We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
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 no-reply@cambridge.org
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.
Complications following the Fontan procedure include prolonged pleural drainage and readmission for effusions. To address these complications, a post-Fontan management pathway was implemented with primary goals of reducing chest tube duration/reinsertion rates and decreasing hospital length of stay and readmissions.
Methods:
Fontan patients were identified by retrospective chart review (2017–2019) to obtain baseline data for chest tube duration/reinsertion rates, hospital length of stay, and readmission rates for effusion. A post-Fontan management pathway was implemented (2020–2021) utilising post-operative vasopressin, nasal cannula oxygen until chest tube removal, and discharge regimen of three times daily diuretics, sildenafil, and afterload reducing medications. Patients were followed to evaluate primary outcomes.
Results:
The pre- and post-pathway groups were similar in single ventricle morphology, demographics, and pre-operative haemodynamics. Forty-three and 36 patients were included in the pre- and post-pathway cohorts, respectively. There were statistically significant reductions in chest tube duration (8 vs. 5 days, p ≤ 0.001), chest tube output on post-operative day 4 (20.4 vs. 9.9 mL/kg/day, p = 0.003), and hospital readmission rates for effusion (13[30%] vs. 3[8%], p = 0.02) compared to baseline. There was an absolute reduction in hospital length of stay (11 vs. 9.5 days, p = 0.052). When combining average cost savings for the Fontan hospitalisations, readmissions for effusion, and cardiac catheterisations within 6 months of Fontan completion, there was a $325,144 total cost savings for 36 patients following pathway implementation.
Conclusion:
Implementation of a post-Fontan management pathway resulted in significant reductions in chest tube duration and output, and readmission rates for effusion in the perioperative period.
Chapter 11 focuses on ancient ‘contracts’, with specific reference to commerce, property and other economic activities for which there is relevant evidence. The chapter begins with urbanization in southern Mesopotamia in the fourth millennium bce, bringing together archaeological, material and written evidence in order to introduce a broad working idea of ‘contracts’. The next section moves on to a discussion of technical ancient terms and concepts, noting the ‘considerable terminological instability in the common English translations of the original terms’. The following section turns to ‘contracts’ between states, whilst the next develops a comparative analysis of ‘oaths in interpersonal agreements’. The following two sections analyse specific questions surrounding the use of writing and ’the contract of sale’, noting that there is surviving evidence for the use of (different forms of) contacts of sale across every ancient legal system. The chapter concludes by drawing together a set of generalized conceptions of ‘contract’ and briefly suggesting that long-distance trade - among other factors - may lie behind some of the similarities - for example the use of seals - evident across the extant ancient evidence.
The sorption of the uranyl oxo-cation (UO22+)at different types of binding sites on layer silicate mineral surfaces was investigated. Well-characterized samples of vermiculite and hydrobiotite were exposed to aqueous uranyl under conditions designed to promote surface sorption either at fixed charge ionexchange sites or at amphoteric surface hydroxyl sites. The local structure of uranium in the sorption samples was directly measured using uranium L3-edge extended X-ray absorption fine structure (EXAFS). Polarized L1- and L3-edge X-ray absorption near-edge structure (XANES) measurements were used to characterize the orientation of uranyl groups in layered samples. X-ray diffraction (XRD) measurements of interlayer spacings were used to assess the effects of ion-exchange and dehydration upon the mineral structure. The most significant findings are: (1) Under conditions which greatly favor ion-exchange sorption mechanisms, uranyl retains a symmetric local structure suggestive of an outer-sphere complex, with a preferred orientation of the uranyl axis parallel to the mineral layers; (2) Upon dehydration, the ionexchange complexes adopt a less symmetric structure, consistent with an inner-sphere complex, with less pronounced orientation of the uranyl axis; and (3) For conditions which favor sorption at surface hydroxyl sites, uranyl has a highly distorted equatorial shell, indicative of stronger equatorial ligation, and the detection of a neighboring U atom suggests the formation of surface precipitates and/or oligomeric complexes.
