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Ward round quality is a pivotal component of surgical care and is intimately associated with patient outcomes. Despite this, ward rounds remain largely understudied and underrepresented in medical literature. Accurate and thorough ward round documentation is known to improve communication and patient outcomes and to reduce hospital expenditure. This study aimed to determine the accuracy of ward round documentation.
Methods
A prospective observational cohort study was performed as a sub-analysis of a larger study by reviewing 135 audiovisual recordings of surgical ward rounds over two years at two hospitals. The recordings were transcribed verbatim, and content was designated a level of importance by an external reviewer. This was then compared to the written case notes to determine the accuracy and importance of omitted documentation. Patient age, sex, and length of stay, as well as the senior doctor leading and the intern documenting the ward round, were assessed using multivariable linear mixed-effect models to determine their impact on documentation accuracy.
Results
Nearly one-third (32.4%) of spoken information on the surgical ward round that was deemed “important”, including discharge plans and bookings for surgery, was absent from the patients’ electronic medical records. Additionally, in 11 percent of case notes there was a major conflict between the ward round discussion and what was documented. Younger patients (p=0.04) and patients who had been on the ward longer (p=0.005) were less likely to have accurate documentation. Some interns were significantly worse at documenting discussions than were others (p<0.0001). Day of the week, location, and the senior doctor present did not affect documentation accuracy.
Conclusions
This study demonstrates that a significant amount of important discussion during surgical ward rounds regarding patient care is not recorded accurately, or at all, in the patient medical record. This can lead to preventable patient complications and longer hospital stays, resulting in increased strain on hospital resources. This study emphasizes the need for further research to address this problem.
A common assessment research design is the single-group pre-test/post-test design in which examinees are administered an assessment before instruction and then another assessment after instruction. In this type of study, the primary objective is to measure growth in examinees, individually and collectively. In an item response theory (IRT) framework, longitudinal IRT models can be used to assess growth in examinee ability over time. In a diagnostic classification model (DCM) framework, assessing growth translates to measuring changes in attribute mastery status over time, thereby providing a categorical, criterion-referenced interpretation of growth. This study introduces the Transition Diagnostic Classification Model (TDCM), which combines latent transition analysis with the log-linear cognitive diagnosis model to provide methodology for analyzing growth in a general DCM framework. Simulation study results indicate that the proposed model is flexible, provides accurate and reliable classifications, and is quite robust to violations to measurement invariance over time. The TDCM is used to analyze pre-test/post-test data from a diagnostic mathematics assessment.
Field experiments were conducted at Clayton and Rocky Mount, NC, during summer 2020 to determine the growth and fecundity of Palmer amaranth plants that survived glufosinate with and without grass competition in cotton. Glufosinate (590 g ai ha−1) was applied to Palmer amaranth early postemergence (5 cm tall), mid-postemergence (7 to 10 cm tall), and late postemergence (>10 cm tall) and at orthogonal combinations of those timings. Nontreated Palmer amaranth was grown in weedy, weed-free in-crop (WFIC) and weed-free fallow (WFNC) conditions for comparisons. Palmer amaranth control decreased as larger plants were treated; no plants survived the sequential glufosinate applications in both experiments. The apical and circumferential growth of Palmer amaranth surviving glufosinate treatments was reduced by more than 44% compared to the WFIC and WFNC Palmer amaranth in both experiments. The biomass of Palmer amaranth plants surviving glufosinate was reduced by more than 62% when compared with the WFIC and WFNC in all experiments. The fecundity of Palmer amaranth surviving glufosinate treatments was reduced by more than 73% compared to WFNC Palmer amaranth in all experiments. Remarkably, the plants that survived glufosinate were fecund as WFIC plants only in the Grass Competition experiment. The results prove that despite decreased vegetative growth of Palmer amaranth surviving glufosinate treatment, plants remain fecund and can be fecund as nontreated plants in cotton. These results suggest that a glufosinate-treated grass weed may not have a significant interspecific competition effect on Palmer amaranth that survives glufosinate. Glufosinate should be applied to 5 to 7 cm Palmer amaranth to cease vegetative and reproductive capacities.
Fructose-containing sugars can exaggerate postprandial lipaemia and stimulate hepatic de novo lipogenesis (DNL) when compared to glucose-based carbohydrates(1). Galactose has recently been shown to increase postprandial lipaemia compared to glucose(2), but mechanisms remain uncharacterised. The aim of this study was to assess the effect and mechanisms of lactose-induced lipaemia.
Twenty-four non-obese adults (12 male and 12 female) completed three trials in a randomised, crossover design (28 ± 7-day washout). During trials, participants consumed test drinks containing 50 g fat with 100 g of carbohydrate. The control carbohydrate was a glucose polymer (maltodextrin), the experimental carbohydrate was galactose-containing carbohydrate (lactose) and the active comparator was fructose-containing carbohydrate (sucrose). Hepatic DNL was assessed by the 2H2O method and [U-13C]-palmitate was added to the test drink to trace the fate of the ingested fat. Blood and breath samples were taken to determine plasma metabolite and hormone concentrations, in addition to plasma and breath 2H and 13C enrichments. Data were converted into incremental under the curve (iAUC) and were checked for normality by visual inspection of residuals. Differences between trials were assessed by one-way ANOVA. Where a main effect of trial was detected, post- hoc t-tests were performed to determine which trials differed from lactose according to the principle of closed-loop testing.
