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While past research suggested that living arrangements are associated with suicide death, no study has examined the impact of sustained living arrangements and the change in living arrangements. Also, previous survival analysis studies only reported a single hazard ratio (HR), whereas the actual HR may change over time. We aimed to address these limitations using causal inference approaches.
Methods
Multi-point data from a general Japanese population sample were used. Participants reported their living arrangements twice within a 5-year time interval. After that, suicide death, non-suicide death and all-cause mortality were evaluated over 14 years. We used inverse probability weighted pooled logistic regression and cumulative incidence curve, evaluating the association of time-varying living arrangements with suicide death. We also studied non-suicide death and all-cause mortality to contextualize the association. Missing data for covariates were handled using random forest imputation.
Results
A total of 86,749 participants were analysed, with a mean age (standard deviation) of 51.7 (7.90) at baseline. Of these, 306 died by suicide during the 14-year follow-up. Persistently living alone was associated with an increased risk of suicide death (risk difference [RD]: 1.1%, 95% confidence interval [CI]: 0.3–2.5%; risk ratio [RR]: 4.00, 95% CI: 1.83–7.41), non-suicide death (RD: 7.8%, 95% CI: 5.2–10.5%; RR: 1.56, 95% CI: 1.38–1.74) and all-cause mortality (RD: 8.7%, 95% CI: 6.2–11.3%; RR: 1.60, 95% CI: 1.42–1.79) at the end of the follow-up. The cumulative incidence curve showed that these associations were consistent throughout the follow-up. Across all types of mortality, the increased risk was smaller for those who started to live with someone and those who transitioned to living alone. The results remained robust in sensitivity analyses.
Conclusions
Individuals who persistently live alone have an increased risk of suicide death as well as non-suicide death and all-cause mortality, whereas this impact is weaker for those who change their living arrangements.
The red snow algae species found in snow at Resolute, Canadian Arctic, is a unicellular Chlamydomonas nivalis. Investigations by SEM-EDX, TEM, FT-IR, GC and GC-MS suggest that clay aerosols may provide nutrients for these unique systems. The clays provide P, S, K, Si, Ca, and Mg. Soot is also present and halite is very common. This salt probably plays a significant role in lowering the freezing temperature. The red snow algae is coated by a sticky thin film composed of both organic membrane material and inorganics consisting of mica and smectite. Green algae rich in Ca are involved in active photosynthesis while red algae are in a resting stage. Protamine, stearic acid, and decanoic acid were found at Ca-rich green cells while carminic acid and nopalcol BR-13 were found at Ca-poor red cells. The cell wall of red algae is composed of protein with cellulose. The major fatty acides in cells are all of even-carbon species with maximum concentrations of palmitic acid, stearic acid, and behenic acid, suggesting normal chemistry of algae species without C22. High concentration of n-alkanes with n-C24 is a characteristic component in this red snow algae, suggesting the presence of hydrocarbons that could be derived from the Arctic cold desert and/or organic debris of wind-transported bacteria. It is likely that such organic and inorganic matter provide the nutrient sources for the red snow algae in ice.
Novel ST398 methicillin susceptible Staphylococcus aureus (MSSA) in the United States was first observed in New York City (2004–2007); its diffusion across the country resulted in changing treatment options. Utilizing outpatient antimicrobial susceptibility data from the Veterans Health Administration from 2010 to 2019, the spatiotemporal prevalence of potential ST398 MSSA is documented.