We recently reported on the radio-frequency attenuation length of cold polar ice at Summit Station, Greenland, based on bi-static radar measurements of radio-frequency bedrock echo strengths taken during the summer of 2021. Those data also allow studies of (a) the relative contributions of coherent (such as discrete internal conducting layers with sub-centimeter transverse scale) vs incoherent (e.g. bulk volumetric) scattering, (b) the magnitude of internal layer reflection coefficients, (c) limits on signal propagation velocity asymmetries (‘birefringence’) and (d) limits on signal dispersion in-ice over a bandwidth of ~100 MHz. We find that (1) attenuation lengths approach 1 km in our band, (2) after averaging 10 000 echo triggers, reflected signals observable over the thermal floor (to depths of ~1500 m) are consistent with being entirely coherent, (3) internal layer reflectivities are ≈–60$\to$–70 dB, (4) birefringent effects for vertically propagating signals are smaller by an order of magnitude relative to South Pole and (5) within our experimental limits, glacial ice is non-dispersive over the frequency band relevant for neutrino detection experiments.
The U.S. Department of Agriculture–Agricultural Research Service (USDA-ARS) has been a leader in weed science research covering topics ranging from the development and use of integrated weed management (IWM) tactics to basic mechanistic studies, including biotic resistance of desirable plant communities and herbicide resistance. ARS weed scientists have worked in agricultural and natural ecosystems, including agronomic and horticultural crops, pastures, forests, wild lands, aquatic habitats, wetlands, and riparian areas. Through strong partnerships with academia, state agencies, private industry, and numerous federal programs, ARS weed scientists have made contributions to discoveries in the newest fields of robotics and genetics, as well as the traditional and fundamental subjects of weed–crop competition and physiology and integration of weed control tactics and practices. Weed science at ARS is often overshadowed by other research topics; thus, few are aware of the long history of ARS weed science and its important contributions. This review is the result of a symposium held at the Weed Science Society of America’s 62nd Annual Meeting in 2022 that included 10 separate presentations in a virtual Weed Science Webinar Series. The overarching themes of management tactics (IWM, biological control, and automation), basic mechanisms (competition, invasive plant genetics, and herbicide resistance), and ecosystem impacts (invasive plant spread, climate change, conservation, and restoration) represent core ARS weed science research that is dynamic and efficacious and has been a significant component of the agency’s national and international efforts. This review highlights current studies and future directions that exemplify the science and collaborative relationships both within and outside ARS. Given the constraints of weeds and invasive plants on all aspects of food, feed, and fiber systems, there is an acknowledged need to face new challenges, including agriculture and natural resources sustainability, economic resilience and reliability, and societal health and well-being.
Field studies were conducted to assess the efficacy of physical weed management of Palmer amaranth management in cucumber, peanut, and sweetpotato. Treatments were arranged in a 3 × 4 factorial in which the first factor included a treatment method of electrical, mechanical, or hand-roguing Palmer amaranth control and the second factor consisted of treatments applied when Palmer amaranth was approximately 0.3, 0.6, 0.9, or 1.2 m above the crop canopy. Four wk after treatment (WAT), the electrical applications controlled Palmer amaranth at least 27 percentage points more than the mechanical applications when applied at the 0.3- and 0.6-m timings. At the 0.9- and 1.2-m application timings 4 WAT, electrical and mechanical applications controlled Palmer amaranth by at most 87%. Though hand removal generally resulted in the greatest peanut pod count and total sweetpotato yield, mechanical and electrical control resulted in similar yield to the hand-rogued plots, depending on the treatment timing. With additional research to provide insight into the optimal applications, there is potential for electrical control and mechanical control to be used as alternatives to hand removal. Additional studies were conducted to determine the effects of electrical treatments on Palmer amaranth seed production and viability. Treatments consisted of electricity applied to Palmer amaranth at first visible inflorescence, 2 wk after first visible inflorescence (WAI) or 4 WAI. Treatments at varying reproductive maturities did not reduce the seed production immediately after treatment. However, after treatment, plants primarily died and ceased maturation, reducing seed production assessed at 4 WAI by 93% and 70% when treated at 0 and 2 WAI, respectively. Treatments did not have a negative effect on germination or seedling length.
We assessed patterns of enteric infections caused by 14 pathogens, in a longitudinal cohort study of sequelae in British Columbia (BC) Canada, 2005–2014. Our population cohort of 5.8 million individuals was followed for an average of 7.5 years/person; during this time, 40 523 individuals experienced 42 308 incident laboratory-confirmed, provincially reported enteric infections (96.4 incident infections per 100 000 person-years). Most individuals (38 882/40 523; 96%) had only one, but 4% had multiple concurrent infections or more than one infection across the study. Among individuals with more than one infection, the pathogens and combinations occurring most frequently per individual matched the pathogens occurring most frequently in the BC population. An additional 298 557 new fee-for-service physician visits and hospitalisations for enteric infections, that did not coincide with a reported enteric infection, also occurred, and some may be potentially unreported enteric infections. Our findings demonstrate that sequelae risk analyses should explore the possible impacts of multiple infections, and that estimating risk for individuals who may have had a potentially unreported enteric infection is warranted.
