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Background: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a frequent cause of healthcare-associated infections (HAIs). The CDC Emerging Infections Program (EIP) conducted population and laboratory-based surveillance of CRPA in selected areas in 8 states from August 1, 2016, through July 31, 2018. We aimed to describe the molecular epidemiology and mechanisms of resistance of CRPA isolates collected through this surveillance. Methods: We defined a case as the first isolate of P. aeruginosa resistant to imipenem, meropenem, or doripenem from the lower respiratory tract, urine, wounds, or normally sterile sites identified from a resident of the EIP catchment area in a 30-day period; EIP sites submitted a systematic random sample of isolates to CDC for further characterization. Of 1,021 CRPA clinical isolates submitted, 707 have been sequenced to date using an Illumina MiSeq. Sequenced genomes were classified using the 7-gene multilocus sequence typing (MLST) scheme, and a core genome MLST (cgMLST) scheme was used to determine phylogeny. Antimicrobial resistance genes were identified using publicly available databases, and chromosomal mechanisms of carbapenem resistance were determined using previously validated genetic markers. Results: There were 189 sequence types (STs) among the 707 sequenced genomes (Fig. 1). The most frequently occurring were high-risk clones ST235 (8.5%) and ST298 (4.7%), which were found across all EIP sites. Carbapenemase genes were identified in 5 (<1%) isolates. Overall, 95.6% of the isolates had chromosomal mutations associated with carbapenem resistance: 93.2% had porinD-associated mutations that decrease membrane permeability to the drugs; 24.8% had mutations associated with overexpression of the multidrug efflux pump MexAB-OprM; and 22.9% had mutations associated with overexpression of the endogenous β-lactamase ampC. More than 1 such chromosomal resistance mutation type was present in 37.8% of the isolates. Conclusions: The diversity of the sequence types demonstrates that HAIs caused by CRPA can arise from a variety of strains and that high-risk clones are broadly disseminated across the EIP sites but are a minority of CRPA strains overall. Carbapenem resistance in P. aeruginosa was predominantly driven by chromosomal mutations rather than acquired mechanisms (ie, carbapenemases). The diversity of the CRPA isolates and the lack of carbapenemase genes suggest that this ubiquitous pathogen can readily evolve chromosomal resistance mechanisms, but unlike carbapenemases, these cannot be easily spread through horizontal transfer.
Acute change in mental status (ACMS), defined by the Confusion Assessment Method, is used to identify infections in nursing home residents. A medical record review revealed that none of 15,276 residents had an ACMS documented. Using the revised McGeer criteria with a possible ACMS definition, we identified 296 residents and 21 additional infections. The use of a possible ACMS definition should be considered for retrospective nursing home infection surveillance.
To determine whether there were changes in the prevalence or healthiness of products carrying claims post-implementation of Standard 1.2.7: Nutrition, Health and Related Claims in the Australia New Zealand Food Standards Code.
Observational survey of claims on food packages in three categories: non-alcoholic beverages, breakfast cereals and cereal bars. Nutrient profiling was applied to products to determine their eligibility to carry health claims under Standard 1.2.7. The Standard came into effect in 2013. The proportion of products carrying claims and the proportion of those not meeting the nutrient profiling criteria were calculated. A comparative analysis was conducted to determine changes between 2011 and 2016.
Three large metropolitan stores from the three major supermarket chains in Sydney, Australia were surveyed in 2011 and 2016.
All claims on all available products in 2016 (n 1737). Nutrition composition and ingredients were collected from the packaging.
Overall in 2016, 76 % of products carried claims and there were 7367 claims identified in the three food categories. Of products in 2016 with health claims, 34 % did not meet nutrient profiling criteria. These may breach Standard 1.2.7. Comparison of 2011–2016 showed a significant increase in the number of products carrying claims (66 v. 76 %, P < 0·001).
The proportion of products carrying claims that do not meet nutrient profiling and consumers’ tendency to infer health benefits from nutrition content claims warrants the regulation of all claims using the nutrient profiling. This will ensure consumers are not misled by claims on unhealthy food products.
