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Two independent temporal-spatial clusters of hospital-onset Rhizopus infections were evaluated using whole-genome sequencing (WGS). Phylogenetic analysis confirmed that isolates within each cluster were unrelated despite epidemiological suspicion of outbreaks. The ITS1 region alone was insufficient for accurate analysis. WGS has utility for rapid rule-out of suspected nosocomial Rhizopus outbreaks.
This paper explores the relationship between unionism and quits. Three channels of influence are investigated: unions-collective voice-quits; unions-training-quits; unions-job dissatisfaction-quits. Estimates of each model, using data from the Australian Longitudinal Survey, indicate that unions reduce the probability of quitting via the training effect by 0.5 percentage points, they reduce the probability of quitting via the collective voice effect by 4 percentage points and they increase the probability of quitting via the job dissatisfaction effect by 1.2 percentage points. The net effect of unions is, therefore, to reduce the probability of quitting by around 3 percentage points.
During the past decade—more precisely during the last five to seven years—the increased use of urban guerrilla warfare and terrorism have characterized the activities of many revolutionary groups in the less developed world. High-lighted by the olympic assassinations of 1972, this phenomenon has also been evident in various African and Asian states. It is in Latin America, however, that the change from the traditional rural base for guerrilla operations to an urban environment has been most pronounced. The years from 1962 to 1967 saw many Latin American insurgents copying the Cuban revolutionary model, with its emphasis on rural guerrilla operations and the peasantry as the ultimate motive force, but recent years have seen an equally strong pull toward either purely urban insurgency or a more balanced strategy according equal importance to both rural and urban activities. In either case, the identifiable shift away from a totally rural guerrilla strategy for most Latin American revolutionary groups seems an established fact.
Urban insurgency has been used with increasing frequency and effectiveness in many areas of the developed and less developed world during the past decade. In Latin America, this trend toward expanded urban guerrilla warfare has been most pronounced in Brazil, Uruguay, and Argentina. In the three nations, revolutionary forces have rejected completely the concept of the primacy of guerrilla activities based in the countryside, a theory adapted to the Latin American environment by Cuba's Ernesto “Che” Guevara and French Marxist Régis Debray. Instead, attention has been focused on organizing and developing guerrilla and terrorist operations in such population centers as Rio de Janeiro, São Paulo, Montevideo, Buenos Aires, Rosario, and Córdoba. (For a discussion of factors leading to the development of urban insurgency in Latin America see “The Urban Guerrilla in Latin America: A Select Bibliography,” LARR: 9: 1).
Gastropods are an important component of subtidal Antarctic communities including in common association with macroalgae. Nonetheless, limited data exist detailing their abundance and distribution on macroalgal species. This study documents the abundance and species composition of gastropod assemblages on the two largest, blade-forming Antarctic macroalgae, Himantothallus grandifolius and Sarcopeltis antarctica, sampled across two depths (9 and 18 m) at four sites for each species off Anvers Island, Antarctica. Gastropods were also enumerated on Desmarestia anceps, Desmarestia antarctica and Plocamium sp. but were not included in the main analyses because of small sample sizes. There were major differences between the gastropod assemblages on deep vs shallow H. grandifolius and S. antarctica with much higher numbers of individuals and also greater numbers of gastropod species at the greater depth. Differences between the gastropod assemblages on H. grandifolius and S. antarctica across sampling sites were apparent in non-parametric, multivariate analyses, although depth contributed more than site to these differences. Within common sites, assemblages on H. grandifolius were significantly different from those on S. antarctica at 18 m depth but not at 9 m depth, indicating that the host species can be but is not always more important than site in influencing the gastropod assemblages.
Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen in neonatal intensive care units (NICU) that confers significant morbidity and mortality.
Improving our understanding of MRSA transmission dynamics, especially among high-risk patients, is an infection prevention priority.
We investigated a cluster of clinical MRSA cases in the NICU using a combination of epidemiologic review and whole-genome sequencing (WGS) of isolates from clinical and surveillance cultures obtained from patients and healthcare personnel (HCP).
Phylogenetic analysis identified 2 genetically distinct phylogenetic clades and revealed multiple silent-transmission events between HCP and infants. The predominant outbreak strain harbored multiple virulence factors. Epidemiologic investigation and genomic analysis identified a HCP colonized with the dominant MRSA outbreak strain who cared for most NICU patients who were infected or colonized with the same strain, including 1 NICU patient with severe infection 7 months before the described outbreak. These results guided implementation of infection prevention interventions that prevented further transmission events.