The prehensile-tailed skink Corucia zebrata is endemic to the Solomon Islands. It is the most traded reptile from the country. During 2000–2019, CITES reported the legal export of 10,567 individuals. Although the level of this trade is well documented, impacts on the skink's survival in its native range are comparatively unknown. During January–May 2020, we surveyed 146 people on 12 islands to collect information on the habitats preferred by the prehensile-tailed skink, to understand perceptions of the species' conservation status and identify any potential threats. Respondents reported lowland and hill forests as being favoured habitats, with low proportions of respondents identifying coastal and montane forests as suitable habitat. Habitat loss (72%), hunting (17%), and predation (6%) were identified as the main threats. People younger than 30 years of age reported killing the skinks more frequently than did people over the age of 30. Prehensile-tailed skinks have a relatively small home range, long reproductive cycle, and are vulnerable to numerous threats. We thus recommend a halt to the current practice of exporting wild-caught prehensile-tailed skinks, and replacement by a well-regulated captive breeding programme.
Sports participation, physical activity, and friendship quality are theorized to have protective effects on the developmental emergence of substance use and self-harm behavior in adolescence, but existing research has been mixed. This ambiguity could reflect, in part, the potential for confounding of observed associations by genetic and environmental factors, which previous research has been unable to rigorously rule out. We used data from the prospective, population-based Child and Adolescent Twin Study in Sweden (n = 18,234 born 1994–2001) and applied a co-twin control design to account for potential genetic and environmental confounding of sports participation, physical activity, and friendship quality (assessed at age 15) as presumed protective factors for adolescent substance use and self-harm behavior (assessed at age 18). While confidence intervals widened to include the null in numerous co-twin control analyses adjusting for childhood psychopathology, parent-reported sports participation and twin-reported positive friendship quality were associated with increased odds of alcohol problems and nicotine use. However, parent-reported sports participation, twin-reported physical activity, and twin-reported friendship quality were associated with decreased odds of self-harm behavior. The findings provide a more nuanced understanding of the risks and benefits of putative protective factors for risky behaviors that emerge during adolescence.
Whole-genome sequencing (WGS) shotgun metagenomics (metagenomics) attempts to sequence the entire genetic content straight from the sample. Diagnostic advantages lie in the ability to detect unsuspected, uncultivatable, or very slow-growing organisms.
Objective:
To evaluate the clinical and economic effects of using WGS and metagenomics for outbreak management in a large metropolitan hospital.
Design:
Cost-effectiveness study.
Setting:
Intensive care unit and burn unit of large metropolitan hospital.
Patients:
Simulated intensive care unit and burn unit patients.
Methods:
We built a complex simulation model to estimate pathogen transmission, associated hospital costs, and quality-adjusted life years (QALYs) during a 32-month outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB). Model parameters were determined using microbiology surveillance data, genome sequencing results, hospital admission databases, and local clinical knowledge. The model was calibrated to the actual pathogen spread within the intensive care unit and burn unit (scenario 1) and compared with early use of WGS (scenario 2) and early use of WGS and metagenomics (scenario 3) to determine their respective cost-effectiveness. Sensitivity analyses were performed to address model uncertainty.
Results:
On average compared with scenario 1, scenario 2 resulted in 14 fewer patients with CRAB, 59 additional QALYs, and $75,099 cost savings. Scenario 3, compared with scenario 1, resulted in 18 fewer patients with CRAB, 74 additional QALYs, and $93,822 in hospital cost savings. The likelihoods that scenario 2 and scenario 3 were cost-effective were 57% and 60%, respectively.
Conclusions:
The use of WGS and metagenomics in infection control processes were predicted to produce favorable economic and clinical outcomes.
