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Clinical Enterobacteriacae isolates with a colistin minimum inhibitory concentration (MIC) ≥4 mg/L from a United States hospital were screened for the mcr-1 gene using real-time polymerase chain reaction (RT-PCR) and confirmed by whole-genome sequencing. Four colistin-resistant Escherichia coli isolates contained mcr-1. Two isolates belonged to the same sequence type (ST-632). All subjects had prior international travel and antimicrobial exposure.
In the USA, western Washington (WWA) and the Alaska (AK) Interior are two regions where maritime and continental climates, high latitude and cropping systems necessitate early maturing spring wheat (Triticum aestivum L.). Both regions aim to increase the production of hard spring bread wheat for human consumption to support regional agriculture and food systems. The Nordic region of Europe has a history of breeding for early maturing spring wheat and also experiences long daylengths with mixed maritime and continental climates. Nordic wheat also carries wildtype (wt) NAM-B1, an allele associated with accelerated senescence and increased grain protein and micronutrient content, at a higher frequency than global germplasm. Time to senescence, yield, protein and mineral content were evaluated on 42 accessions of Nordic hard red spring wheat containing wt NAM-B1 over 2 years on experimental stations in WWA and the AK Interior. Significant variation was found by location and accession for time to senescence, suggesting potential parental lines for breeding programmes targeting early maturity. Additionally, multiple regression analysis showed that decreased time to senescence correlated negatively with grain yield and positively with grain protein, iron and zinc content. Breeding for early maturity in these regions will need to account for this potential trade-off in yield. Nordic wt NAM-B1 accessions with early senescence yet with yields similar to regional checks are reported. Collaboration among alternative wheat regions can aid in germplasm exchange and varietal development as shown here for the early maturing trait.
One year of antipsychotic treatment from symptom remission is recommended following a first episode of psychosis (FEP).
To investigate the effectiveness of commonly used antipsychotic medications in FEP.
A retrospective cohort study of naturalistic treatment of patients (N = 460) accepted by FEP services across seven UK sites. Treatment initiation to all-cause discontinuation determined from case files.
Risk of treatment discontinuation is greatest within 3 months of treatment initiation. Risperidone had longest median survival time. No significant differences were observed in time to discontinuation between commonly used antipsychotics on multivariable Cox regression analysis. Poor adherence and efficacy failure were the most common reasons for discontinuation.
Effectiveness differences appear not to be a current reason for antipsychotic choice in FEP. Adherence strategies and weighing up likely adverse effects should be the clinical focus.
To determine features associated with better perceived quality of training for psychiatrists on advance decision-making in the Mental Capacity Act 2005 (MCA), and whether the quality or amount of training were associated with positive attitudes or use of advance decisions to refuse treatment (ADRTs) by psychiatrists in people with bipolar disorder. An anonymised national survey of 650 trainee and consultant psychiatrists in England and Wales was performed.
Good or better quality of training was associated with use of case summaries, role-play, ADRTs, assessment of mental capacity and its fluctuation. Good or better quality and two or more sessions of MCA training were associated with more positive attitudes and reported use of ADRTs, although many psychiatrists would never discuss them clinically with people with bipolar disorder.
Consistent delivery of better-quality training is required for all psychiatrists to increase use of ADRTs in people with bipolar disorder.
The purpose of this study was to quantify the effect of multidrug-resistant (MDR) gram-negative bacteria and methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated infections (HAIs) on mortality following infection, regardless of patient location.
We conducted a retrospective cohort study of patients with an inpatient admission in the US Department of Veterans Affairs (VA) system between October 1, 2007, and November 30, 2010. We constructed multivariate log-binomial regressions to assess the impact of a positive culture on mortality in the 30- and 90-day periods following the first positive culture, using a propensity-score–matched subsample.
Patients identified with positive cultures due to MDR Acinetobacter (n=218), MDR Pseudomonas aeruginosa (n=1,026), and MDR Enterobacteriaceae (n=3,498) were propensity-score matched to 14,591 patients without positive cultures due to these organisms. In addition, 3,471 patients with positive cultures due to MRSA were propensity-score matched to 12,499 patients without positive MRSA cultures. Multidrug-resistant gram-negative bacteria were associated with a significantly elevated risk of mortality both for invasive (RR, 2.32; 95% CI, 1.85–2.92) and noninvasive cultures (RR, 1.33; 95% CI, 1.22–1.44) during the 30-day period. Similarly, patients with MRSA HAIs (RR, 2.77; 95% CI, 2.39–3.21) and colonizations (RR, 1.32; 95% CI, 1.22–1.50) had an increased risk of death at 30 days.
