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Estimates of the incubation period for Q fever vary substantially between different reviews and expert advice documents. We systematically reviewed and quality appraised the literature to provide an evidence-based estimate of the incubation period of the Q fever by the aerosolised infection route. Medline (OVIDSP) and EMBASE were searched with the search limited to human studies and English language. Eligible studies included persons with symptomatic, acute Q fever, and defined exposure to Coxiella burnetti. After review of 7115 titles and abstracts, 320 records were screened at full-text level. Of these, 23 studies contained potentially useful data and were quality assessed, with eight studies (with 403 individual cases where the derivation of incubation period was possible) being of sufficient quality and providing individual-level data to produce a pooled summary. We found a median incubation period of 18 days, with 95% of cases expected to occur between 7 and 32 days after exposure.
In recent papers, we show how accretion disks around massive black holes could act as dynamos producing magnetic jets similar to the jets that create spheromaks in the laboratory. In this paper, we discuss how these magnetic astrophysical jets might naturally produce runaway ion beams accelerated to
eV or more, finally ejected as ultra high energy cosmic rays (UHECRs) long regarded as one of the mysteries of astrophysics. The acceleration is mainly due to the drift cyclotron loss cone kinetic instability known from plasma research. Experiments and simulations are suggested to verify the acceleration process.
Plasma free energy is that part of the total energy that feeds the growth of turbulence. The most successful free energy formulation in plasma physics is the MHD Energy Principle – successful because, within magnetohydrodynamics (MHD), the free energy
is both exact and self-adjoint (or Hermitian). A corresponding result in Vlasov theory is the free energy of equilibria neighbouring stable Maxwellian states – again giving a free energy of Hermitian form for the linearized equations. Since quantum mechanics is inherently Hermitian, here I speculate that quantum free energy is the ultimate way to understand classical plasma dynamics.
Research was conducted from 2011 to 2014 to determine weed population
dynamics and frequency of glyphosate-resistant (GR) Palmer amaranth with
herbicide programs consisting of glyphosate, dicamba, and residual
herbicides in dicamba-tolerant cotton. Five treatments were maintained in
the same plots over the duration of the experiment: three sequential POST
applications of glyphosate with or without pendimethalin plus diuron PRE;
three sequential POST applications of glyphosate plus dicamba with and
without the PRE herbicides; and a POST application of glyphosate plus
dicamba plus acetochlor followed by one or two POST applications of
glyphosate plus dicamba without PRE herbicides. Additional treatments
included alternating years with three sequential POST applications of
glyphosate only and glyphosate plus dicamba POST with and without PRE
herbicides. The greatest population of Palmer amaranth was observed when
glyphosate was the only POST herbicide throughout the experiment. Although
diuron plus pendimethalin PRE in a program with only glyphosate POST
improved control during the first 2 yr, these herbicides were ineffective by
the final 2 yr on the basis of weed counts from soil cores. The lowest
population of Palmer amaranth was observed when glyphosate plus dicamba were
applied regardless of PRE herbicides or inclusion of acetochlor POST.
Frequency of GR Palmer amaranth was 8% or less when the experiment was
initiated. Frequency of GR Palmer amaranth varied by herbicide program
during 2012 but was similar among all herbicide programs in 2013 and 2014.
Similar frequency of GR Palmer amaranth across all treatments at the end of
the experiment most likely resulted from pollen movement from Palmer
amaranth treated with glyphosate only to any surviving female plants
regardless of PRE or POST treatment. These data suggest that GR Palmer
amaranth can be controlled by dicamba and that dicamba is an effective
alternative mode of action to glyphosate in fields where GR Palmer amaranth
To describe the epidemiology of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP) infections
Inpatient care at community hospitals
All patients with ESBL-EC or ESBL-KP infections
ESBL-EC and ESBL-KP infections from 26 community hospitals were prospectively entered into a centralized database from January 2009 to December 2014.
A total of 925 infections caused by ESBL-EC (10.5 infections per 100,000 patient days) and 463 infections caused by ESBL-KP (5.3 infections per 100,000 patient days) were identified during 8,791,243 patient days of surveillance. The incidence of ESBL-EC infections increased from 5.28 to 10.5 patients per 100,000 patient days during the study period (P=.006). The number of community hospitals with ESBL-EC infections increased from 17 (65%) in 2009 to 20 (77%) in 2014. The median ESBL-EC infection rates among individual hospitals with ≥1 ESBL-EC infection increased from 11.1 infections/100,000 patient days (range, 2.2–33.9 days) in 2009 to 22.1 infections per 100,000 patient days (range, 0.66–134 days) in 2014 (P=.05). The incidence of ESBL-KP infections remained constant over the study period (P=.14). Community-associated and healthcare-associated ESBL-EC infections trended upward (P=.006 and P=.02, respectively), while hospital-onset infections remained stable (P=.07). ESBL-EC infections were more common in females (54% vs 44%, P<.001) and Caucasians (50% vs 40%, P<.0001), and were more likely to be isolated from the urinary tract (61% vs 52%, P<.0001) than ESBL-KP infections.
The incidence of ESBL-EC infection has increased in community hospitals throughout the southeastern United States, while the incidence of ESBL-KP infection has remained stable. Community- and healthcare-associated ESBL-EC infections are driving the upward trend.
