plesiorycteropus sp., and giant ground cuckoos (Coua). Many of these represent considerable range extensions. Extant species that were extirpated from the region (e.g., Prolemur simus) are also present. Calibrated radiocarbon ages for 10 bones from extinct primates span the last three millennia. The largely undisturbed taphonomy of bone deposits supports the interpretation that many specimens fell in from a rock ledge above the entrance. Some primates and other mammals may have been prey items of avian predators, but human predation is also evident. Strontium isotope ratios (87Sr/86Sr) suggest that fossils were local to the area. Pottery sherds and bones of extinct and extant vertebrates with cut and chop marks indicate human activity in previous centuries. Scarcity of charcoal and human artifacts suggests only occasional visitation to the site by humans. The fossil assemblage from this site is unusual in that, while it contains many sloth lemurs, it lacks ratites, hippopotami, and crocodiles typical of nearly all other Holocene subfossil sites on Madagascar.
A high prevalence of asthma has been documented among the inhabitants of Tristan da Cunha, an isolated island in the South Atlantic. The population derives from just 28 founders. We performed lung function testing, including methacholine inhalation challenge, allergen skin prick testing, and collected DNA from essentially all of the current island population (269 individuals), and genotyped a panel of 43 single-nucleotide polymorphisms (SNPs) reported as associated with asthma and atopy. We carried out a mixed-model association analysis using the known pedigree. There were 96 individuals diagnosed as asthmatic (36%), and heritability estimates were similar to those from nonisolated population samples (multifactorial threshold model, h2 = 48%). The first component from a genetic principal components analysis using the entire SNP panel was nonlinearly associated with asthma, with the maximum risk to those intermediate to reference (Human Genome Diversity Project) European and African samples means. The single most strongly associated SNP was rs2786098 (p = 5.5 × 10−5), known to regulate the gene DENND1B. This explained approximately one-third of the trait heritability, with an allelic odds ratio for the A allele of 2.6. Among A/A carriers, 10 out of 12 individuals were asthmatic. The rs2786098*A variant was initially reported to decrease the risk of childhood (atopic) asthma in European but slightly increase the risk in African-descended populations, and does significantly alter Th2 cell function. Despite an absence of overall association with this variant in recent asthma genome wide association studies meta-analyses, an effect may exist on the particular genetic background of the Tristan da Cunha population.
Microcredit – joint-liability loans to the poorest of the poor – has been touted as a powerful approach for combatting global poverty, but sustainability varies dramatically across banks. Efforts to improve the sustainability of microcredit have assumed defaults are caused by free-riding. Here, we point out that the response of other group members to delinquent groupmates also plays an important role in defaults. Even in the absence of any free-rider problem, some people will be unable to make their payments due to bad luck. It is other group members’ unwillingness to pitch in extra – due to, among other things, not wanting to have less than other group members – that leads to default. To support this argument, we utilize the Ultimatum Game (UG), a standard paradigm from behavioral economics for measuring one's aversion to inequitable outcomes. First, we show that country-level variation in microloan default rates is strongly correlated (overall r = 0.81) with country-level UG rejection rates, but not free-riding measures. We then introduce a laboratory model ‘Microloan Game’ and present evidence that defaults arise from inequity-averse individuals refusing to make up the difference when others fail to pay their fair share. This perspective suggests a suite of new approaches for combatting defaults that leverage findings on reducing UG rejections.
Automatic differentiation (AD) is a technique for augmenting computer programs to compute derivatives. The essence of AD in its forward accumulation mode is to attach perturbations to each number, and propagate these through the computation by overloading the arithmetic operators. When derivatives are nested, the distinct derivative calculations, and their associated perturbations, must be distinguished. This is typically accomplished by creating a unique tag for each derivative calculation and tagging the perturbations. We exhibit a subtle bug, present in fielded implementations which support derivatives of higher-order functions, in which perturbations are confused despite the tagging machinery, leading to incorrect results. The essence of the bug is as follows: a unique tag is needed for each derivative calculation, but in existing implementations unique tags are created when taking the derivative of a function at a point. When taking derivatives of higher-order functions, these need not correspond! We exhibit a simple example: a higher-order function f whose derivative at a point x, namely f′(x), is itself a function which calculates a derivative. This situation arises naturally when taking derivatives of curried functions. Two potential solutions are presented, and their deficiencies discussed. One uses eta expansion to delay the creation of fresh tags in order to put them into one-to-one correspondence with derivative calculations. The other wraps outputs of derivative operators with tag substitution machinery. Both solutions seem very difficult to implement without violating the desirable complexity guarantees of forward AD.