The impact of hurricane-related flooding on infectious diseases in the US is not well understood. Using geocoded electronic health records for 62,762 veterans living in North Carolina counties impacted by Hurricane Matthew coupled with flood maps, we explore the impact of hurricane and flood exposure on infectious outcomes in outpatient settings and emergency departments as well as antimicrobial prescribing. Declines in outpatient visits and antimicrobial prescribing are observed in weeks 0-2 following the hurricane as compared with the baseline period and the year prior, while increases in antimicrobial prescribing are observed 3+ weeks following the hurricane. Taken together, hurricane and flood exposure appear to have had minor impacts on infectious outcomes in North Carolina veterans, not resulting in large increases in infections or antimicrobial prescribing
The home-field advantage (HFA) hypothesis establishes that plant litter decomposes faster at ‘home’ sites than in ‘away’ sites due to more specialized decomposers acting at home sites. This hypothesis has predominantly been tested through ‘yes or no’ transplanting experiments, where the litter decomposition of a focal species is quantified near and away from their conspecifics. Herein, we evaluated the occurrence and magnitude of home-field effects on the leaf litter decomposition of Myrcia ramuliflora (O.Berg) N. Silveira (Myrtaceae) along a natural gradient of conspecific litterfall input and also if home-field effects are affected by litter and soil traits. Litter decomposition of M. ramuliflora was assessed through litterbags placed in 39 plots in a tropical heath vegetation over a period of 12 months. We also characterized abiotic factors, litter layer traits, and litter diversity. Our results indicated the occurrence of positive (i.e. Home-field advantage) and negative (i.e. Home-field disadvantage) effects in more than half of the plots. Positive and negative effects occurred in a similar frequency and magnitude. Among all predictors tested, only the community weighted mean C/N ratio of the litterfall input was associated with home-field effects. Our results reinforce the lack of generality for home-field effects found in the literature and thus challenge the understanding of litter-decomposer interaction in tropical ecosystems.
Temporal overlap of the Atlantic hurricane season and seasonal influenza vaccine rollout has the potential to result in delays or disruptions of vaccination campaigns. We documented seasonal influenza vaccination behavior over a 5-year period and explored associations between flooding following Hurricane Harvey and timing and uptake of vaccines, as well as how the impacts of Hurricane Harvey on vaccination vary by race, wealth, and rurality.
Design:
Retrospective cohort analysis.
Setting:
Texas counties affected by Hurricane Harvey.
Patients:
Active users of the Veterans’ Health Administration in 2017.
Methods:
We used geocoded residential address data to assess flood exposure status following Hurricane Harvey. Days to receipt of seasonal influenza vaccines were calculated for each year from 2014 to 2019. Proportional hazards models were used to determine how likelihood of vaccination varied according to flood status as well as the race, wealth, and rural–urban residence of patients.
Results:
The year of Hurricane Harvey was associated with a median delay of 2 weeks to vaccination and lower overall vaccination than in prior years. Residential status in flooded areas was associated with lower hazards of influenza vaccination in all years. White patients had higher proportional hazards of influenza vaccination than non-White patients, though this attenuated to 6.39% (hazard ratio [HR], 1.0639; 95% confidence interval [CI], 1.034–1.095) in the hurricane. year.
Conclusions:
Receipt of seasonal influenza vaccination following regional exposure to the effects of Hurricane Harvey was delayed among US veterans. White, non–low-income, and rural patients had higher likelihood of vaccination in all years of the study, but these gaps narrowed during the hurricane year.
Red ear syndrome is a rare disorder in which the colour of the ear suddenly becomes red, with discomfort, pain and a burning sensation. This paper reports a case of primary red ear syndrome presenting with vestibular migraine.
Case report
A 39-year-old woman from Bangladesh reported dizziness and repeated headaches experienced since 18 years of age. She initially attended our hospital with dizziness aged 34 years. When dizzy, the colour of her right ear sometimes became red. Therefore, she was diagnosed with red ear syndrome with vestibular migraine.
Conclusion
This patient experienced repeated episodes of a red ear with discomfort, leading to the diagnosis of red ear syndrome. In addition, she had repeated dizziness and headaches, and was also diagnosed with vestibular migraine. The diagnosis of red ear syndrome with vestibular migraine should be considered in cases of dizziness and headache with recurrent redness of the ear.
To develop a fully automated algorithm using data from the Veterans’ Affairs (VA) electrical medical record (EMR) to identify deep-incisional surgical site infections (SSIs) after cardiac surgeries and total joint arthroplasties (TJAs) to be used for research studies.
