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Haematopoietic stem cell transplantation is an important and effective treatment strategy for many malignancies, marrow failure syndromes, and immunodeficiencies in children, adolescents, and young adults. Despite advances in supportive care, patients undergoing transplant are at increased risk to develop cardiovascular co-morbidities.
This study was performed as a feasibility study of a rapid cardiac MRI protocol to substitute for echocardiography in the assessment of left ventricular size and function, pericardial effusion, and right ventricular hypertension.
A total of 13 patients were enrolled for the study (age 17.5 ± 7.7 years, 77% male, 77% white). Mean study time was 13.2 ± 5.6 minutes for MRI and 18.8 ± 5.7 minutes for echocardiogram (p = 0.064). Correlation between left ventricular ejection fraction by MRI and echocardiogram was good (ICC 0.76; 95% CI 0.47, 0.92). None of the patients had documented right ventricular hypertension. Patients were given a survey regarding their experiences, with the majority both perceiving that the echocardiogram took longer (7/13) and indicating they would prefer the MRI if given a choice (10/13).
A rapid cardiac MRI protocol was shown feasible to substitute for echocardiogram in the assessment of key factors prior to or in follow-up after haematopoietic stem cell transplantation.
Social cognitive deficits can have many negative consequences, spanning social withdrawal to psychopathology. Prior work has shown that child maltreatment may associate with poorer social cognitive skills in later life. However, no studies have examined this association from early childhood into adolescence. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC; n = 4,438), we examined the association between maltreatment (caregiver physical or emotional abuse; sexual or physical abuse), assessed repeatedly (every 1–3 years) from birth to age 9, and social cognitive skills at ages 7.5, 10.5, and 14 years. We evaluated the role of both the developmental timing (defined by age at exposure) and accumulation of maltreatment (defined as the number of occasions exposed) using a least angle regression variable selection procedure, followed by structural equation modeling. Among females, accumulation of maltreatment explained the most variation in social cognitive skills. For males, no significant associations were found. These findings underscore the importance of early intervention to minimize the accumulation of maltreatment and showcase the importance of prospective studies to understand the development of social cognition over time.
Engelmann spruce, Picea engelmannii Parry ex Engelm. (Pinaceae), in the southern Rocky Mountains is composed of two distinct phloem monoterpene chemotypes that differ in relative abundances of multiple monoterpenes, particularly α-pinene and Δ3-carene (hereafter, the “α-pinene chemotype” and the “Δ3-carene chemotype”). Here, relative toxicity of these chemotypes is tested on spruce beetle (Dendroctonus rufipennis Kirby) (Coleoptera: Scolytinae), a phloeophagous herbivore that colonises trees of both types. Synthetic monoterpene blends representing each chemotype were tested across a range of concentrations (0, 10, 50, 100, 200, and 500 µg/L) in the lab, and probability of survival of adult beetles exposed to each blend was modelled using a logit function. Logit curves were solved to determine LC25, LC50, and LC75 of each monoterpene blend. On average, probability of beetle survival was lower when exposed to the Δ3-carene chemotype than when exposed to the α-pinene chemotype. However, both chemotypes were completely lethal to beetles at concentrations exceeding 100 µg/L. Adult body mass did not affect survival probability. It is concluded that spruce phloem chemotypes may differ in their toxicity to spruce beetles, with potential consequences for patterns of host-tree colonisation by spruce beetle.
A thorough understanding of commonly used herbicide application practices and technologies is needed to provide recommendations and determine necessary application education efforts. An online survey to assess ground and aerial herbicide application practices in Arkansas was made available online in spring 2019. The survey was direct-emailed to 272 agricultural aviators and 831 certified commercial pesticide applicators, as well as made publicly available online through multiple media sources. A total of 124 responses were received, of which 75 responses were specific to herbicide applications in Arkansas agronomic crops, accounting for approximately 49% of Arkansas’ planted agronomic crop hectares in 2019. Ground and aerial application equipment were used for 49% and 51% of the herbicide applications on reported hectares, respectively. Rate controllers were commonly used application technologies for both ground and aerial application equipment. In contrast, global positioning system-driven automatic nozzle and boom shut-offs were much more common on ground spray equipment than aerial equipment. Applicator knowledge of nozzles and usage was limited, regardless of ground or aerial applicators, as only 28% of respondents provided a specific nozzle type used, indicating a need for educational efforts on nozzles and their importance in herbicide applications. Of the reported nozzle types, venturi nozzles and straight-stream nozzles were the most commonly used for ground and aerial spray equipment, respectively. Spray carrier volumes of 96.3 and 118.8 L ha−1 for ground spray equipment and 49.6 and 59.9 L ha−1 for aerial application equipment were the means of reported spray volumes for systemic and contact herbicides, respectively. Respondents indicated application optimization was a major benefit of utilizing newer application technologies, herbicide drift was a primary challenge, and research needs expressed by respondents included adjuvants, spray volume efficacy, and herbicide drift. Findings from this survey provided insight into current practices, technologies, and needs of Arkansas herbicide applicators. Research and education efforts can be implemented as a result to address aforementioned needs while providing applied research-based information to applicators based on current practices.
