To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Several hypotheses may explain the association between substance use, posttraumatic stress disorder (PTSD), and depression. However, few studies have utilized a large multisite dataset to understand this complex relationship. Our study assessed the relationship between alcohol and cannabis use trajectories and PTSD and depression symptoms across 3 months in recently trauma-exposed civilians.
In total, 1618 (1037 female) participants provided self-report data on past 30-day alcohol and cannabis use and PTSD and depression symptoms during their emergency department (baseline) visit. We reassessed participant's substance use and clinical symptoms 2, 8, and 12 weeks posttrauma. Latent class mixture modeling determined alcohol and cannabis use trajectories in the sample. Changes in PTSD and depression symptoms were assessed across alcohol and cannabis use trajectories via a mixed-model repeated-measures analysis of variance.
Three trajectory classes (low, high, increasing use) provided the best model fit for alcohol and cannabis use. The low alcohol use class exhibited lower PTSD symptoms at baseline than the high use class; the low cannabis use class exhibited lower PTSD and depression symptoms at baseline than the high and increasing use classes; these symptoms greatly increased at week 8 and declined at week 12. Participants who already use alcohol and cannabis exhibited greater PTSD and depression symptoms at baseline that increased at week 8 with a decrease in symptoms at week 12.
Our findings suggest that alcohol and cannabis use trajectories are associated with the intensity of posttrauma psychopathology. These findings could potentially inform the timing of therapeutic strategies.
To estimate the incidence, duration and risk factors for diagnostic delays associated with pertussis.
We used longitudinal retrospective insurance claims from the Marketscan Commercial Claims and Encounters, Medicare Supplemental (2001–2020), and Multi-State Medicaid (2014–2018) databases.
Inpatient, emergency department, and outpatient visits.
The study included patients diagnosed with pertussis (International Classification of Diseases [ICD] codes) and receipt of macrolide antibiotic treatment.
We estimated the number of visits with pertussis-related symptoms before diagnosis beyond that expected in the absence of diagnostic delays. Using a bootstrapping approach, we estimated the number of visits representing a delay, the number of missed diagnostic opportunities per patient, and the duration of delays. Results were stratified by age groups. We also used a logistic regression model to evaluate potential factors associated with delay.
We identified 20,828 patients meeting inclusion criteria. On average, patients had almost 2 missed opportunities prior to diagnosis, and delay duration was 12 days. Across age groups, the percentage of patients experiencing a delay ranged from 29.7% to 37.6%. The duration of delays increased considerably with age from an average of 5.6 days for patients aged <2 years to 13.8 days for patients aged ≥18 years. Factors associated with increased risk of delays included emergency department visits, telehealth visits, and recent prescriptions for antibiotics not effective against pertussis.
Diagnostic delays for pertussis are frequent. More work is needed to decrease diagnostic delays, especially among adults. Earlier case identification may play an important role in the response to outbreaks by facilitating treatment, isolation, and improved contact tracing.
It has previously been reported that in ex vivo planar explants prepared from Xenopus laevis embryos, the intracellular pH (pHi) increases in cells of the dorsal ectoderm from stage 10.5 to 11.5 (i.e. 11–12.5 hpf). It was proposed that such increases (potentially due to H+ being extruded, sequestered, or buffered in some manner), play a role in regulating neural induction. Here, we used an extracellular ion-selective electrode to non-invasively measure H+ fluxes at eight locations around the equatorial circumference of intact X. laevis embryos between stages 9–12 (˜7–13.25 hpf). We showed that at stages 9–11, there was a small H+ efflux recorded from all the measuring positions. At stage 12 there was a small, but significant, increase in the efflux of H+ from most locations, but the efflux from the dorsal side of the embryo was significantly greater than from the other positions. Embryos were also treated from stages 9–12 with bafilomycin A1, to block the activity of the ATP-driven H+ pump. By stage 22 (24 hpf), these embryos displayed retarded development, arresting before the end of gastrulation and therefore did not display the usual anterior and neural structures, which were observed in the solvent-control embryos. In addition, expression of the early neural gene, Zic3, was absent in treated embryos compared with the solvent controls. Together, our new in vivo data corroborated and extended the earlier explant-derived report describing changes in pHi that were suggested to play a role during neural induction in X. laevis embryos.