Silent transmission of MRSA between HCP and NICU patients likely contributed to a NICU outbreak involving a virulent MRSA strain. WGS enabled data-driven decision making to inform implementation of infection control policies that mitigated the outbreak. Prospective WGS coupled with epidemiologic analysis can be used to detect transmission events and prompt early implementation of control strategies.
Synthetic peptide and peptido-mimetic filaments and tubes represent a diverse class of nanomaterials with a broad range of potential applications, such as drug delivery, vaccine development, synthetic catalyst design, encapsulation, and energy transduction. The structures of these filaments comprise supramolecular polymers based on helical arrangements of subunits that can be derived from self-assembly of monomers based on diverse structural motifs. In recent years, structural analyses of these materials at near-atomic resolution (NAR) have yielded critical insights into the relationship between sequence, local conformation, and higher-order structure and morphology. This structural information offers the opportunity for development of new tools to facilitate the predictable and reproducible de novo design of synthetic helical filaments. However, these studies have also revealed several significant impediments to the latter process – most notably, the common occurrence of structural polymorphism due to the lability of helical symmetry in structural space. This article summarizes the current state of knowledge on the structures of designed peptide and peptido-mimetic filamentous assemblies, with a focus on structures that have been solved to NAR for which reliable atomic models are available.
The aim of the study was to assess occupational health effects 1 month after responding to a natural gas pipeline explosion.
First responders to a pipeline explosion in Kentucky were interviewed about pre- and post-response health symptoms, post-response health care, and physical exertion and personal protective equipment (PPE) use during the response. Logistic regression was used to examine associations between several risk factors and development of post-response symptoms.
Among 173 first responders involved, 105 (firefighters [58%], emergency medical services [19%], law enforcement [10%], and others [12%]) were interviewed. Half (53%) reported at least 1 new or worsening symptom, including upper respiratory symptoms (39%), headache (18%), eye irritation (17%), and lower respiratory symptoms (16%). The majority (79%) of symptomatic responders did not seek post-response care. Compared with light-exertion responders, hard-exertion responders (48%) had significantly greater odds of upper respiratory symptoms (aOR: 2.99, 95% CI: 1.25–7.50). Forty-four percent of responders and 77% of non-firefighter responders reported not using any PPE.
Upper respiratory symptoms were common among first responders of a natural gas pipeline explosion and associated with hard-exertion activity. Emergency managers should ensure responders are trained in, equipped with, and properly use PPE during these incidents and encourage responders to seek post-response health care when needed.
To describe epidemiologic and genomic characteristics of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in a large skilled-nursing facility (SNF), and the strategies that controlled transmission.
Design, setting, and participants:
This cohort study was conducted during March 22–May 4, 2020, among all staff and residents at a 780-bed SNF in San Francisco, California.
Contact tracing and symptom screening guided targeted testing of staff and residents; respiratory specimens were also collected through serial point prevalence surveys (PPSs) in units with confirmed cases. Cases were confirmed by real-time reverse transcription–polymerase chain reaction testing for SARS-CoV-2, and whole-genome sequencing (WGS) was used to characterize viral isolate lineages and relatedness. Infection prevention and control (IPC) interventions included restricting from work any staff who had close contact with a confirmed case; restricting movement between units; implementing surgical face masking facility-wide; and the use of recommended PPE (ie, isolation gown, gloves, N95 respirator and eye protection) for clinical interactions in units with confirmed cases.
Of 725 staff and residents tested through targeted testing and serial PPSs, 21 (3%) were SARS-CoV-2 positive: 16 (76%) staff and 5 (24%) residents. Fifteen cases (71%) were linked to a single unit. Targeted testing identified 17 cases (81%), and PPSs identified 4 cases (19%). Most cases (71%) were identified before IPC interventions could be implemented. WGS was performed on SARS-CoV-2 isolates from 4 staff and 4 residents: 5 were of Santa Clara County lineage and the 3 others were distinct lineages.
Early implementation of targeted testing, serial PPSs, and multimodal IPC interventions limited SARS-CoV-2 transmission within the SNF.
Magnetic-resonance-guided focused ultrasound surgery (MRgFUS) is the only truly non-invasive procedure for the treatment of uterine fibroids. In MRgFUS, high-frequency ultrasound beams target specific tissue, in this case fibroids, causing increased temperatures leading to destruction of the tissue by coagulative necrosis. The resultant fibroid shrinkage occurs under the guidance of real-time magnetic resonance imaging (MRI) for accuracy and preservation of healthy surrounding myometrium . This chapter will begin with an overview of the history of MRgFUS, then examine the technical parameters of the procedure and measurement of success, discuss patient eligibility and selection, preparation for the procedure, recovery, potential complications, and finally, outlooks for fertility and other outcomes.