Prescribing metrics, cost, and surrogate markers are often used to describe the value of antimicrobial stewardship (AMS) programs. However, process measures are only indirectly related to clinical outcomes and may not represent the total effect of an intervention. We determined the global impact of a multifaceted AMS initiative for hospitalized adults with common infections.
Single center, quasi-experimental study.
Hospitalized adults with urinary, skin, and respiratory tract infections discharged from family medicine and internal medicine wards before (January 2017–June 2017) and after (January 2018–June 2018) an AMS initiative on a family medicine ward were included. A series of AMS-focused initiatives comprised the development and dissemination of: handheld prescribing tools, AMS positive feedback cases, and academic modules. We compared the effect on an ordinal end point consisting of clinical resolution, adverse drug events, and antimicrobial optimization between the preintervention and postintervention periods.
In total, 256 subjects were included before and after an AMS intervention. Excessive durations of therapy were reduced from 40.3% to 22% (P < .001). Patients without an optimized antimicrobial course were more likely to experience clinical failure (OR, 2.35; 95% CI, 1.17–4.72). The likelihood of a better global outcome was greater in the family medicine intervention arm (62.0%, 95% CI, 59.6–67.1) than in the preintervention family medicine arm.
Collaborative, targeted feedback with prescribing metrics, AMS cases, and education improved global outcomes for hospitalized adults on a family medicine ward.
This study provides a morphological and phylogenetic characterization of two novel species of the order Haplosporida (Haplosporidium carcini n. sp., and H. cranc n. sp.) infecting the common shore crab Carcinus maenas collected at one location in Swansea Bay, South Wales, UK. Both parasites were observed in the haemolymph, gills and hepatopancreas. The prevalence of clinical infections (i.e. parasites seen directly in fresh haemolymph preparations) was low, at ~1%, whereas subclinical levels, detected by polymerase chain reaction, were slightly higher at ~2%. Although no spores were found in any of the infected crabs examined histologically (n = 334), the morphology of monokaryotic and dikaryotic unicellular stages of the parasites enabled differentiation between the two new species. Phylogenetic analyses of the new species based on the small subunit (SSU) rDNA gene placed H. cranc in a clade of otherwise uncharacterized environmental sequences from marine samples, and H. carcini in a clade with other crustacean-associated lineages.
The social model of disability was implemented in the United States partially through the Americans with Disabilities Act (ADA), and most notably through certain universal accommodations for physical disabilities. The social model has also been applied to mental health, but the ADA did not provide for universal accommodations in mental health. In this Chapter, the authors conduct a systematic review of PubMed and PsycARTICLES to identify evidence for potential universal accommodations in mental health and discuss the policy and ethical considerations of implementing universal accommodations in mental health.
Williams syndrome is a multisystem, congenital disorder which is commonly associated with arterial stenoses: supravalvar aortic stenosis and peripheral pulmonary artery stenosis. Venous abnormalities have not been previously reported in children with Williams syndrome. We present a case of a 3-year-old girl with Williams syndrome and diffuse venous ectasia as detected by MRI.
Patients often have very different ideas from clinicians about what they want treatments to achieve. Their views on what outcomes are important are not always reflected in trials.
To elicit the views of people who self-harm on the most commonly used outcome measures and to identify the outcomes that matter to them.
We conducted in-depth interviews with 18 people with histories of self-harm, recruited from hospital and community settings. We conducted thematic analysis using a framework approach and used visual mapping to arrive at our final analysis and interpretation.
Participants' accounts contained a number of challenges to the validity and meaningfulness of current trial outcome measures. Five broad issues emerged: (a) relationship between frequency and severity of self-harm; (b) behavioural substitution; (b) self-management skills; (d) the role of self-harm as survival tool and affect regulator, and (e) strategic self-presentation. We show how these affect the visibility and measurability of commonly used outcomes. The outcomes that mattered to participants focused on positive achievements in three domains: (a) general functioning and activities of everyday living; (b) social participation, and (c) engagement with services. Participants conceptualised these as both measures and means of sustained improvement.
Our findings suggest that current self-harm trial science rests on flawed assumptions about the relationship between mental states and behaviours and about our ability to measure both. Greater understanding of the outcomes that matter to people who self-harm is needed to inform both intervention development and trial design.
