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Resource utilisation for infants with single ventricle CHD remains high without well-studied ways to decrease economic burden. Same-day discharge following cardiac catheterisation has been shown to be safe and effective in children with CHD, but those with single ventricle physiology are commonly excluded. The purpose of this study was to investigate the economic implications of planned same-day discharge following cardiac catheterisation versus universal overnight hospital admission in infants with single ventricle CHD.
Methods and Results:
A probabilistic decision-tree analysis with sensitivity analyses was performed. All included patients were categorised into four possible outcomes; discharge, readmission following discharge (within 48 hours), observation and prolonged hospitalisation. Baseline probabilities of each node of the tree were then combined with the cost data to evaluate the comparative dominance of one decision (immediately discharge) versus the other decision (routinely admit). Patients discharged on the same day as the procedure accrued the lowest attributed hospital cost ($5469), while patients readmitted to the hospital had the highest attributed cost ($11,851). Currently, no other studies have assessed the cost of hospitalisation following cardiac catheterisation in this population. Thus, we allowed for a wide range of cost variation, but same-day discharge dominated the decision outcome with a lower economic burden.
Same-day discharge following routine cardiac catheterisation in patients with single ventricle physiology is less costly compared to universal overnight admission. This demonstrates an important cost-limiting step in a complex population of patients who have high resource utilisation.
A considerable literature has grown up around the analysis of the structure of a function in terms of its derivative, and the structure of functions F(x) which are integrals of various kinds. Some of this relates to derivatives and integrals of F(x) with respect to functions of bounded variation ω(x) (1-6) or, in the case of a paper by Ward (4), with respect to a function of generalized bounded variation in the restricted sense.
In this paper we consider measures determined by arbitrary functions G(x) for which finite right and left limits exist everywhere and indicate how some of these measures permit the definition of generalized integrals of constructive or Denjoy type. These definitions are related to corresponding descriptive definitions based on the Perron approach as given by Ward (6) and Henstock (2). An exposition of the introductory theory is given in (1).
Recently, several incidents of glyphosate failure on junglerice [Echinochloa colona (L.) Link] have been reported in the midsouthern United States, specifically in Mississippi and Tennessee. Research was conducted to measure the magnitude of glyphosate resistance and to determine the mechanism(s) of resistance to glyphosate in E. colona populations from Mississippi and Tennessee. ED50 (dose required to reduce plant growth by 50%) values for a resistant MSGR4 biotype, a resistant TNGR population, and a known susceptible MSGS population were 0.8, 1.62, and 0.23 kg ae ha−1 of glyphosate, respectively. The resistance index calculated from the these ED50 values indicated that the MSGR4 biotype and TNGR population were 4- and 7-fold, respectively, resistant to glyphosate relative to the MSGS population. The absorption patterns of [14C]glyphosate in the TNGR and MSGS populations were similar. However, the MSGS population translocated 13% more [14C]glyphosate out of the treated leaf compared with the TNGR population at 48 h after treatment. EPSPS gene sequence analyses of TNGR E. colona indicated no evidence of any point mutations, but several resistant biotypes, including MSGR4, possessed a single-nucleotide substitution of T for C at codon 106 position, resulting in a proline-to-serine substitution (CCA to TCA). Results from quantitative polymerase chain reaction analyses suggested that there was no amplification of the EPSPS gene in the resistant populations and biotypes. Thus, the mechanism of resistance in the MSGR population (and associated biotypes) is, in part, due to a target-site mutation at the 106 loci of the EPSPS gene, while reduced translocation of glyphosate was found to confer glyphosate resistance in the TNGR population.
