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The Canadian Nosocomial Infection Surveillance Program conducted point-prevalence surveys in acute-care hospitals in 2002, 2009, and 2017 to identify trends in antimicrobial use.
Eligible inpatients were identified from a 24-hour period in February of each survey year. Patients were eligible (1) if they were admitted for ≥48 hours or (2) if they had been admitted to the hospital within a month. Chart reviews were conducted. We calculated the prevalence of antimicrobial use as follows: patients receiving ≥1 antimicrobial during survey period per number of patients surveyed × 100%.
In each survey, 28−47 hospitals participated. In 2002, 2,460 (36.5%; 95% CI, 35.3%−37.6%) of 6,747 surveyed patients received ≥1 antimicrobial. In 2009, 3,566 (40.1%, 95% CI, 39.0%−41.1%) of 8,902 patients received ≥1 antimicrobial. In 2017, 3,936 (39.6%, 95% CI, 38.7%−40.6%) of 9,929 patients received ≥1 antimicrobial. Among patients who received ≥1 antimicrobial, penicillin use increased 36.8% between 2002 and 2017, and third-generation cephalosporin use increased from 13.9% to 18.1% (P < .0001). Between 2002 and 2017, fluoroquinolone use decreased from 25.7% to 16.3% (P < .0001) and clindamycin use decreased from 25.7% to 16.3% (P < .0001) among patients who received ≥1 antimicrobial. Aminoglycoside use decreased from 8.8% to 2.4% (P < .0001) and metronidazole use decreased from 18.1% to 9.4% (P < .0001). Carbapenem use increased from 3.9% in 2002 to 6.1% in 2009 (P < .0001) and increased by 4.8% between 2009 and 2017 (P = .60).
The prevalence of antimicrobial use increased between 2002 and 2009 and then stabilized between 2009 and 2017. These data provide important information for antimicrobial stewardship programs.
Studies were conducted in 2019 and 2020 in Lewiston, NC, to determine the crop response of 4-hydroxyphenylpyrivate dioxygenase (HPPD)-resistant cotton to isoxaflutole (IFT) and other cotton herbicides as part of a cotton weed management program that included herbicides applied preemergence, early postemergence (EPOST), and mid-postemergence (MPOST). IFT was applied PRE at 105 g ha−1 alone and in various combinations with acetochlor, diuron, fluometuron, fluridone, fomesafen, pendimethalin, and pyrithiobac. EPOST treatments included IFT at 53 or 105 g ha−1 alone or in combination with glyphosate or glufosinate, or dimethenamid-P + glufosinate. Glyphosate + glufosinate was applied MPOST to all treatments except the nontreated control. Cotton injury from IFT applied PRE was minimal (0% to 3%). Injury following EPOST application of dimethenamid-P + glufosinate ranged from 3% to 5% and 6% to 9% in 2019 and 2020, respectively. In both years, injury from IFT applied PRE followed by IFT applied EPOST never exceeded injury from IFT applied PRE followed by dimethenamid-P + glufosinate. Isoxaflutole applied PRE followed by IFT applied EPOST at 105 g ha−1 resulted in 0% to 2% cotton injury, indicating that IFT can be applied either PRE or EPOST with minimal risk to cotton. Late-season cotton height and cotton lint yield were not affected by any herbicide treatment. The experimental HPPD-resistant cotton cultivar was minimally injured by IFT applied PRE and EPOST, it tolerated standard cotton herbicides, and yield loss was not observed. Given these results, HPPD-resistant cotton and IFT may be integrated into cotton weed management systems with minimal risk for cotton injury and provide an additional effective mechanism of action for managing troublesome weeds in cotton.
The critical period for weed control (CPWC) adds value to integrated weed management by identifying the period during which weeds need to be controlled to avoid yield losses exceeding a defined threshold. However, the traditional application of the CPWC does not identify the timing of control needed for weeds that emerge late in the critical period. In this study, CPWC models were developed from field data in high-yielding cotton crops during three summer seasons from 2005 to 2008, using the mimic weed, common sunflower, at densities of two to 20 plants per square meter. Common sunflower plants were introduced at up to 450 growing degree days (GDD) after crop planting and removed at successive 200 GDD intervals after introduction. The CPWC models were described using extended Gompertz and logistic functions that included weed density, time of weed introduction, and time of weed removal (logistic function only) in the relationships. The resulting models defined the CPWC for late-emerging weeds, identifying a period after weed emergence before weed control was required to prevent yield loss exceeding the yield-loss threshold. When weeds emerged in sufficient numbers toward the end of the critical period, the model predicted that crop yield loss resulting from competition by these weeds would not exceed the yield-loss threshold until well after the end of the CPWC. These findings support the traditional practice of ensuring weeds are controlled before crop canopy closure, with later weed control inputs used as required.