Codex published the ‘Guidelines for Risk Analysis of Foodborne Antimicrobial Resistance’ to standardise the approach for evaluating risk posed by foodborne antimicrobial-resistant bacteria. One of the first steps in the guidelines is to compile a risk profile, which provides the current state of knowledge regarding a food safety issue, describes risk management options and recommends next steps. In Canada, ceftiofur/ceftriaxone-resistant Salmonella enterica subsp. enterica serovar Heidelberg from poultry was identified as an antimicrobial resistance (AMR) food safety issue. The first objective of this article was to contextualise this food safety issue, using the risk profile format of the Codex Guidelines. A second objective was to evaluate the applicability of the Codex Guidelines. This risk profile indicated that ceftiofur/ceftriaxone-resistant S. Heidelberg (CSH) was commonly isolated from poultry and was associated with severe disease in humans. Ceftiofur use in poultry hatcheries temporally mirrored the prevalence of CSH from poultry meat at retail and from people with salmonellosis. The evidence was sufficient to indicate the need for risk management options, such as restricting the use of ceftiofur in poultry. The Codex Guidelines provided a useful approach to summarise data for decision-makers to evaluate an AMR food safety issue.
Ethnic minority groups often have more complex and aversive pathways to mental health care. However, large population-based studies are lacking, particularly regarding involuntary hospitalisation. We sought to examine the risk of involuntary admission among first-generation ethnic minority groups with early psychosis in Ontario, Canada.
Using health administrative data, we constructed a retrospective cohort (2009–2013) of people with first-onset non-affective psychotic disorder aged 16–35 years. This cohort was linked to immigration data to ascertain migrant status and country of birth. We identified the first involuntary admission within 2 years and compared the risk of involuntary admission for first-generation migrant groups to the general population. To control for the role of migrant status, we restricted the sample to first-generation migrants and examined differences by country of birth, comparing risk of involuntary admission among ethnic minority groups to a European reference. We further explored the role of migrant class by adjusting for immigrant vs refugee status within the migrant cohort. We also explored effect modification of migrant class by ethnic minority group.
We identified 15 844 incident cases of psychotic disorder, of whom 19% (n = 3049) were first-generation migrants. Risk of involuntary admission was higher than the general population in five of seven ethnic minority groups. African and Caribbean migrants had the highest risk of involuntary admission (African: risk ratio (RR) = 1.52, 95% CI = 1.34–1.73; Caribbean: RR = 1.58, 95% CI = 1.37–1.82), and were the only groups where the elevated risk persisted when compared to the European reference group within the migrant cohort (African: RR = 1.24, 95% CI = 1.04–1.48; Caribbean: RR = 1.29, 95% CI = 1.07–1.56). Refugee status was independently associated with involuntary admission (RR = 1.16, 95% CI = 1.02–1.32); however, this risk varied by ethnic minority group, with Caribbean refugees having an elevated risk of involuntary admission compared with Caribbean immigrants (RR = 1.72, 95% CI = 1.15–2.58).
Our findings are consistent with the international literature showing increased rates of involuntary admission among some ethnic minority groups with early psychosis. Interventions aimed at improving pathways to care could be targeted at these groups to reduce disparities.
Although data sharing platforms host diverse data types the features of these platforms are well-suited to facilitating biomarker research. Given the current state of biomarker discovery, an innovative paradigm to accelerate biomarker discovery is to utilize platforms such as Vivli to leverage researchers' abilities to integrate certain classes of biomarkers.
Geomorphic evidence of past glaciation, such as U-shaped valleys, aretes, glacial lakes, and moraines, is preserved in the highland surrounding Cerro Chirripó in the Cordillera de Talamanca, Costa Rica. Previous work to establish a glacial chronology has focused on relative age dating of moraines and on radiocarbon dating of basal lake sediments to infer the timing of deglaciation. We used cosmogenic 36Cl surface exposure dating to constrain the ages of moraines within two formerly glaciated valleys, the Morrenas and Talari valleys. Forty-nine boulder samples were processed and measured from four moraine complexes in the Morrenas Valley and two moraine complexes in the Talari Valley. The exposure ages of these samples indicate a major glacial event occurred in this area from ~25 to 23 ka, broadly synchronous with the global last glacial maximum. Our results also indicate periods of glacial retreats and standstills from the deglacial period to the Early Holocene (~16–10 ka) before the complete disappearance of glaciers in this highland. These findings provide important insights into the glacial chronology and paleoclimate of tropical America.
To assess the extent of error present in self-reported weight data in the Women’s Health Initiative, variables that may be associated with error, and to develop methods to reduce any identified error.
Prospective cohort study.
Forty clinical centres in the USA.
Women (n 75 336) participating in the Women’s Health Initiative Observational Study (WHI-OS) and women (n 6236) participating in the WHI Long Life Study (LLS) with self-reported and measured weight collected about 20 years later (2013–2014).