Diets varying in SFA and MUFA content can impact glycaemic control; however, whether underlying differences in genetic make-up can influence blood glucose responses to these dietary fatty acids is unknown. We examined the impact of dietary oils varying in SFA/MUFA content on changes in blood glucose levels (primary outcome) and whether these changes were modified by variants in the stearoyl-CoA desaturase (SCD) gene (secondary outcome). Obese men and women participating in the randomised, crossover, isoenergetic, controlled-feeding Canola Oil Multicenter Intervention Trial II consumed three dietary oils for 6 weeks, with washout periods of ˜6 weeks between each treatment. Diets studied included a high SFA/low MUFA Control oil (36·6 % SFA/28·2 % MUFA), a conventional canola oil (6·2 % SFA/63·1 % MUFA) and a high-oleic acid canola oil (5·8 % SFA/74·7 % MUFA). No differences in fasting blood glucose were observed following the consumption of the dietary oils. However, when stratified by SCD genotypes, significant SNP-by-treatment interactions on blood glucose response were found with additive models for rs1502593 (P = 0·01), rs3071 (P = 0·02) and rs522951 (P = 0·03). The interaction for rs3071 remained significant (P = 0·005) when analysed with a recessive model, where individuals carrying the CC genotype showed an increase (0·14 (sem 0·09) mmol/l) in blood glucose levels with the Control oil diet, but reductions in blood glucose with both MUFA oil diets. Individuals carrying the AA and AC genotypes experienced reductions in blood glucose in response to all three oils. These findings identify a potential new target for personalised nutrition approaches aimed at improving glycaemic control.
Annual sedge (Cyperus compressus L.) populations with resistance to halosulfuron were identified in turfgrass at two new locations in Georgia. Research was conducted to evaluate (1) resistance levels to two acetolactate synthase (ALS) inhibitors, (2) ALS enzyme susceptibility, (3) genetic differences associated with resistance, and (4) differential levels of ALS gene expression in these biotypes. In dose–response experiments, the biotypes were >160 times resistant to halosulfuron but only 12 times more resistant to imazaquin compared with a susceptible biotype. In vitro enzyme assays indicated that resistant (R) biotypes required 6.1-fold greater concentrations of imazaquin to reduce ALS activity 50% compared with the susceptible (S) biotype. Both R biotypes had a similar Pro-197-Ser amino acid substitution in the ALS gene that confers resistance to sulfonylureas. Compared with the S biotype, R biotypes had 4.4 times higher ALS gene expression than the S biotype. No differences in gene copy number were found between any biotypes for the ALS gene. Overall, ALS-resistant C. compressus selected by halosulfuron use in turfgrass may be exhibiting partial susceptibility to imazaquin but complete resistance to sulfonylureas. Differential levels of susceptibility to ALS inhibitors for these biotypes are associated with the Pro-197-Ser substitution and enhanced expression of the ALS gene.
After five positive randomized controlled trials showed benefit of mechanical thrombectomy in the management of acute ischemic stroke with emergent large-vessel occlusion, a multi-society meeting was organized during the 17th Congress of the World Federation of Interventional and Therapeutic Neuroradiology in October 2017 in Budapest, Hungary. This multi-society meeting was dedicated to establish standards of practice in acute ischemic stroke intervention aiming for a consensus on the minimum requirements for centers providing such treatment. In an ideal situation, all patients would be treated at a center offering a full spectrum of neuroendovascular care (a level 1 center). However, for geographical reasons, some patients are unable to reach such a center in a reasonable period of time. With this in mind, the group paid special attention to define recommendations on the prerequisites of organizing stroke centers providing medical thrombectomy for acute ischemic stroke, but not for other neurovascular diseases (level 2 centers). Finally, some centers will have a stroke unit and offer intravenous thrombolysis, but not any endovascular stroke therapy (level 3 centers). Together, these level 1, 2, and 3 centers form a complete stroke system of care. The multi-society group provides recommendations and a framework for the development of medical thrombectomy services worldwide.
Glyphosate-resistant (GR) common waterhemp (CW) is a localized weed in Ontario and one of the most problematic weeds in the US Corn Belt. First confirmed in Ontario in 2014, GR CW has now been confirmed in forty fields in three counties in Ontario as of 2015. Historically, the primary POST herbicides used for the control of CW in soybean were glyphosate, acifluorfen and fomesafen, but resistance to all three has been confirmed in many US states. Research was conducted in 2015 and 2016 to determine the control of GR CW with some of the new herbicide-resistant soybean technologies including glufosinate (LibertyLink), 2,4-D and glyphosate (Enlist), and isoxaflutole, mesotrione, and glufosinate (HPPD-resistant). Glyphosate-resistant CW was controlled (≥90%) all season with a two-pass weed control system across all herbicide-resistant soybean technologies evaluated. The two-pass weed control system in this research is defined as a PRE herbicide followed by a POST herbicide. At 12 WAA, the two-pass programs in LibertyLink, Enlist, and HPPD-resistant systems controlled GR CW up to 98, 98, and 92%, respectively, and reduced GR CW densities to 0 to 2% of the weedy control at 4 WAA. The two-pass programs provided greater GR CW control than PRE or POST herbicides alone. This study found that the use of two-pass weed control programs in glufosinate-resistant, glyphosate DMA/2,4-D choline-resistant and HPPD-resistant soybean can provide excellent control of GR CW, and can be valuable tools to reduce the selection intensity for herbicide-resistant weeds. Through the rotational use of different technologies, growers may be able to better manage their weed populations in reducing the risk of resistance when compared to the use of one herbicide repeatedly.