Background: Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, California (SHIELD OC) was a CDC-funded regional decolonization intervention from April 2017 through July 2019 involving 38 hospitals, nursing homes (NHs), and long-term acute-care hospitals (LTACHs) to reduce MDROs. Decolonization in NH and LTACHs consisted of universal antiseptic bathing with chlorhexidine (CHG) for routine bathing and showering plus nasal iodophor decolonization (Monday through Friday, twice daily every other week). Hospitals used universal CHG in ICUs and provided daily CHG and nasal iodophor to patients in contact precautions. We sought to evaluate whether decolonization reduced hospitalization and associated healthcare costs due to infections among residents of NHs participating in SHIELD compared to nonparticipating NHs. Methods: Medicaid insurer data covering NH residents in Orange County were used to calculate hospitalization rates due to a primary diagnosis of infection (counts per member quarter), hospital bed days/member-quarter, and expenditures/member quarter from the fourth quarter of 2015 to the second quarter of 2019. We used a time-series design and a segmented regression analysis to evaluate changes attributable to the SHIELD OC intervention among participating and nonparticipating NHs. Results: Across the SHIELD OC intervention period, intervention NHs experienced a 44% decrease in hospitalization rates, a 43% decrease in hospital bed days, and a 53% decrease in Medicaid expenditures when comparing the last quarter of the intervention to the baseline period (Fig. 1). These data translated to a significant downward slope, with a reduction of 4% per quarter in hospital admissions due to infection (P < .001), a reduction of 7% per quarter in hospitalization days due to infection (P < .001), and a reduction of 9% per quarter in Medicaid expenditures (P = .019) per NH resident. Conclusions: The universal CHG bathing and nasal decolonization intervention adopted by NHs in the SHIELD OC collaborative resulted in large, meaningful reductions in hospitalization events, hospitalization days, and healthcare expenditures among Medicaid-insured NH residents. The findings led CalOptima, the Medicaid provider in Orange County, California, to launch an NH incentive program that provides dedicated training and covers the cost of CHG and nasal iodophor for OC NHs that enroll.
Disclosures: Gabrielle M. Gussin, University of California, Irvine, Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.
In several recently published phylogenetic analyses, two Lower Devonian taxa, Doliodus and Pucapampella, both fall on the chondrichthyan stem, very close to the base of ‘conventionally defined chondrichthyans’ (i.e., forms possessing tessellated mineralization of the cartilaginous endoskeleton). These two taxa nevertheless exhibit strongly discordant morphologies from each other. A summary of the anatomical data concerning these taxa is presented here, including new, as well as previously published, findings. A new family Pucapampellidae is erected, containing Pucapampella and a newly recognized genus from South Africa. Morphological evidence is summarized for the monophyly of crown elasmobranchs (sharks and rays), holocephalans (chimaeras) and other chondrichthyans. Based on these data, Doliodus and pucapampellids both fall outside the chondrichthyan crown, but their relative phylogenetic positions on the chondrichthyan stem are unclear. Pucapampellid interrelationships are particularly hard to assess because little is known beyond their cranial and visceral arch morphology and also because pucapampellids possess a suite of ontogenetically primitive (and thus potentially neotenic) features. By contrast, the phylogenetic position of Doliodus seems less elusive; it possessed an ‘acanthodian-like’ complex of dermal spines, including pectoral fin spines, prepectoral, admedian, and prepelvic spines, and possibly dorsal and pelvic fin spines, in conjunction with numerous ‘chondrichthyan-like’ endoskeletal features and a heterodont ‘sharklike’ dentition. Doliodus can be viewed as a quintessential component of the evolutionary transition between ‘acanthodians’ and ‘conventionally defined chondrichthyans’, leaving little doubt that the chondrichthyan total group includes ‘acanthodians’ (now widely perceived to be a paraphyletic group, populating the basal part of the chondrichthyan stem). Although Doliodus has been resolved as a basal member of the ‘conventionally defined chondrichthyans’, it could occupy a more basal position on the chondrichthyan stem.