This volume has achieved a large coverage of the experimentally well-studied areas of the temperate and subtropical coasts of the world (see Figure 1.1) – venturing into the tropics in some regions (Chapter 14, South-East Asia) and including mangroves (Chapter 17). Coral reef systems have not been considered. Much of the emphasis has been on rocky habitats as this is where the majority of experimental work on interactions has been done (but see Chapter 6). As well as reviewing regions where there has been a long history of experimental research (e.g., Chapters 2–4, 6, 10, 11, 13, 15, 16), areas of emerging experimental research in the last twenty-five years (e.g., Chapter 8, western Mediterranean; Chapter 12, south-east Pacific) and understudied regions (e.g., Chapter 7, Argentina; Chapter 14, South-East Asia) have also been included, allowing more comprehensive insights into the processes important for shaping these communities. In this short synthesis chapter, we first consider the main processes determining patterns covered by the previous chapters. We then consider major human impacts in these regions. Finally, we identify gaps in knowledge and make some suggestions for the way forward. We make the case for combining phylogeographic studies with macro-ecology and biogeography, coupled with well-designed hypothesis testing experiments, to better understand processes generating patterns on micro-evolutionary (hundreds to thousands of years) and ecological (up to hundreds of years) time scales.
We summarise processes determining large-scale patterns of distribution and abundance of macroinfauna from Florida to Newfoundland, ~25°N to 52°N, focussing on intertidal and shallow subtidal (~ 5 m depth) muddy sands and sandy muds, habitats with abundant experimental data. Within the theme of geographic distribution of processes, mechanisms and patterns we suggest latitudinal patterns will likely change most as climate changes intensify. Published studies support the following major biogeographic patterns: (1) reduced importance of large disturbance predators north of Cape Cod, driven by latitudinal shifts in thermal regimes; (2) large digging predators from Delaware Bay (39.25°N) southwards dramatically reduce infaunal densities, restricting competitive interactions; (3) disturbance refugia, e.g., Zostera, drive southern spatial patterns; (4) rising seawater temperatures and reduced water clarity limit the extent and diversity of rooted plants in the south and mid-Atlantic; (5) latitudinal changes in tidal regimes result in greater aerial exposure in the north, magnifying latitudinal sea surface temperature changes; (6) ice cover intensifies to the north and (7) the Boston−Washington, DC megalopolis accentuates human signatures through eutrophication between 36.5°N and 42.6°N. Finally, we discuss potential shifts with climate change in these latitudinal patterns and processes.
The rocky shores of New Zealand (NZ) and Australia provide many interesting comparisons in their intertidal species and structuring processes. Both countries are in the biogeographic realm of temperate Australasia and share many common species and closely related taxa. Here we review similarities and contrasts in communities and structuring processes, especially involving grazing invertebrates and macroalgae. We consider the similarity of the structure of intertidal shores of NZ and south-eastern Australia, a suite of important trophic interactions within and between regions, the utility of local-scale experiments in understanding large-scale processes and how we might better plan for and manage our coasts. The major comparisons are between warm-temperate areas of northern NZ and New South Wales, and the cooler areas of southern NZ and south-eastern Australia. In the quest for ‘ecosystem’-level understanding, which perforce involves large-scale events, there is an increasing tendency to minimise or ignore the hard-won insights gained from well-structured experiments across multiple sites. Because all large-scale effects must be manifested at local sites, it is incumbent on us to determine what scales up or down, and the caveats that make comparisons across biogeographic regions challenging. Here, we discuss these issues using austral shores as models.