In November 2013, national public health agencies in England and Scotland identified an increase in laboratory-confirmed Salmonella Mikawasima. The role of proton pump inhibitors (PPIs) as a risk factor for salmonellosis is unclear; we therefore captured information on PPI usage as part of our outbreak investigation. We conducted a case-control study, comparing each case with two controls. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression. Thirty-nine of 61 eligible cases were included in the study. The median age of cases was 45 years; 56% were female. Of these, 33% were admitted to hospital and 31% reported taking PPIs. We identified an association between PPIs and non-typhoidal salmonellosis (aOR 8·8, 95% CI 2·0–38·3). There is increasing evidence supporting the existence of an association between salmonellosis and PPIs; however, biological studies are needed to understand the effect of PPIs in the pathogenesis of Salmonella. We recommend future outbreak studies investigate PPI usage to strengthen evidence on the relevance of PPIs in Salmonella infection. These findings should be used to support the development of guidelines for patients and prescribers on the risk of gastrointestinal infection and PPI usage.
Large numbers of evacuees arrived in Dallas, Texas, from Hurricanes Katrina and Rita just 3 weeks apart in 2005 and from Hurricanes Gustav and Ike just 3 weeks apart again in 2008. The Dallas community needed to locate, organize, and manage the response to provide shelter and health care with locally available resources. With each successive hurricane, disaster response leaders applied many lessons learned from prior operations to become more efficient and effective in the provision of services. Mental health services proved to be an essential component. From these experiences, a set of operating guidelines for large evacuee shelter mental health services in Dallas was developed, with involvement of key stakeholders. A generic description of the processes and procedures used in Dallas that highlights the important concepts, key considerations, and organizational steps was then created for potential adaptation by other communities. (Disaster Med Public Health Preparedness. 2015;9:423–429)
(See the commentary by Pfeiffer and Beldavs, on pages 984–986.)
Describe the epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) and examine the effect of lower carbapenem breakpoints on CRE detection.
Inpatient care at community hospitals.
All patients with CRE-positive cultures were included.
CRE isolated from 25 community hospitals were prospectively entered into a centralized database from January 2008 through December 2012. Microbiology laboratory practices were assessed using questionnaires.
A total of 305 CRE isolates were detected at 16 hospitals (64%). Patients with CRE had symptomatic infection in 180 cases (59%) and asymptomatic colonization in the remainder (125 cases; 41%). Klebsiella pneumoniae (277 isolates; 91%) was the most prevalent species. The majority of cases were healthcare associated (288 cases; 94%). The rate of CRE detection increased more than fivefold from 2008 (0.26 cases per 100,000 patient-days) to 2012 (1.4 cases per 100,000 patient-days; incidence rate ratio (IRR), 5.3 [95% confidence interval (CI), 1.22–22.7]; P = .01). Only 5 hospitals (20%) had adopted the 2010 Clinical and Laboratory Standards Institute (CLSI) carbapenem breakpoints. The 5 hospitals that adopted the lower carbapenem breakpoints were more likely to detect CRE after implementation of breakpoints than before (4.1 vs 0.5 cases per 100,000 patient-days; P < .001; IRR, 8.1 [95% CI, 2.7–24.6]). Hospitals that implemented the lower carbapenem breakpoints were more likely to detect CRE than were hospitals that did not (3.3 vs 1.1 cases per 100,000 patient-days; P = .01).
The rate of CRE detection increased fivefold in community hospitals in the southeastern United States from 2008 to 2012. Despite this, our estimates are likely underestimates of the true rate of CRE detection, given the low adoption of the carbapenem breakpoints recommended in the 2010 CLSI guidelines.
Intrauterine factors important for cognitive development, such as birth weight, chorionicity and umbilical cord characteristics were investigated. A total of 663 twin pairs completed the Wechsler Intelligence Scale for Children-Revised and scores were available for Performance, Verbal and Total Intelligence Quotient (IQ). The intrauterine factors examined were birth weight, placental weight and morphology, cord knots, cord length and cord insertion. IQ scores for the varying levels of the intrauterine markers adjusting for gender and gestational age were calculated. The heritability of IQ and the association between IQ and intrauterine environment were examined. Twins with lower birth weight and cord knots had lower IQ scores. The aetiology of IQ is largely distinct from that of birth weight and cord knots, and non-shared environment may influence the observed relationships.
This two-volume work comprises a fourteenth-century cartulary containing charters and deeds that document the history of Selby Abbey from its foundation under William the Conqueror in 1069 until the mid-fifteenth century. The editor, J. T. Fowler (1834–1924), originally a surgeon, left medicine for the church. He studied at Durham University before becoming a deacon in the Durham diocese and holding posts in the university itself. The contents of the cartulary are divided across the two volumes, originally published between 1891 and 1893, and Fowler has aimed to reproduce the Latin text as closely as possible, noting any errors in occasional footnotes. Volume 1 includes the Historia Selebiensis monasterii, a history of Selby written in 1174 by an anonymous Selby monk. Fowler's version is reprinted from an imperfect 1657 edition by the Jesuit historian Philippe Labbe and does not attempt to correct the errors found in that version.