Design:
Retrospective cohort study.
Setting:
This study was conducted in 11 VA hospitals.
Participants:
Patients who underwent coronary artery bypass grafting or valve replacement between January 1, 2010, and March 31, 2018 (cardiac cohort) and patients who underwent total hip arthroplasty or total knee arthroplasty between January 1, 2007, and March 31, 2018 (TJA cohort).
Methods:
Relevant clinical information and administrative code data were extracted from the EMR. The outcomes of interest were mediastinitis, endocarditis, or deep-incisional or organ-space SSI within 30 days after surgery. Multiple logistic regression analysis with a repeated regular bootstrap procedure was used to select variables and to assign points in the models. Sensitivities, specificities, positive predictive values (PPVs) and negative predictive values were calculated with comparison to outcomes collected by the Veterans’ Affairs Surgical Quality Improvement Program (VASQIP).
Results:
Overall, 49 (0.5%) of the 13,341 cardiac surgeries were classified as mediastinitis or endocarditis, and 83 (0.6%) of the 12,992 TJAs were classified as deep-incisional or organ-space SSIs. With at least 60% sensitivity, the PPVs of the SSI detection algorithms after cardiac surgeries and TJAs were 52.5% and 62.0%, respectively.
Conclusions:
Considering the low prevalence rate of SSIs, our algorithms were successful in identifying a majority of patients with a true SSI while simultaneously reducing false-positive cases. As a next step, validation of these algorithms in different hospital systems with EMR will be needed.
N-acetylaspartate (NAA) levels and serum brain-derived neurotrophic factor (BDNF) levels in patients with first-episode schizophrenia psychosis and age- and sex-matched healthy control subjects were investigated. In addition, plasma levels of homovanillic acid (HVA) and 3-methoxy-4-hydroxyphenylglycol (MHPG) were compared between the two groups.
Method:
Eighteen patients (nine males, nine females; age range: 13–52 years) were enrolled in the study, and 18 volunteers (nine males, nine females; age range: 15–49 years) with no current or past psychiatric history were also studied by magnetic resonance spectroscopy (MRS) as sex- and age-matched controls.
Results:
Levels of NAA/Cr in the left basal ganglia (p = 0.0065) and parieto-occipital lobe (p = 0.00498), but not in the frontal lobe, were significantly lower in patients with first-episode schizophrenia psychosis than in control subjects. No difference was observed between the serum BDNF levels of patients with first-episode schizophrenia psychosis and control subjects. In regard to the plasma levels of catecholamine metabolites, plasma MHPG, but not HVA, was significantly lower in the patients with first-episode psychosis than in control subjects. In addition, a significantly positive correlation was observed between the levels of NAA/Cr of the left basal ganglia and plasma MHPG in all subjects.
Conclusions:
These results suggest that brain NAA levels in the left basal ganglia and plasma MHPG levels were significantly reduced at the first episode of schizophrenia psychosis, indicating that neurodegeneration via noradrenergic neurons might be associated with the initial progression of the disease.
Although most hospitals report very high levels of hand hygiene compliance (HHC), the accuracy of these overtly observed rates is questionable due to the Hawthorne effect and other sources of bias. In the study, we aimed (1) to compare HHC rates estimated using the standard audit method of overt observation by a known observer and a new audit method that employed a rapid (<15 minutes) “secret shopper” method and (2) to pilot test a novel feedback tool.
Design
Quality improvement project using a quasi-experimental stepped-wedge design.
Setting
This study was conducted in 5 acute-care hospitals (17 wards, 5 intensive care units) in the Midwestern United States.
Methods
Sites recruited a hand hygiene observer from outside the acute-care units to rapidly and covertly observe entry and exit HHC during the study period, October 2016–September 2017. After 3 months of observations, sites received a monthly feedback tool that communicated HHC information from the new audit method.