The plasma triacylglycerol iAUC (mean ± SD) in response to maltodextrin was 51 ± 68 mmol/L*360 min. Following lactose ingestion, plasma triacylglycerol iAUC increased to 98 ± 88 mmol/L*360 min (p<0.001 vs maltodextrin), which was comparable to sucrose [90 ± 95 mmol/L*360 min (p=0.41 vs lactose)]. Hepatic DNL in response to maltodextrin was 6.6 ± 3.0%. Following ingestion of lactose, hepatic DNL increased to 12.4 ± 6.9% (p=0.02 vs maltodextrin), which was comparable to sucrose [12.2 ± 6.9% (p=0.96 vs lactose)]. Exhaled 13CO2 in response to maltodextrin was 10.4 ± 4.1 mmol/kgFFM*360 min. Following ingestion of lactose, exhaled 13CO2 was 8.8 ± 4.9 mmol/kgFFM*360 min (p=0.09 vs maltodextrin), which was lower than sucrose [11.1 ± 3.9 mmol/kgFFM*360 min (p=0.01 vs lactose)].
These data are consistent with the hypothesis that hepatic de novo lipogenesis contributes to both lactose and sucrose-induced lipaemia and provide a rationale to investigate the longer-term effects of lactose and sucrose on metabolism.
Field experiments were conducted at Clayton and Rocky Mount, North Carolina, during the summer of 2020 to determine the growth and fecundity of Palmer amaranth plants that survived glufosinate with and without grass competition in soybean crops. Glufosinate (590 g ai ha−1) was applied at early postemergence (when Palmer amaranth plants were 5 cm tall), mid-postemergence (7–10 cm), and late postemergence (>10 cm) and at orthogonal combinations of those timings. Nontreated Palmer amaranth was grown in weedy (i.e., intraspecific and grass competition), weed-free in-crop (WFIC), and weed-free fallow (WFNC) conditions for comparisons. No Palmer amaranth plants survived the sequential glufosinate applications and control decreased as the plants were treated at a larger size in both experiments. The apical and circumferential growth rate of Palmer amaranth surviving glufosinate was reduced by more than 44% compared with the WFNC Palmer amaranth. The biomass of Palmer amaranth plants that survived glufosinate was reduced by more than 87% compared with the WFNC Palmer amaranth. The fecundity of Palmer amaranth that survived glufosinate was reduced by more than 70% compared with WFNC Palmer amaranth. Palmer amaranth plants that survived glufosinate were as fecund as the WFIC Palmer amaranth in both experiments in soybean fields. The results prove that despite the significant vegetative growth rate decrease of Palmer amaranth that survived glufosinate, plants can be as fecund as nontreated plants. The trends in growth and fecundity of Palmer amaranth that survives glufosinate with and without grass competition were similar. These results suggest that glufosinate-treated grass weeds may not reduce the growth or fecundity of Palmer amaranth that survives glufosinate.
We prove an incidence result counting the k-rich $\delta $-tubes induced by a well-spaced set of $\delta $-atoms. Our result coincides with the bound that would be heuristically predicted by the Szemerédi–Trotter theorem and holds in all dimensions $d \geq 2$. We also prove an analogue of Beck’s theorem for $\delta $-atoms and $\delta $-tubes as an application of our result.
An experiment was conducted to investigate the incidence of travel sickness in pigs, specific hormone concentrations at exsanguination and subsequent meat quality. Fifty, 80kg slaughter pigs were transported on a lorry for 4.5h. During the journey, behavioural observations of the individually marked pigs were made by scanning every 8min to establish whether the pigs exhibited certain symptoms of travel sickness (foaming at the mouth and chomping) and incidences of retching and vomiting were noted as they occurred. Upon arrival at the slaughterhouse, pigs were unloaded, slaughtered immediately and a blood sample was taken at exsanguination for analysis of plasma Cortisol, beta-endorphin and lysine vasopressin concentrations. On the day following slaughter, the chilled carcase of each pig was assessed for meat quality (using pH, Fibre Optic Probe, and Tecpro Pork Quality Meter measurements) in the longissimus dorsi, semimembranosus and adductor muscles to determine the incidence of PSE (pale, soft, exudative) or DFD (dark, firm, dry) meat quality. Twenty-six per cent of the pigs (a total of 13 individuals) vomited or retched during the journey. There was no relationship between the incidence of travel sickness and either the concentrations of the hormones analysed at exsanguination or subsequent meat quality. Correlations revealed no significant relationship between concentrations of the hormones and meat quality measurements.