The Protectorate is arguably the Cinderella of Interregnum studies: it lacks the immediate drama of the Regicide, the Republic or the Restoration, and is often dismissed as a 'retreat from revolution', a short period of conservative rule before the inevitable return of the Stuarts. The essays in this volume present new research that challenges this view. They argue instead that the Protectorate was dynamic and progressive, even if the policies put forward were not always successful, and often created further tensions within the government and between Whitehall and the localities. Particular topics include studies of Oliver Cromwell and his relationship with Parliament, and the awkward position inherited by his son, Richard; the role of art and architecture in creating a splendid protectoral court; and the important part played by the council, as a law-making body, as a political cockpit, and as part of a hierarchy of government covering not just England but also Ireland and Scotland. There are also investigations of the reactions to Cromwellian rule in Wales, in the towns and cities of the Severn/Avon basin, and in the local communities of England faced with a far-reaching programme of religious reform. PATRICK LITTLE is Senior Research Fellow at the History of Parliament Trust. Contributors: BARRY COWARD, DAVID L. SMITH, JASON PEACEY, PAUL HUNNEYBALL, BLAIR WORDEN, PETER GAUNT, LLOYD BOWEN, STEPHEN K. ROBERTS, CHRISTOPHER DURSTON.
Glyphosate-resistant (GR) common waterhemp is the fifth GR weed species confirmed in Canada, and the fourth in Ontario. As of 2017, GR common waterhemp has been confirmed in Lambton, Essex, and Chatham-Kent counties in Ontario. Greenhouse and field dose–response experiments revealed that GR common waterhemp in Ontario had a resistance level of 4.5 and 28, respectively, when compared with known glyphosate-susceptible populations. At 12 wk after application, pyroxasulfone/flumioxazin (240 g ai ha−1), pyroxasulfone/sulfentrazone (300 g ai ha−1), and S-metolachlor/metribuzin (1,943 g ai ha−1) controlled GR common waterhemp 97%, 92%, and 87%, respectively. Pyroxasulfone/sulfentrazone or S-metolachlor/metribuzin applied PRE followed by acifluorfen (600 g ai ha−1) or fomesafen (240 g ai ha−1) applied POST controlled GR common waterhemp 98% and performed better than PRE or POST alone. This research is the first to determine the resistance factor of GR common waterhemp in Ontario and identifies control strategies in soybean to mitigate the impact of common waterhemp interference in soybean crop production.
Molecular assays are often implemented by weed scientists for detection of
herbicide-resistant individuals; however, the utility of these assays can be
limited if multiple mechanisms of evolved resistance exist. Waterhemp
resistant to protoporphyrinogen oxidase (PPO)– inhibiting herbicides is
conferred by a target-site mutation in PPX2L (a gene coding
for PPO), resulting in the loss of a glycine at position 210 (ΔG210). This
ΔG210 mutation of PPX2L is the only known mechanism
responsible for PPO-inhibitor resistance (PPO-R) in waterhemp from five
states (Illinois, Indiana, Iowa, Kansas, and Missouri); however, a limited
number of populations have been tested, especially in Illinois. To verify
the ubiquity of the ΔG210 in PPO-R waterhemp populations in Illinois, a
previously published allele-specific PCR (asPCR) was used for the detection
of the ΔG210 mutation to associate this mutation with phenotypic resistance
in 94 Illinois waterhemp populations. The ΔG210 mutation was detected in all
populations displaying phenotypic resistance to lactofen (220 g ai
ha−1), indicating the deletion is likely the only mechanism of
resistance. With evidence that the ΔG210 mutation dominates PPO-R waterhemp
biotypes, molecular detection techniques have considerable utility.
Unfortunately, the previously published asPCR is time consuming, very
sensitive to PCR conditions, and requires additional steps to eliminate the
possibility of false negatives. To overcome these limitations, a streamlined
molecular method using the TaqMan® technique was developed, utilizing
allele-specific, fluorescent probes for high-throughput, robust
discrimination of each allele (resistant and susceptible) at the 210th amino
acid position of PPX2L.