Gadamer has made a tremendous contribution to twentieth century thought, for he has proposed a new and different model of understanding and understanding in the human sciences that carries us beyond the dilemma of ethnocentrism and relativism. This model is not that of a “science” that grasps an object but rather one of speech-partners who come to an understanding together. Three important features of understanding are (1) it is bilateral in character, (2) it is party dependent, and (3) it involves revising goals. It follows that there is an important difference between the human sciences and the natural sciences. Important to Gadamer’s model of the human sciences is the “fusion of horizons.” This chapter discusses the proximity of Davidson and Gadamer and their differences.
COVID-19 has had a significant impact on healthcare provision, accessibility and psychiatric presentations. We aim to investigate the impact of the pandemic on psychiatric services and the severity of presentations in Edinburgh, with a particular focus on the North-West Edinburgh Community Mental Health Team (NW CMHT).
Measures of the impact of the pandemic on NW CMHT were identified as referral numbers from primary care and Did Not Attend (DNA) rates. Royal Edinburgh Hospital admissions, detentions under the Mental Health (Care and Treatment) (Scotland) Act 2003 (MHA) and Out of Hours (OOH) contacts were used as proxy measures to explore the severity and urgency of presentations.
Quantitative data focussing on these parameters for patients aged 18–65 years in NW CMHT in 2019 and 2020 were collected from NHS Lothian Analytical Services. OOH data were only available Edinburgh-wide. All data were anonymised in line with NHS Lothian Information Governance Policy.
In order to assess the impact on staff, a questionnaire was created and disseminated, with qualitative data returned anonymously.
Referrals to NW CMHT decreased by 9.3% in 2020 (n = 2164) compared to 2019 (n = 2366). Referrals in April (n = 81) and May (n = 102) 2020 were far below the monthly average across the two years (n = 188).
Appointment numbers were very similar in 2019 (n = 3542) and 2020 (n = 3514). Despite this, DNA and cancellation rates decreased by 3.94% in 2020. Questionnaire results illustrated some of the challenges for staff of working during a pandemic.
Admissions to hospital reduced by 6.8% in 2020 (n = 219 vs n = 235). While MHA detentions in NW Edinburgh increased by only 1.8% (n = 173 vs n = 170), new Compulsory Treatment Orders (CTO) increased by 60%. Furthermore, OOH contacts across Edinburgh increased by 45.2% when compared to 2019.
The COVID-19 pandemic altered the way patients accessed healthcare. Uncertainty of the public in accessing primary care services early in the pandemic may have contributed to reduced referral numbers.
The increase in CTOs is suggestive of severe relapses in previously stable patients or new episodes of illness. The pandemic may have contributed to a reduction in early recognition, and referral, of those with major mental disorders resulting in more protracted or severe illness episodes. The increase in OOH crisis contacts supports such a hypothesis.
Despite what would be expected, DNA and cancellation rates in NW CMHT reduced. The contribution of telemedicine to this warrants further exploration as a means of delivering healthcare in an efficient and accessible way.