Field experiments were conducted in 1983 and 1984 at two locations to determine the influence of various densities and durations of kochia interference in sunflower. Sunflower achene yield and dry weight were reduced by all densities of kochia, averaged over locations and years. Season-long competition by kochia densities of 0.3, 1, 3, and 6 plants/m of row decreased sunflower achene yield 7, 10, 20, and 27%, respectively. Sunflower achene yield and sunflower dry weight decreased as weeks of kochia competition increased. Only 2 weeks of kochia competition after sunflower emergence decreased sunflower achene yield 6%. Sunflower achene yield loss increased as the duration of kochia competition increased. Sunflower 200 achene weight, oil content, and plant height were not influenced by various densities or durations of kochia competition.
The critical weed-control period in field seeded cabbage using natural weed stands was 2 wk in 1988 and 4 wk in 1989. Regression analysis showed that the length of weed-free period, weed density, and ambient light reduction by competing weeds were factors affecting cabbage yield. Weeds that emerged after the initial weed-free period shaded the soil and subsequently lowered soil surface temperatures in 1989. Velvetleaf densities of 1.2 and 3.6 plants per m2 that competed all season with cabbage reduced cabbage yields 52% and 71% of the weed-free treatment in 1988 and 76% and 92% in 1989, respectively. Cabbage yields were reduced at all velvetleaf densities seeded 0, 1, and 2 wk after cabbage, but cabbage yield was not reduced when velvetleaf was seeded 4 or 6 wk after cabbage. Cabbage yield was not different between parallel and staggered velvetleaf configurations at 0.6 plants per m2, but was reduced with longer periods of competition. Velvetleaf seed production was prevented with 6 wk weed-free period after cabbage emergence and subsequent destruction of emerging velvetleaf after cabbage harvest.
A fossil assemblage containing molluscs, mammals, insects, ostracodes, and plants has been recovered from a silt-filled depression near Lima, in west-central Illinois. The reversed remanent magnetic signature of the sediments and the temporal ranges of two mammals, Microtus paroperarius and Lasiopodomys deceitensis, constrain the age of the assemblage to between 730,000 and 830,000 yr B.P. The extent of isoleucine epimerization in the molluscan shell is consistent with this age interpretation. The fauna includes at least 43 taxa of beetles from 11 families, 35 nominal species of molluscs, and two genera of ostracodes. The mammals include two shrews, three rodents, and a rabbit. The plant macrofossils (no pollen recovered) include 25 species of seed plants and four kinds of terrestrial or wetland mosses. Most of the plant species identified still occur in the upper Midwest, although a few of the taxa are found mainly to the north of the site. The fauna is characterized by an almost total absence of true aquatic taxa. The association of both boreal and thermophilous faunal and floral elements suggest that summer temperatures were not greatly different from present ones, but cooler, moist areas must have been available to support the boreal elements. Local conditions were probably similar to those now found in northeastern Iowa, where rains blocks, fissures, and joints in carbonate bedrock serve as traps for debris accumulations, provide shade, and are kept cool and moist during the hot summer months by cold-air drainage and groundwater seepage. Summer mean temperature in these microhabitats was probably between 18 and 20°C, similar to temperatures that now occur near the northern hardwood spruce-fir transition in the eastern United States.