The correlation between self-reported and measured weights was 0·97. On average, women under-reported their weight by about 2 lb (0·91 kg). The discrepancies varied by age, race/ethnicity, education and BMI. Compared with normal-weight women, underweight women over-reported their weight by 3·86 lb (1·75 kg) and obese women under-reported their weight by 4·18 lb (1·90 kg) on average. The higher the degree of excess weight, the greater the under-reporting of weight. Adjusting self-reported weight for an individual’s age, race/ethnicity and education yielded an identical average weight to that measured.
Correlations between self-reported and measured weights in the WHI are high. Discrepancies varied by different sociodemographic characteristics, especially an individual’s BMI. Correction of self-reported weight for individual characteristics could improve the accuracy of assessment of obesity status in postmenopausal women.
The role that vitamin D plays in pulmonary function remains uncertain. Epidemiological studies reported mixed findings for serum 25-hydroxyvitamin D (25(OH)D)–pulmonary function association. We conducted the largest cross-sectional meta-analysis of the 25(OH)D–pulmonary function association to date, based on nine European ancestry (EA) cohorts (n 22 838) and five African ancestry (AA) cohorts (n 4290) in the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium. Data were analysed using linear models by cohort and ancestry. Effect modification by smoking status (current/former/never) was tested. Results were combined using fixed-effects meta-analysis. Mean serum 25(OH)D was 68 (sd 29) nmol/l for EA and 49 (sd 21) nmol/l for AA. For each 1 nmol/l higher 25(OH)D, forced expiratory volume in the 1st second (FEV1) was higher by 1·1 ml in EA (95 % CI 0·9, 1·3; P<0·0001) and 1·8 ml (95 % CI 1·1, 2·5; P<0·0001) in AA (Prace difference=0·06), and forced vital capacity (FVC) was higher by 1·3 ml in EA (95 % CI 1·0, 1·6; P<0·0001) and 1·5 ml (95 % CI 0·8, 2·3; P=0·0001) in AA (Prace difference=0·56). Among EA, the 25(OH)D–FVC association was stronger in smokers: per 1 nmol/l higher 25(OH)D, FVC was higher by 1·7 ml (95 % CI 1·1, 2·3) for current smokers and 1·7 ml (95 % CI 1·2, 2·1) for former smokers, compared with 0·8 ml (95 % CI 0·4, 1·2) for never smokers. In summary, the 25(OH)D associations with FEV1 and FVC were positive in both ancestries. In EA, a stronger association was observed for smokers compared with never smokers, which supports the importance of vitamin D in vulnerable populations.
The widespread use of smartphones makes effective therapies such as cognitive–behavioural therapy (CBT) potentially accessible to large numbers of people.
This paper reports the usage data of the first trial of Catch It, a new CBT smartphone app.
Uptake and usage rates, fidelity of user responses to CBT principles, and impact on reported negative and positive moods were assessed.
A relatively modest proportion of people chose to download the app. Once used, the app tended to be used more than once, and 84% of the user-generated content was consistent with the basic concepts of CBT. There were statistically significant reductions in negative mood intensity and increases in positive mood intensity.
Smartphone apps have potential beneficial effects in mental health through the application of basic CBT principles. More research with randomised controlled trial designs should be conducted.
Dental pulp stem cells (DPSCs) can differentiate into bone cells when provided the correct environment, potentially generating cells to repair non-union fractures. Polylactic Acid (PLA) is a biocompatible polymer for 3-D printing of scaffolds, but DPSCs do not proliferate well on PLA. With the goal of making PLA more conducive for DPSC growth, Graphene Oxide (GO); partially reduced Graphene Oxide (pRGO); GO with iron nanoparticles (FeGO) or Fe-pRGO were incorporated into PLA and spun cast as thin films onto silicon wafers for DPSC plating. DPSCs on Fe-pRGO displayed the fastest doubling time and the highest cell modulus; Fe-pRGO with exterior magnets produced high cell density. SEM demonstrated DPSC mineralization, whereas PLA-only DPSC cultures showed none. Results suggest that PLA/Fe-pRGO and PLA/pRGO enhance DPSC proliferation and possibly differentiation with the potential for use as a 3-D printed scaffold for tissue engineering.
To identify key decisions along the continuum of care (conventional, contingency, and crisis) and the critical triggers and data elements used to inform those decisions concerning public health and health care response during an emergency.
A classic Delphi method, a consensus-building survey technique, was used with clinicians around Washington State to identify regional triggers and indicators. Additionally, using a modified Delphi method, we combined a workshop and single-round survey with panelists from public health (state and local) and health care coalitions to identify consensus state-level triggers and indicators.