OBJECTIVES/SPECIFIC AIMS: Clostridium difficile infection (CDI) is the most common cause of antibiotic-associated diarrhea and an increasingly common infection in children in both hospital and community settings. Between 20% and 30% of pediatric patients will have a recurrence of symptoms in the days to weeks following an initial infection. Multiple recurrences have been successfully treated with fecal microbiota transplantation (FMT), though the body of evidence in pediatric patients is limited primarily to case reports and case series. The goal of our study was to better understand practices, success, and safety of FMT in children as well as identify risk factors associated with a failed FMT in our pediatric patients. METHODS/STUDY POPULATION: This multicenter retrospective analysis included 373 patients who underwent FMT for CDI between January 1, 2006 and January 1, 2017 from 18 pediatric centers. Demographics, baseline characteristics, FMT practices, C. difficile outcomes, and post-FMT complications were collected through chart abstraction. Successful FMT was defined as no recurrence of CDI within 60 days after FMT. Of the 373 patients in the cohort, 342 had known outcome data at two months post-FMT and were included in the primary analysis evaluating risk factors for recurrence post-FMT. An additional six patients who underwent FMT for refractory CDI were excluded from the primary analysis. Unadjusted analysis was performed using Wilcoxon rank-sum test, Pearson χ2 test, or Fisher exact test where appropriate. Stepwise logistic regression was utilized to determine independent predictors of success. RESULTS/ANTICIPATED RESULTS: The median age of included patients was 10 years (IQR; 3.0, 15.0) and 50% of patients were female. The majority of the cohort was White (89.0%). Comorbidities included 120 patients with inflammatory bowel disease (IBD) and 14 patients who had undergone a solid organ or stem cell transplantation. Of the 336 patients with known outcomes at two months, 272 (81%) had a successful outcome. In the 64 (19%) patients that did have a recurrence, 35 underwent repeat FMT which was successful in 20 of the 35 (57%). The overall success rate of FMT in preventing further episodes of CDI in the cohort with known outcome data was 87%. Unadjusted predictors of a primary FMT response are summarized. Based on stepwise logistic regression modeling, the use of fresh stool, FMT delivery via colonoscopy, the lack of a feeding tube, and a lower number of CDI episodes before undergoing FMT were independently associated with a successful outcome. There were 20 adverse events in the cohort assessed to be related to FMT, 6 of which were felt to be severe. There were no deaths assessed to be related to FMT in the cohort. DISCUSSION/SIGNIFICANCE OF IMPACT: The overall success of FMT in pediatric patients with recurrent or severe CDI is 81% after a single FMT. Children without a feeding tube, who receive an early FMT, FMT with fresh stool, or FMT via colonoscopy are less likely to have a recurrence of CDI in the 2 months following FMT. This is the first large study of FMT for CDI in a pediatric cohort. These findings, if confirmed by additional prospective studies, will support alterations in the practice of FMT in children.
Herbicide resistance, and in particular multiple-herbicide resistance, poses an ever-increasing threat to food security. A biotype of junglerice [Echinochloa colona (L.) Link] with resistance to four herbicides, imazamox, fenoxaprop-P-ethyl, quinclorac, and propanil, each representing a different mechanism of action, was identified in Sunflower County, MS. Dose responses were performed on the resistant biotype and a biotype sensitive to all four herbicides to determine the level of resistance. Application of a cytochrome P450 inhibitor, malathion, with the herbicides imazamox and quinclorac resulted in increased susceptibility in the resistant biotype. Differential gene expression analysis of resistant and sensitive plants revealed that 170 transcripts were upregulated in resistant plants relative to sensitive plants and 160 transcripts were upregulated in sensitive plants. In addition, 507 transcripts were only expressed in resistant plants and 562 only in sensitive plants. A subset of these transcripts were investigated further using quantitative PCR (qPCR) to compare gene expression in resistant plants with expression in additional sensitive biotypes. The qPCR analysis identified two transcripts, a kinase and a glutathione S-transferase that were significantly upregulated in resistant plants compared with the sensitive plants. A third transcript, encoding an F-box protein, was downregulated in the resistant plants relative to the sensitive plants. As no cytochrome P450s were differentially expressed between the resistant and sensitive plants, a single-nucleotide polymorphism analysis was performed, revealing several nonsynonymous point mutations of interest. These candidate genes will require further study to elucidate the resistance mechanisms present in the resistant biotype.