Background: Healthcare services are increasingly shifting from inpatient to outpatient settings. Outpatient settings such as emergency departments (EDs), oncology clinics, dialysis clinics, and day surgery often involve invasive procedures with the risk of acquiring healthcare-associated infections (HAIs). As a leading cause of HAI, Clostridioides difficile infection (CDI) in outpatient settings has not been sufficiently described in Canada. The Canadian Nosocomial Infection Surveillance Program (CNISP) aims to describe the epidemiology, molecular characterization, and antimicrobial susceptibility of outpatient CDI across Canada. Methods: Epidemiologic data were collected from patients diagnosed with CDI from a network of 47 adult and pediatric CNISP hospitals. Patients presenting to an outpatient setting such as the ED or outpatient clinics were considered as outpatient CDI. Cases were considered HAIs if the patient had had a healthcare intervention within the previous 4 weeks, and they were considered community-associated if there was no history of hospitalization within the previous 12 weeks. Clostridioides difficile isolates were submitted to the National Microbiology Laboratory for testing during an annual 2-month targeted surveillance period. National and regional rates of CDI were stratified by outpatient location. Results: Between January 1, 2015, and June 30, 2019, 2,691 cases of outpatient-CDI were reported, and 348 isolates were available for testing. Most cases (1,475 of 2,691, 54.8%) were identified in outpatient clinics, and 72.8% (1,960 of 2,691) were classified as community associated. CDI cases per 100,000 ED visits were highest in 2015, at 10.3, and decreased to 8.1 in 2018. Rates from outpatient clinics decreased from 3.5 in 2016 to 2.7 in 2018 (Fig. 1). Regionally, CDI rates in the ED declined in Central Canada and increased in the West after 2016. Rates in outpatient clinics were >2 times higher in the West compared to other regions. RT027 associated with NAP1 was most common among ED patients (26 of 195, 13.3%), whereas RT106 associated with NAP11 was predominant in outpatient clinics (22 of 189, 11.6%). Overall, 10.4% of isolates were resistant to moxifloxacin, 0.5% were resistant to rifampin, and 24.2% were resistant to clindamycin. No resistance was observed for metronidazole, vancomycin, or tigecycline. Compared to CNISP inpatient CDI data, outpatients with CDI were younger (51.8 ± 23.3 vs 64.2 ± 21.6; P < .001), included more females (56.4% vs 50.9%; P < .001), and were more often treated with metronidazole (63.0% vs 56.1%; P < .001). Conclusions: For the first time, CDI cases identified in outpatient settings were characterized in a Canadian context. Outpatient CDI rates are decreasing overall, but they vary by region. Predominant ribotypes vary based on outpatient location. Outpatients with CDI are younger and are more likely female than inpatients with CDI.
Disclosures: Susy Hota reports contract research for Finch Therapeutics.
The long-accepted theory to explain why snow is slippery postulates self-lubrication: frictional heat from sliding melts and thereby lubricates the contacting snow grains. We recently published micro-scale interface observations that contradicted this explanation: contacting snow grains abraded and did not melt under a polyethylene slider, despite low friction values. Here we provide additional observational and theoretical evidence that abrasion can govern snow kinetic friction. We obtained coordinated infrared, visible-light and scanning-electron micrographs that confirm that the evolving shapes observed during our tribometer tests are contacting snow grains polished by abrasion, and that the wear particles can sinter together and fill the adjacent pore spaces. Furthermore, dry-contact abrasive wear reasonably predicts the evolution of snow-slider contact area, and sliding-heat-source theory confirms that contact temperatures would not reach 0°C during our tribometer tests. Importantly, published measurements of interface temperatures also indicate that melting did not occur during field tests on sleds and skis. Although prevailing theory anticipates a transition from dry to lubricated contact along a slider, we suggest that dry-contact abrasion and heat flow can prevent this transition from occurring for snow-friction scenarios of practical interest.
Prominent figures are frequently subjected to unwanted and intrusive attentions. Such stalking behaviour is often driven by psychotic illness, angrily blaming the public figure for delusional persecution (resentful motivation), or based on erotomanic delusions (intimacy seeking motivation), for example. This behaviour can cause psychological harm to both perpetrator and victim, and is unlawful. In the rare instances where a public figure has been attacked, the perpetrator has usually had a history of such stalking behaviour and of severe mental illness. For these reasons, early identification and diversion into appropriate care and treatment will be for the benefit of both parties and will prevent more serious violence in a minority of cases. The importance of the provision of education to improve both reporting rates by victims and an appropriate response from the criminal justice system is highlighted. A multi-agency approach involving the criminal justice system and mental health services is the most effective means of achieving these aims.
DECLARATION OF INTEREST
• Learn that severe mental illness, particularly psychosis, is often an important driver of stalking behaviour
• Learn that delusional disorder is a treatable mental illness
• Appreciate that prevention rather than prediction is the approach to managing the risks of high-harm low-probability outcomes.