In the clinical survey, 122 of 223 proposed triggers or indicators (43.7%) reached consensus and were deemed important in regional decision-making during a disaster. In the state-level survey, 110 of 140 proposed triggers or indicators (78.6%) reached consensus and were deemed important in state-level decision-making during a disaster.
The identification of consensus triggers and indicators for health care emergency response is crucial in supporting a comprehensive health care situational awareness process. This can inform the creation of standardized questions to ask health care, public health, and other partners to support decision-making during a response. (Disaster Med Public Health Preparedness. 2017;11:467–472)
The spoon-billed sandpiper Calidris pygmaea is a Critically Endangered shorebird that breeds in the Russian arctic and winters in coastal and estuarine habitats in South-east Asia. We report the first formal estimate of its global population size, combining a mark–resighting estimate of the number of leg-flagged individuals alive in autumn 2014 with an estimate of the proportion of birds with flags from scan surveys conducted during the same period at a migration stop-over site on the Jiangsu coast of China. We estimate that the world breeding population of spoon-billed sandpipers in 2014 was 210–228 pairs and the post-breeding population of all age classes combined was 661–718 individuals. This and related methods have considerable potential for surveillance of the population size of other globally threatened species, especially widely dispersed long-distance migrants.
The Polymer Electrolyte Membrane Fuel Cells (PEMFCs) platinum catalyst’s susceptibility to poisoning by carbon monoxide (CO) reduces its output power. In an effort to diminish poisoning, gold and platinum nanoparticles were incorporated onto partially reduced graphene oxide (Au/Pt-prGO) sheets to reduce both nanoparticle aggregation and the amount of precious metal needed. Applying this material onto the electrodes and Nafion membrane of a PEMFC was hypothesized to increase CO tolerance as well as power output.
Aliquots of graphene oxide (GO) were functionalized with platinum and/or gold nanoparticles using a simple desktop synthesis at room temperature. Partial reduction with NaBH4 maintained hydrophilic solubility. Test solutions applied to electrodes and to electrodes + Nafion membrane were first tested in a PEM fuel cell with a pure H2 gas feed and then repeated with a H2 gas feed containing 1000 ppm of CO. Test arrangements averaged doubling the output power of the poisoned control, with the most effective yielding an output power ∼250% that of the poisoned control. Additionally, each system’s poisoned output power (PP) was compared to its highest possible output power (PM), with the most effective setup showing no reduction in output power, even with a H2 gas feed containing 1000 ppm of CO. Thus, this offers promise of a simple, cost-effective method of both improving PEMFC power output while reducing or even eliminating CO poisoning at room temperature.
Previously, it has been suggested that metal ions complexed to humic acid in the environment might show slower dissociation than those added to humic substances in the laboratory, which has serious implications for the transport of radionuclides in the environment. The dissociation of lanthanide and anthropogenic actinide ions from humic substance complexes has been studied as a function of humic concentration and metal ion:humic concentration ratio. The results suggest that the apparently slower kinetics observed for metal ions complexed in the environment are probably due to the large humic concentrations that are used in those studies. Further, there is no evidence that the dissociation rate constant varies at very low metal ion concentrations. Although humic samples size-fractionated by ultrafiltration showed that more metal may be bound non-exchangeably, there was no evidence for different rate constants. Ultrafiltration of Eu(III)/humic acid mixtures did show a shift in Eu from smaller to larger fractions over a period of two days. Therefore, the results suggest that dissociation rate constants determined in the laboratory at metal ion concentrations higher than those expected in the environment may be used in predicting radionuclide mobility, provided that the humic acid concentration is in the range expected at the site.
The oxidation of CO to CO2 is necessary in the operation of Proton Exchange Membrane Fuel Cells (PEMFCs) since even a small amount of CO that is formed when the PEMFC is operated under ambient conditions is sufficient to poison the Pt catalyst in the electrodes and degrade the performance. Operation using higher loads of Pt catalysts or increasing the purity of the H2 input gas significantly adds to the cost, adversely impacting the commercial development of PEMFCs. We combined graphene oxide (GO) with metallic salts and partially reduced the mixture with sodium borohydride, yielding a metallized form of partially reduced graphene oxide (prGO) platelets that remained in solution. When these platelets were coated on the Nafion membrane of a PEMFC, a 72% increase in the power output was observed, whereas a 62% increase was observed when the membrane was coated with partially reduced graphene oxide without the metallic salts. Results will be presented for AuGO/prGO, PtGO/prGO, and AuPtGO/prGO combinations.