We found that HAIs due to gram-negative bacteria and MRSA conferred significantly elevated 30- and 90-day risks of mortality. This finding held true both for invasive cultures, which are likely to be true infections, and noninvasive infections, which are possibly colonizations.
The emerging statistical properties from the first 50 extrasolar planets are startlingly different from the picture that was imagined prior to 1995. About 0.75% of nearby solar type stars harbor jovian planets in 3 to 5 day circular orbits. Another ∽7% of stars have jupiter–mass companions orbiting in eccentric orbits within 3.5 AU. The mass distribution of substellar companions rises abruptly near 5 MJup and continues increasing down to the detection limit near 1 MJup-Orbital eccentricities correlate positively with semimajor axes, even for planets beyond the tidal circularization zone within 0.1 AU, distinguishing planets from binary stars. The planet bearing stars are metal–rich relative to both nearby stars and to the Sun. Analogs of Solar System planets have not been detected to date as they require precision of 3 m s−1 maintained for more than a decade.
Molecular bands have been used as a diagnostic of spectral type since the 1860's. TiO was first identified as the dominant feature in optical spectra of cool giants in 1904 (Fowler 1904). Many diatomic molecules have now been included (e.g. Jørgensen & Larsson 1990) in detailed calculations of stellar opacity and attention is starting to focus on the incorporation of accurate data for triatomics. Triatomic molecules have a much greater density of states than diatomics; bending vibrational bands - generally lower in frequency than bond-stretching modes - may contribute considerably to “filling in” spectral gaps.
Psychological interventions may be beneficial in bipolar disorder.
To evaluate the efficacy of psychological interventions for adults with
A systematic review of randomised controlled trials was conducted.
Outcomes were meta-analysed using RevMan and confidence assessed using
the GRADE method.
We included 55 trials with 6010 participants. Moderate-quality evidence
associated individual psychological interventions with reduced relapses
at post-treatment (risk ratio (RR) = 0.66, 95% CI 0.48–0.92) and
follow-up (RR = 0.74, 95% CI 0.63–0.87), and collaborative care with a
reduction in hospital admissions (RR =0.68, 95% CI 0.49–0.94).
Low-quality evidence associated group interventions with fewer depression
relapses at post-treatment and follow-up, and family psychoeducation with
reduced symptoms of depression and mania.
There is evidence that psychological interventions are effective for
people with bipolar disorder. Much of the evidence was of low or very low
quality thereby limiting our conclusions. Further research should
identify the most effective (and cost-effective) interventions for each
phase of this disorder.
This article explores the changing relationship between paupers and the parish authorities in Tongue, in the far north of Scotland, between the passing of the Scottish New Poor Law in 1845 and the end of the nineteenth century. It does so by focusing on Scottish pauper letters and petitions for relief. Such sources, though relatively abundant in the archives, have so far been ignored by welfare historians. The article begins with a discussion of the trials of Tongue's poor crofting community in the early years of the century, the impact of widespread land clearance, and the dislocation of long-established communities. Following on from this, through a close reading of pauper appeals alongside other official sources the authors demonstrate that, despite persistent hardship and inadequate resources, the relationship between paupers and the parish authorities changed markedly over the period. An attitude of supplication and entreaty, rooted in Highland traditions of deference and reflective of a rigid social hierarchy, gave way to a clear sense of entitlement and an expectation that paupers' appeals would—indeed, must—be heard toward the end of the century. This fundamental shift mirrored, and was profoundly influenced by, wider agitation among crofting communities for change.