In 2018, the Alliance for Open Media (AOMedia) finalized its first video compression format AV1, which is jointly developed by the industry consortium of leading video technology companies. The main goal of AV1 is to provide an open source and royalty-free video coding format that substantially outperforms state-of-the-art codecs available on the market in compression efficiency while remaining practical decoding complexity as well as being optimized for hardware feasibility and scalability on modern devices. To give detailed insights into how the targeted performance and feasibility is realized, this paper provides a technical overview of key coding techniques in AV1. Besides, the coding performance gains are validated by video compression tests performed with the libaom AV1 encoder against the libvpx VP9 encoder. Preliminary comparison with two leading HEVC encoders, x265 and HM, and the reference software of VVC is also conducted on AOM's common test set and an open 4k set.
To develop and validate the Discrepancy-based Evidence for Loss of Thinking Abilities (DELTA) score. The DELTA score characterizes the strength of evidence for cognitive decline on a continuous spectrum using well-established psychometric principles for improving detection of cognitive changes.
DELTA score development used neuropsychological test scores from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort (two tests each from Memory, Executive Function, and Language domains). We derived regression-based normative reference scores using age, gender, years of education, and word-reading ability from robust cognitively normal ADNI participants. Discrepancies between predicted and observed scores were used for calculating the DELTA score (range 0–15). We validated DELTA scores primarily against longitudinal Clinical Dementia Rating-Sum of Boxes (CDR-SOB) and Functional Activities Questionnaire (FAQ) scores (baseline assessment through Year 3) using linear mixed models and secondarily against cross-sectional Alzheimer’s biomarkers.
There were 1359 ADNI participants with calculable baseline DELTA scores (age 73.7 ± 7.1 years, 55.4% female, 100% white/Caucasian). Higher baseline DELTA scores (stronger evidence of cognitive decline) predicted higher baseline CDR-SOB (ΔR2 = .318) and faster rates of CDR-SOB increase over time (ΔR2 = .209). Longitudinal changes in DELTA scores tracked closely and in the same direction as CDR-SOB scores (fixed and random effects of mean + mean-centered DELTA, ΔR2 > .7). Results were similar for FAQ scores. High DELTA scores predicted higher PET-Aβ SUVr (ρ = 324), higher CSF-pTau/CSF-Aβ ratio (ρ = .460), and demonstrated PPV > .9 for positive Alzheimer’s disease biomarker classification.
Data support initial development and validation of the DELTA score through its associations with longitudinal functional changes and Alzheimer’s biomarkers. We provide several considerations for future research and include an automated scoring program for clinical use.
Comparisons of antipsychotics with placebo can be biased by unblinding due to side effects. Therefore, this meta-analysis compared the efficacy of antipsychotics for acute schizophrenia in trials using barbiturates or benzodiazepines as active placebos.
Randomized controlled trials (RCTs) in acute schizophrenia with at least 3 weeks duration and comparing any antipsychotic with barbiturates or benzodiazepines were eligible. ClinicalTrials.gov, CENTRAL, EMBASE, MEDLINE, PsycINFO, PubMed, WHO-ICTRP as well as previous reviews were searched up to 9 January 2018. Two separate meta-analyses, one for barbiturates and one for benzodiazepines, were conducted using random-effects models. The primary outcome was response to treatment, and mean values of schizophrenia rating scales and dropouts were analyzed as secondary outcomes. This study is registered with PROSPERO (CRD42018086263).
Seven barbiturate-RCTs (number of participants n = 1736), and two benzodiazepine-RCTs (n = 76) were included in the analysis. The studies were published between 1960 and 1968 and involved mainly chronically ill patients. More patients on antipsychotics in comparison to barbiturates achieved a ‘good’ response (36.2% v. 16.8%; RR 2.15; 95% CI 1.36–3.41; I2 = 48.9) and ‘any’ response (57.4% v. 27.8%; RR 2.07; 95% CI 1.35–3.18; I2 = 68.2). In a single small trial (n = 60), there was no difference between antipsychotics and benzodiazepines on ‘any’ response (74.7% v. 65%; RR 1.15; 95% CI 0.82–1.62).
Antipsychotic drugs were more efficacious than barbiturates, based on a large sample size. Response ratios were similar to those observed in placebo-controlled trials. The results on benzodiazepines were inconclusive due to the small number of studies and participants.
Although there has been widespread attention to the apparent rise of a transnational society of cross-border non-state actors alongside the international society of states, transnational society and international society have traditionally been treated as distinctive domains with different institutions. This article, by contrast, aims to transform theorization of world order through its investigation of how actors in transnational society have developed institutions that mirror in notable respects some of the primary institutions of the international society of states such as through serving constitutive and regulative functions. In addition to delineating these institutions of transnational society, the article interrogates the interdependence of these institutions of transnational society and those of international society, as well as their differences and repercussions for world order. The analysis considers how, in conjunction with the contribution of institutions of international society to international order, institutions of transnational society contribute to transnational order. By exploring not only the tensions between but also the complementarities of transnational and interstate institutions, the article both provides a reinterpretation of contemporary world order and helps reveal the potential for its more harmonious operation.