Results
The absolute difference in HHC estimates between the standard and new audit methods was ~30%. No significant differences in HHC were detected between the baseline and feedback phases (OR, 0.92; 95% CI, 0.84–1.01), but the standard audit method had significantly higher estimates than the new audit method (OR, 9.83; 95% CI, 8.82–10.95).
Conclusions
HHC estimates obtained using the new audit method were substantially lower than estimates obtained using the standard audit method, suggesting that the rapid, secret-shopper method is less subject to bias. Providing feedback using HHC from the new audit method did not seem to impact HHC behaviors.
We study the relationship between the reduction number of a primary ideal of a local ring relative to one of its minimal reductions and the multiplicity of the corresponding Sally module. This paper is focused on three goals: (i) to develop a change of rings technique for the Sally module of an ideal to allow extension of results from Cohen–Macaulay rings to more general rings; (ii) to use the fiber of the Sally modules of almost complete intersection ideals to connect its structure to the Cohen–Macaulayness of the special fiber ring; (iii) to extend some of the results of (i) to two-dimensional Buchsbaum rings. Along the way, we provide an explicit realization of the $S_{2}$-fication of arbitrary Buchsbaum rings.
NUMO and JAEA have been conducting a joint research since FY2011, which is aimed
to enhance the methodology of repository design and performance assessment in
preliminary investigation stage for the deep geological disposal of high-level
radioactive waste. As a part of this joint research, we have been developing
glass dissolution models which include various processes derived from
glass-overpack-bentonite buffer interaction, considering the precipitation of
Fe-silicates associated with steel overpack corrosion, and Si transport through
altered layer of glass. The objective of this modeling work is to show
comprehensively the lifetime of the vitrified waste due to glass matrix
dissolution timescales through sensitivity analysis, and to identify the
feature/process that most strongly influences the lifetime, and to identify
future R&D issues that would help to improve the nuclide transport
analysis with confidential value and the safety case in future. The sensitivity
analysis suggested that the duration of the glass dissolution might be predicted
in the ranges from 3.8×103 to 1.9×105
years. Also, the results indicated that the precipitation of
Fe–silicate has the strongest influence on the long-team behavior of
vitrified waste.
Meiotic maturation of oocytes requires a variety of ATP-dependent reactions, such as germinal vesicle breakdown, spindle formation, and rearrangement of plasma membrane structure, which is required for fertilization. Mitochondria are accordingly expected be localized to subcellular sites of energy utilization. Although microtubule-dependent cellular traffic for mitochondria has been studied extensively in cultured neuronal (and some other somatic) cells, the molecular mechanism of their dynamics in mammalian oocytes at different stages of maturation remains obscure. The present work describes dynamic aspects of mitochondria in porcine oocytes at the germinal vesicle stage. After incubation of oocytes with MitoTracker Orange followed by centrifugation, mitochondria-enriched ooplasm was obtained using a glass needle and transferred into a recipient oocyte. The intracellular distribution of the fluorescent mitochondria was then observed over time using a laser scanning confocal microscopy equipped with an incubator. Kinetic analysis revealed that fluorescent mitochondria moved from central to subcortical areas of oocytes and were dispersed along plasma membranes. Such movement of mitochondria was inhibited by either cytochalasin B or cytochalasin D but not by colcemid, suggesting the involvement of microfilaments. This method of visualizing mitochondrial dynamics in live cells permits study of the pathophysiology of cytoskeleton-dependent intracellular traffic of mitochondria and associated energy metabolism during meiotic maturation of oocytes.
To identify important risk factors for recurrent methicillin-resistant Staphylococcus aureus (MRSA) to assist clinicians in identifying high-risk patients for continued surveillance and follow-up.