One of the risks of electronic power morcellation, central to the morcellation debate, is the concern of spread of malignant uterine tissue. Uterine cancer is the most common gynaecologic cancer in the United States with an estimated 49,560 cases and 8,190 deaths in 2013. Uterine sarcomas arise from the mesodermal tissues of the uterine body and account for 3% of all uterine cancers, and represent 3.3 cases per 100,000 women . Leiomyosarcoma (LMS) represents 40% of all uterine sarcomas, and 2% of all uterine malignancies, and the annual incidence has been estimated to be 0.64 per 100,000 women . It can present at any age, but most commonly between 45 and 55 years old, and its prevalence increases by 10% in patients over 60 years old.
This is a cross-sectional study aiming to understand the early characteristics and background of bone health impairment in clinically well children with Fontan circulation.
We enrolled 10 clinically well children with Fontan palliation (operated >5 years before study entrance, Tanner stage ≤3, age 12.1 ± 1.77 years, 7 males) and 11 healthy controls (age 12.0 ± 1.45 years, 9 males) at two children’s hospitals. All patients underwent peripheral quantitative CT. For the Fontan group, we obtained clinical characteristics, NYHA class, cardiac index by MRI, dual x-ray absorptiometry, and biochemical studies. Linear regression was used to compare radius and tibia peripheral quantitative CT measures between Fontan patients and controls.
All Fontan patients were clinically well (NYHA class 1 or 2, cardiac index 4.85 ± 1.51 L/min/m2) and without significant comorbidities. Adjusted trabecular bone mineral density, cortical thickness, and bone strength index at the radius were significantly decreased in Fontan patients compared to controls with mean differences −30.13 mg/cm3 (p = 0.041), −0.31 mm (p = 0.043), and −6.65 mg2/mm4 (p = 0.036), respectively. No differences were found for tibial measures. In Fontan patients, the mean height-adjusted lumbar bone mineral density and total body less head z scores were −0.46 ± 1.1 and −0.63 ± 1.1, respectively, which are below the average, but within normal range for age and sex.
In a clinically well Fontan cohort, we found significant bone deficits by peripheral quantitative CT in the radius but not the tibia, suggesting non-weight-bearing bones may be more vulnerable to the unique haemodynamics of the Fontan circulation.
Brain health diplomacy aims to influence the global policy environment for brain health (i.e. dementia, depression, and other mind/brain disorders) and bridges the disciplines of global brain health, international affairs, management, law, and economics. Determinants of brain health include educational attainment, diet, access to health care, physical activity, social support, and environmental exposures, as well as chronic brain disorders and treatment. Global challenges associated with these determinants include large-scale conflicts and consequent mass migration, chemical contaminants, air quality, socioeconomic status, climate change, and global population aging. Given the rapidly advancing technological innovations impacting brain health, it is paramount to optimize the benefits and mitigate the drawbacks of such technologies.
We propose a working model of Brain health INnovation Diplomacy (BIND).
We prepared a selective review using literature searches of studies pertaining to brain health technological innovation and diplomacy.
BIND aims to improve global brain health outcomes by leveraging technological innovation, entrepreneurship, and innovation diplomacy. It acknowledges the key role that technology, entrepreneurship, and digitization play and will increasingly play in the future of brain health for individuals and societies alike. It strengthens the positive role of novel solutions, recognizes and works to manage both real and potential risks of digital platforms. It is recognition of the political, ethical, cultural, and economic influences that brain health technological innovation and entrepreneurship can have.
By creating a framework for BIND, we can use this to ensure a systematic model for the use of technology to optimize brain health.
What explains combat motivation in warfare? Scholars argue that monitoring, material rewards, and punishment alone are insufficient explanations. Further, competing ideological accounts of motivation are also problematic because ideas are difficult to operationalize and measure. To solve this puzzle, the authors combine extensive information from World War II about German soldiers’ combat performance with data about conditionally exogenous potential exposure to Nazi radio propaganda. They find evidence that soldiers with higher potential exposure to propaganda were more likely to be decorated for valor even after controlling for individual socioeconomic factors, home district characteristics like urbanization, and proxies for combat exposure.