Incorporation of cover crop residue into the soil has been suggested as a means for reducing weed seedbanks. To explore this hypothesis, we buried mesh bags of seeds mixed with sand at 15-cm depth in late fall in plots that had been planted with rye (Secale cereale L.) or hairy vetch (Vicia villosa Roth.) or left unplanted. Separate bags contained either velvetleaf (Abutilon theophrasti Medik.), giant foxtail (Setaria faberi Herrm.), Powell amaranth (Amaranthus powellii S. Watson), or common lambsquarters (Chenopodium album L.). The experiment used a randomized complete block design with five replications, and enough bags were buried to allow a final recovery in each of the following three springs. Each spring, bags were exhumed, and seeds were either counted and tested for viability or mixed with chopped cover crop material or simply stirred for control bags, and the material was reburied. The experiment was completed twice with initial burials in fall of 2011 and 2013. Rye had no consistent effect on persistence of seeds of any of the species. For two observation intervals, rye increased persistence of a species; for another two intervals, it decreased persistence relative to the control; but mostly rye did not affect persistence. Hairy vetch decreased persistence of C. album and A. powellii in both runs of the experiment but had no effect on persistence of A. theophrasti and S. faberi. Germination of the first two species is promoted by nitrate, whereas A. theophrasti germination is not sensitive to nitrate, and S. faberi is only rarely nitrate sensitive. We suggest that nitrate released during decomposition of hairy vetch may have promoted fatal germination of C. album and A. powellii. Incorporation of legume cover crops like hairy vetch may provide a means for decreasing the seedbanks of the many weed species whose germination is promoted by nitrate. The lack of any reduction of A. theophrasti and S. faberi seed persistence in response to hairy vetch and the inconsistent and mostly negligible effect of rye indicate that a general increase in readily decomposable organic matter through incorporation of cover crops may be ineffective at reducing weed seedbanks.
This study utilizes Farm Service Agency lending data to verify if previous racial and gender bias allegations still persist in more recent lending decisions. Beyond loan approval decisions, this study focuses on trends in direct loan packaging terms for approved single proprietorship farm borrowers. Results indicate that although no significant disparities were noted in loan amounts and maturities prescribed for various racial and gender minority groups, nonwhite male and female borrowers were usually charged higher interest rates than the others. Loan pricing differentials could have been the lenders' strategy for price management of borrowers' credit risks.
Late Medieval Castles is a companion to Anglo-Norman Castles (2003), a volume that brought together a series of historiographically significant articles on castles and castle-building in the period from the Norman Conquest to the early thirteenth century. The format and themes of the present collection are broadly comparable with the earlier book, but with the focus on those castles dating to the period c.1250–1500.
In the course of bringing Anglo-Norman Castles to publication the somewhat arbitrary cut-off date of c.1225 seemed unsatisfactory for a number of reasons. On a practical level, there were highly relevant articles that could not be included because the subject matter fell outside the chronological range of the volume. A more scholarly concern was the fact that a number of issues pertinent to castle-building in the eleventh and twelfth centuries could not be satisfactorily addressed without reference to subsequent developments in the thirteenth and fourteenth. Allied to this, a focus on Anglo-Norman building (no matter how justifiable in historical terms) does perhaps contribute, albeit unwittingly, to the erroneous idea that the eleventh and twelfth centuries are the most important centuries for castle-building, a time when the ‘true’ castle is to be found, and that the period that follows, particularly after 1300, is something of an anti-climax. The present volume should therefore be seen as a continuation of the broad themes discussed in the introduction to Anglo-Norman Castles, with the aim of pursuing them in a late medieval context.
In the years since 2003 there have been a number of important publications in the field of castle studies, and castles continue to be a source of controversy and to provoke debate. Despite the fact that the availability of some secondary material has been made easier through electronic access, I have been consistently reminded by academic colleagues that a compilation such as this is worthwhile, both for the student reader and those seeking a path into the specialist secondary literature. This author at least also believes that there is value in bringing together in one place a series of important contributions that have defined the subject and which also illustrate a diversity of approaches.
The castles of the late medieval period represent some of the finest medieval monuments in Britain, with an almost infinite capacity to fascinate and draw controversy. They are also a source of considerable academic debate. The contents of this volume represent key works in castle scholarship. Topics discussed include castle warfare, fortress customs, architectural design and symbolism, spatial planning and the depiction of castles in medieval romance. The contributions also serve to highlight the diversity of approaches to the medieval castle, ranging from the study of documentary and literary sources, analysis of fragmentary architectural remains and the recording of field archaeology. The result is a survey that offers an in-depth analysis of castle building from the thirteenth to the fifteenth centuries, and places castles within their broader social, architectural and political contexts.
Robert Liddiard is Professor of History, University of East Anglia.
Contributors: Nicola Coldstream, Charles Coulson, Philip Dixon, Graham Fairclough, P.A. Faulkner, John Goodall, Beryl Lott, Charles McKean, T.E. McNeill, Richard K. Morris, Michael Prestwich, Christopher Taylor, Muriel A. Whitaker.