Conservation tillage offers economic and soil quality benefits, yet conventional tillage remains the prevailing system in some regions. The purpose of this study is to identify the effect of profitability factors, risk attitudes, crop rotations, and other farmer and farm characteristics on farmers’ choices to use no-till (NT), strip-till (ST) and reduced/conventional tillage (RCT) in producing dryland corn, wheat, and soybean in Kansas. The results show that factors such as crop yields, risk aversion, crop insurance, baling and grazing of crop residue, crop acreage, and farmers’ approach to adopting new technologies are significant factors in farmers’ choice of tillage practice.
The Pivotal Politics model (Krehbiel) has significantly influenced the study of American politics, but its core empirical prediction – that the size of the gridlock interval is negatively related to legislative productivity – has not found strong empirical support. We argue that previous research featured a disconnect between the exclusively ideological theory and tests that relied on outcome variables that were not purely ideological. We remedy this by dividing landmark laws (Mayhew) into two counts – those that invoke ideological preferences and those that do not – and uncover results consistent with Pivotal Politics’ core prediction: the size of the gridlock interval is negatively related to the production of ideological legislation. We also find that the size of the gridlock zone is positively related to the production of nonideological legislation. These results hold up in the face of various sensitivity analyses and robustness checks. We further show that Pivotal Politics explains variation in ideological legislation better than alternative theories based on partisan agenda control.
Hubble Space Telescope Fine Guidance Sensor 3 can generate sub-milliarcsecond precision parallaxes in eighteen months. We discuss the internal precision and external accuracy of our observations of Proxima Centauri and Barnard's Star. For some classes of targets Hubble Space Telescope will remain the parallax tool of choice for years to come. It can offer 0.5 mas precision. It will remain useful by satisfying urgent needs for quick results, by offering a 13 magnitude dynamic range, and by providing an unparalleled binary dissection capability.
The astrometric capability of the Hubble Space Telescope Planetary Camera (WF/PC1) is investigated, motivated by a study of the internal velocity distribution of globular clusters. The astrometric accuracy of the HST PC will be determined ultimately by 1) the accuracy to which the aberrated images can be ‘centered’, and 2) the accuracy to which the distortions across the PC field can be modeled. A series of overlapping exposures of two clusters, NGC 6752 and M15, are utilized to examine these issues.
We have made use of maximum-likelihood image reconstruction to address the first issue, with good success. Reconstruction improves both the detectability and precision of the image centers. A preliminary exploration of the second issue, that of modeling the distortion across the PC field, is also presented, using positions derived from the multiple overlapping exposures.
Details are given about the operation of a two station network and of a new semi-automatic station which has recently been added. Comparison is made with predicted duty cycles. A possible way of quantifying the sky quality is also given.
Measurements of the line of sight velocity of the sun with respect to earth have been obtained at Izaña (Tenerife) during the years 1976 to 1985. The mean values found for each year show a trend of ~30 m/s from minimum to maximum. Their mean value is of 583.1 ± .2 m/s which is 92% of the gravitational red shift predicted by theory and their variation seems to be related to the solar cycle with the clear exception of 1985. The most likely interpretation is that the velocity limb shift effect, averaged over the whole sun, is the cause of the slight disagreement with theory and this effect changes with time.
Data obtained at Izana (Tenerife) and Haleakala (Maui), using optical resonant scattering with a potassium vapour cell over the years 1980–84, are used to determine the frequencies of the low ℓ p modes. Possible variation in these frequencies with the solar cycle are investigated.
Here we report on the material chemistry following crystallization in the presence of water vapor of chlorinated formamidinium lead-triiodide (NH2CH = NH2PbI3−xClx) perovskite films. We found in-situ exposure to water vapor reduces, or possibly eliminates, the retention of chlorine (Cl) inside NH2CH = NH2PbI3−xClx crystals. There is a strong tendency toward Cl volatility, which indicates the sensitivity of these materials for their integration into solar cells. The requisite for additional efforts focused on the mitigation of water vapor is reported. Based on the in situ results, hot casting (<100 °C) in dry conditions demonstrates improved film coverage and Cl retention with efficiencies reaching 12.07%.