Increasing evidence indicates that gut microbiota may influence colorectal cancer risk. Diet, particularly fibre intake, may modify gut microbiota composition, which may affect cancer risk. We investigated the relationship between dietary fibre intake and gut microbiota in adults. Using 16S rRNA gene sequencing, we assessed gut microbiota in faecal samples from 151 adults in two independent study populations: National Cancer Institute (NCI), n 75, and New York University (NYU), n 76. We calculated energy-adjusted fibre intake based on FFQ. For each study population with adjustment for age, sex, race, BMI and smoking, we evaluated the relationship between fibre intake and gut microbiota community composition and taxon abundance. Total fibre intake was significantly associated with overall microbial community composition in NYU (P=0·008) but not in NCI (P=0·81). In a meta-analysis of both study populations, higher fibre intake tended to be associated with genera of class Clostridia, including higher abundance of SMB53 (fold change (FC)=1·04, P=0·04), Lachnospira (FC=1·03, P=0·05) and Faecalibacterium (FC=1·03, P=0·06), and lower abundance of Actinomyces (FC=0·95, P=0·002), Odoribacter (FC=0·95, P=0·03) and Oscillospira (FC=0·96, P=0·06). A species-level meta-analysis showed that higher fibre intake was marginally associated with greater abundance of Faecalibacterium prausnitzii (FC=1·03, P=0·07) and lower abundance of Eubacterium dolichum (FC=0·96, P=0·04) and Bacteroides uniformis (FC=0·97, P=0·05). Thus, dietary fibre intake may impact gut microbiota composition, particularly class Clostridia, and may favour putatively beneficial bacteria such as F. prausnitzii. These findings warrant further understanding of diet–microbiota relationships for future development of colorectal cancer prevention strategies.
New evidence from archaeological investigations in north-east Thailand shows a transition in rice farming towards wetland cultivation that would have facilitated greater yields and surpluses. This evidence, combined with new dates and palaeoclimatic data, suggests that this transition took place in the Iron Age, at a time of increasingly arid climate, and when a number of broader societal changes become apparent in the archaeological record. For the first time, it is possible to relate changes in subsistence economy to shifts in regional climate and water-management strategies, and to the emergence of state societies in Southeast Asia.
Good education requires student experiences that deliver lessons about practice as well as theory and that encourage students to work for the public good—especially in the operation of democratic institutions (Dewey 1923; Dewy 1938). We report on an evaluation of the pedagogical value of a research project involving 23 colleges and universities across the country. Faculty trained and supervised students who observed polling places in the 2016 General Election. Our findings indicate that this was a valuable learning experience in both the short and long terms. Students found their experiences to be valuable and reported learning generally and specifically related to course material. Postelection, they also felt more knowledgeable about election science topics, voting behavior, and research methods. Students reported interest in participating in similar research in the future, would recommend other students to do so, and expressed interest in more learning and research about the topics central to their experience. Our results suggest that participants appreciated the importance of elections and their study. Collectively, the participating students are engaged and efficacious—essential qualities of citizens in a democracy.
Three annual applications of glyphosate [N-(phosphonomethyl)glycine] with three ropewick applicators were compared to hoeing and cultivation for the control of johnsongrass [Sorghum halepense (L.) Pers. ♯3 SORHA] in cotton (Gossypium hirsutum L. ‘Acala SJ-2′) in 1980 and 1981. The three applicators provided about equal control of johnsongrass. Averaged over treatments, years, and dates of application, plots treated with glyphosate contained 83% fewer live johnsongrass shoots (14/m2) than cultivated control plots (84/m2) 2 to 3 weeks after each application. Glyphosate-treated plots yielded an average of 81% more seed cotton (2010 kg/ha) than cultivated control plots (1110 kg/ha). However, yields of treated plots averaged 33% less than plots maintained weed-free by hoeing. Although applications of glyphosate reduced johnsongrass populations 83%, the competitive effect of johnsongrass on cotton prior to the initiation of treatments, plus the competition from escape plants between treatments, prevented cotton from yielding normally.
A compact incorporator-planter, which incorporates herbicides into moist soil simultaneously with planting of cotton (Gossypium hirsutum L.), was constructed and evaluated over 3 yr using six herbicides. Weed control was consistent with that reported for large, cumbersome units utilizing standard planters and incorporating units from ground-driven rotary tillers and was enhanced in seasons in which rain fell during the first 3 weeks after planting. Among the dinitroaniline herbicides, dinitramine (N4,N4-diethyl-α,α,α-trifluoro-3,5-dinitrotoluene-2,4-diamine) controlled barnyardgrass [Echinochloa crus-galli (L.) Beauv.], and redroot pigweed (Amaranthus retroflexus L.) most effectively. Cotton stands and yields were equivalent to those obtained using standard cotton-planting methods.