METHODS
In this retrospective cohort study, we examined patients with MRSA bacteremia at 122 Veterans Affairs medical facilities from January 1, 2003, through December 31, 2010. Recurrent MRSA bacteremia was identified by a positive blood culture result from 2 to 180 days after index hospitalization discharge. Subset analyses were performed to evaluate risk factors for early-onset (2–60 days after discharge) and late-onset (61–180 days after discharge) recurrence. Risk factors were evaluated using Cox proportional hazards regression.
RESULTS
Of 18,425 patients, 1,159 (6.3%) had recurrent MRSA bacteremia. The median time to recurrence was 63 days. Longer duration of index bacteremia, increased severity of illness, receipt of only vancomycin, community-acquired infection, and several comorbidities were risk factors for recurrence. Congestive heart failure, hypertension, and rheumatoid arthritis/collagen disease were risk factors for early-onset but not late-onset recurrence. Geographic region and cardiac arrhythmias were risk factors for late-onset but not early-onset recurrence.
CONCLUSIONS
Risk factors for recurrent MRSA bacteremia included comorbidities, severity of illness, duration of bacteremia, and receipt of only vancomycin. Awareness of risk factors may be important at patient discharge for implementation of quality improvement initiatives including surveillance, follow-up, and education for high-risk patients.
Human alveolar echinococcosis (AE) is caused by the accidental ingestion of Echinococcus multilocularis eggs. Early detection is essential as surgical resection is the only treatment for a complete cure. However, details are unclear about changes in the antibody response during the initial stages of infection, yet such information is useful for early serodiagnosis. Therefore, a long-term investigation was performed into the time course of the antibody response before ‘positive’ detection. Patient sera were used for enzyme-linked immunosorbent assay (ELISA) and Western blotting (WB) analysis using crude antigens extracted from E. multilocularis protoscoleces. Rats were experimentally infected with AE and similarly analysed by ELISA and WB. Among the markers for diagnoses, the 18 kDa band (main marker) appeared last in the preoperative stages and disappeared first after operation in a WB test. Although the 18 kDa antigen can be useful as a marker for AE diagnosis, it cannot contribute to the detection of some patients before the 18 kDa band appearance. To avoid misdiagnosis, different diagnostic antigens such as the 26–28 and 7–8 kDa bands should also be considered. These bands tend to appear earlier than the 18 kDa band and thus offer the potential for early detection of AE. We first observed changes in the antibody response in a relatively early stage after infection in human AE cases. Notably, changes in the antibody response of two intermediate species were similar. These findings provide valuable information for the early detection of human AE cases in the future.
We successfully obtained the first optical spectra of the faint light echoes around Cassiopeia A and Tycho Brahe's supernova remnants (SNRs) with FOCAS and the Subaru Telescope. We conclude that Cas A and Tycho's SN 1572 belong to the Type IIb and normal Type Ia supernovae, respectively. Light echo spectra are important in order to obtain further insight into the supernova explosion mechanism of Tycho's SN 1572: how the Type Ia explosion actually proceeds, and whether accretion occurs from a companion or by the merging of two white dwarfs. The proximity of the SN 1572 remnant has allowed detailed studies, such as the possible identification of the binary companion, and provides a unique opportunity to test theories of the explosion mechanism and the nature of the progenitor. Future light-echo spectra, obtained in different spatial directions of SN 1572, will enable to construct a three-dimensional spectroscopic view of the explosion.
Huge landslides triggered by strong earthquakes or torrential rains can result in unstable natural dams that pose serious risks to humans. In this study, we attempt to document the age of an ancient earthquake that produced a landslide-dammed lake. A buried forest found in the Toyama River area of the southern Nagano Prefecture, central Japan, provides evidence of this event. The dammed lake formation has been previously estimated to have occurred in AD 714. However, the age of the dam and the way it was formed have never been directly determined. To determine the position and timing of the landslide dam, we analyzed the radiocarbon content of branches and wood fragments from a brecciated deposit. We show that the 14C dating method is suitable for clarifying the timing of burial for a variety of trees, although the method does not produce a narrow age for the event. In addition to the dating, we determined the landslide dam's position and reconstructed the formation of the lake.