The Lockport Gulf site near Lockport, New York, is a 1.9-m sequence of organic-rich marls having a basal date of approximately 10,920 yr B.P. Six bulk samples with a combined weight of 48 kg produced over 780 individual fossil insects representing five orders, as well as molluscs and abundant plant macrofossils. Coleoptera were represented by 24 families. Several major beetle groups (Carabidae, ground beetles; Hydrophilidae, water scavenger beetles; Elmidae, riffle beetles; Staphylinidae, rove beetles; and Scolytidae, bark beetles) indicate a riffle-and-pool stream, surrounded by marsh, with open riparian habitats and nearby trees. Two zones were recognized based on the Coleoptera assemblages. The Zone 1 fauna (ca. 10,920–9800 yr B.P.) was dominated by boreal forest taxa with abundant bark beetles indicating the presence of spruce trees. In Zone 2 (ca. 9700-9100 yr B.P.) the combination of species with a restricted modern distribution in the Great Lakes-St. Lawrence Forest region and pine and deciduous tree inhabitants suggests a change in vegetation by 9700 yr B.P. Thermal estimates from a faunal analysis indicate that the climatic conditions were stable across the spruce-pine transition, with the mean July temperature in the range of 16° to 18°C.
The Fernbank interglacial site, on the west side of Cayuga Lake, New York, has been recently subjected to more detailed study. To a lengthened mollusc list are added ostracodes, insects, fish, pollen, and plant macrofossils. Of these, plants are well preserved and diverse, whereas other groups are poorly preserved and incomplete. Nevertheless, all support the interglacial assignment (Sangamon), which is further supported by minimum age radiocarbon dates (>50,000 14C yr BP) and a TL date of 81 ± 11 ka. In the plant record near the top of the sequence, abundant tree charcoal indicates forest fires. Like the Toronto interglacial record, the plants show a declining July mean temperature from 24 to 18°C (according to transfer functions) through the sequence, from mixed deciduous forest to boreal forest.
This study aimed to examine the dietary glycaemic index (GI) and glycaemic load (GL) of Australian children and adolescents, as well as the major food groups contributing to GL, in the recent 2011–2012 Australian Health Survey. Plausible food intake data from 1876 children and adolescents (51 % boys), collected using a multiple-pass 24-h recall, were analysed. The GI of foods was assigned based on a step-wise published method using values from common GI databases. Descriptive statistics were calculated for dietary GI, GL and contribution to GL by food groups, stratified by age group and sex. Linear regression was used to test for trends across age groups for BMI, dietary GI and GL, and intakes of energy, nutrients and food groups. Pearson’s χ2 test was used to test for differences between age groups for categorical subject characteristic variables. Mean dietary GI and GL of participants were 55·5 (sd 5·3) and 137·4 (sd 50·8), respectively. The main contributors to dietary GL were starchy foods: breads, cereal-based dishes, breakfast cereals, flours, grains and potatoes accounted for 41 % of total GL. Sweetened beverages, fruit and vegetable juices/drinks, cake-type desserts and sweet biscuits contributed 15 %. No significant difference (at P<0·001) was observed between sexes. In conclusion, Australian children and adolescents appear to consume diets with a lower GI than European children. Exchanging high-GI foods for low-GI alternatives within core and non-core foods may improve diet quality of Australian children and adolescents.
The media shape both what people consider significant and how people think about key issues. This paper explored the cultural beliefs and stereotypes that underlie media portrayals of nursing homes. The analysis of texts of 157 articles about nursing homes published from 1999 to 2008 on the front pages of four major-market American newspapers (The New York Times, Chicago Tribune, Los Angeles Times and The Washington Post) was conducted using a qualitative approach inspired by comparative narrative and critical discourse analysis. Results suggest two major themes, each with several narrative components: (a) managing disposable lives (bodies outliving bank accounts; making frailty affordable; and the economics of triage); and (b) retaining purchasing power as successful ageing (consumption as a sign of market participation, spending money as an indicator of autonomy; and financial planning as preparation for future decline). Thus, the results indicate that nursing home residency in-and-of-itself is not a marker of unsuccessful ageing. This, instead, depends, in part, on the extent of choice available as a result of the level of financial solvency. This study shines light on the betwixt and between zone that distinguishes the Third and Fourth Ages; that is, independence versus dependence in old age. If individuals in a nursing home retain control over the management of their lives through the maintenance of financial independence, even if physically frail, association of nursing home residence with the Fourth Age may be ameliorated.