One of the highest priority invasive species at both Yosemite and Sequoia and Kings Canyon national parks is Holcus lanatus L. (common velvetgrass), a perennial bunchgrass that invades mid-elevation montane meadows. Despite velvetgrass being a high priority species, there is little information available on control techniques. The goal of this project was to evaluate the short-term response of a single application of common chemical and manual velvetgrass control techniques. The study was conducted at three montane sites in Yosemite National Park. Glyphosate spot-spray treatments were applied at 0.5, 1.0, 1.5, and 2.0% concentrations, and compared with hand pulling to evaluate effects on cover of common velvetgrass, cover of other plant species, and community species richness. Posttreatment year 1 cover of common velvetgrass was 12.1% ± 1.6 in control plots, 6.3% ± 1.5 averaged over the four chemical treatments (all chemical treatments performed similarly), and 13.6% ± 1.7 for handpulled plots. This represents an approximately 50% reduction in common velvetgrass cover in chemically- treated plots recoded posttreatment year 1 and no statistically significant reduction in hand pulled plots compared with controls. However, there was no treatment effect in posttreatment year 2, and all herbicide application rates performed similarly. In addition, there were no significant treatment effects on nontarget species or species richness. These results suggest that for this level of infestation and habitat type, (1) one year of hand pulling is not an effective control method and (2) glyphosate provides some level of control in the short-term without impact to nontarget plant species, but the effect is temporary as a single year of glyphosate treatment is ineffective over a two-year period.
Standard estimates of the impact of Clostridium difficile infections (CDI) on inpatient lengths of stay (LOS) may overstate inpatient care costs attributable to CDI. In this study, we used multistate modeling (MSM) of CDI timing to reduce bias in estimates of excess LOS.
A retrospective cohort study of all hospitalizations at any of 120 acute care facilities within the US Department of Veterans Affairs (VA) between 2005 and 2012 was conducted. We estimated the excess LOS attributable to CDI using an MSM to address time-dependent bias. Bootstrapping was used to generate 95% confidence intervals (CI). These estimates were compared to unadjusted differences in mean LOS for hospitalizations with and without CDI.
During the study period, there were 3.96 million hospitalizations and 43,540 CDIs. A comparison of unadjusted means suggested an excess LOS of 14.0 days (19.4 vs 5.4 days). In contrast, the MSM estimated an attributable LOS of only 2.27 days (95% CI, 2.14–2.40). The excess LOS for mild-to-moderate CDI was 0.75 days (95% CI, 0.59–0.89), and for severe CDI, it was 4.11 days (95% CI, 3.90–4.32). Substantial variation across the Veteran Integrated Services Networks (VISN) was observed.
CDI significantly contributes to LOS, but the magnitude of its estimated impact is smaller when methods are used that account for the time-varying nature of infection. The greatest impact on LOS occurred among patients with severe CDI. Significant geographic variability was observed. MSM is a useful tool for obtaining more accurate estimates of the inpatient care costs of CDI.
Infect. Control Hosp. Epidemiol. 2015;36(9):1024–1030
Despite evidence for the effectiveness of structured psychological
therapies for bipolar disorder no psychological interventions have been
specifically designed to enhance personal recovery for individuals with
recent-onset bipolar disorder.
A pilot study to assess the feasibility and effectiveness of a new
intervention, recovery-focused cognitive–behavioural therapy (CBT),
designed in collaboration with individuals with recent-onset bipolar
disorder intended to improve clinical and personal recovery outcomes.
A single, blind randomised controlled trial compared treatment as usual
(TAU) with recovery-focused CBT plus TAU (n = 67).
Recruitment and follow-up rates within 10% of pre-planned targets to
12-month follow-up were achieved. An average of 14.15 h (s.d. = 4.21) of
recovery-focused CBT were attended out of a potential maximum of 18 h.
Compared with TAU, recovery-focused CBT significantly improved personal
recovery up to 12-month follow-up (Bipolar Recovery Questionnaire mean
score 310.87, 95% CI 75.00–546.74 (s.e. = 120.34), P =
0.010, d=0.62) and increased time to any mood relapse
during up to 15 months follow-up (χ2 = 7.64,
P<0.006, estimated hazard ratio (HR) = 0.38, 95%
CI 0.18–0.78). Groups did not differ with respect to medication
Recovery-focused CBT seems promising with respect to feasibility and
potential clinical effectiveness. Clinical- and cost-effectiveness now
need to be reliably estimated in a definitive trial.
The straw itch mite, Pyemotes tritici Lagrèze-Fossat and Montané (Acari: Pyemotidae), was discovered parasitising the goldspotted oak borer, Agrilus auroguttatus Schaeffer (Coleoptera: Buprestidae), an invasive exotic species to California, United States of America, and the Mexican goldspotted oak borer, Agrilus coxalis Waterhouse (Coleoptera: Buprestidae), during surveys for natural enemies for a classical biological control programme for A. auroguttatus. Pyemotes tritici caused low levels of mortality to each species of flatheaded borer, but it will likely not be a good candidate for a biological control programme because it is a generalist parasitoid with deleterious human health effects.