Each of two 20-sow groups consisted of gilts ie virgin sows (one third) and sows (parity 2-5, ie sows which had given birth 2-5 times). One group was housed indoors with a straw-covered lying area and dunging area. Another group was housed outdoors with a covered straw lying area and two rooting fields. Behavioural observations were made on both groups: indoor sows were observed for 4h day−1, for 10 days (40h); outdoor sows were observed for 6h day−1, for 21 days (126h). Social interactions were classified as threat, bite, knock and push. Continuous data on the type of interaction and the winner or loser were recorded. Four measures of social status, based on social behaviour, were calculated: i) displacement index; ii) level of interaction; iii) success in interactions; and iv) matrix dominance. Spearman rank correlation coefficients between different ranked measures of social status within each group (outdoor or indoor) were significant for displacement index, success in interaction and matrix dominance. The level of interaction did not correlate with other measures (except for matrix dominance in the indoor group). Measures of displacement, success in interaction and matrix dominance provide highly consistent and correlated measures of social status.
Childhood experiences of animals and current attitudes towards animals were assessed using a questionnaire, which was completed by 227 Japanese students and 174 British students. Pet ownership in childhood, as well as contact with other animals and negative experiences of pets, were used as the independent variables; current attitudes towards pets and other animals were the dependent variables. There were some differences between Japan and the UK: in childhood, the British students had had significantly more pets and more animal-related experiences, such as visiting animal shelters and livestock farms, than had the Japanese students. Their current attitudes were also more positive, and they showed a greater interest in animal welfare issues than did the Japanese students. In both countries there was a positive association between childhood pet-keeping and current favourable attitudes to pets, as measured by the Pet Attitude Scale. Open-ended responses also suggested that the roles of pets for children are perceived in similar ways in Japan and the UK. Adult attitudes to pets and interest in animal welfare seem to be greatly influenced in both countries by childhood experiences of animals, including pets, and may therefore be a general phenomenon.
Biotypes of Palmer amaranth that are resistant to acetolactate synthase (ALS) inhibitor are becoming widespread in western Nebraska. There are limited effective postemergence (POST) herbicides labeled for ALS-inhibitor-resistant Palmer amaranth control in dry edible bean. The objective of this study was to evaluate the efficacy of dimethenamid-P in a sequential preemergence (PRE) fb followed by (fb) POST program at two POST application timings, the first and third trifoliate stages (V1 and V3, respectively), for controlling ALS-inhibitor-resistant Palmer amaranth in dry edible bean. A field study was conducted in 2019, 2020, and 2021 in Scottsbluff, NE. PRE-alone applications of pendimethalin + dimethenamid-P provided inconsistent Palmer amaranth control. Dimethenamid-P applied POST following a PRE application of pendimethalin + dimethenamid-P provided effective (>90%) Palmer amaranth control at 4 wk after V3 only at the V1 application timing in 2019. In 2020 and 2021 dimethenamid-P applied POST at V1 and V3 following a PRE application of pendimethalin + dimethenamid-P provided 99% and 98% Palmer amaranth control at 4 wk after V3, and 98% and 94% Palmer amaranth control at harvest, respectively. Palmer amaranth biomass was reduced by 95% to 99% and by 96% to 98% compared with the -nontreated control when dimethenamid-P was applied POST at V1 and V3, respectively, following a PRE application of pendimethalin + dimethenamid-P in 2020 and 2021. Application of a mixture of dimethenamid-P with imazamox + bentazon POST provided similar results to those of the fomesafen-containing treatments and dimethenamid-P alone POST. Dimethenamid-P applied POST following a PRE application of pendimethalin + dimethenamid-P resulted in similar yield as the fomesafen-containing treatments. If fomesafen is not an option due to the crop rotation interval restriction, using dimethenamid-P in a sequential PRE fb POST program is the only effective alternative to control ALS-inhibitor–resistant Palmer amaranth in Nebraska. The use of dimethenamid-P in a sequential PRE fb POST program, alone or mixed with foliar-active herbicides should be considered by dry edible bean growers who are dealing with ALS-inhibitor-resistant Palmer amaranth.
Although Palmer amaranth is currently not widespread in most dry edible bean−producing states in the United States, it is widespread in western Nebraska, a major dry edible bean−producing region. There is currently a lack of research on management and biology of Palmer amaranth within dry edible bean production. The objective of this study was to quantify the impact of season-long Palmer amaranth interference on yield of dry edible bean and seed production of Palmer amaranth. A field study was conducted in Scottsbluff, NE, in 2020 and 2021. Palmer amaranth interference at densities of 0, 0.2, 0.3, 0.5, 1, and 2 plants m−1 row of dry edible bean was evaluated. Palmer amaranth interference reduced dry edible bean yield by 77% at a weed density of 2 plants m−1 row compared to the weed-free control, and a 5% yield reduction threshold was estimated to occur at a Palmer amaranth density of 0.02 plants m−1 row. Yield reduction occurred primarily through a reduction in the number of pods per plant as Palmer amaranth density increased. Palmer amaranth plants produced 91,000 to 376,000 seeds per plant depending on densities, and as many as 140,000 seeds m−2. Study results will help farmers and other stakeholders estimate Palmer amaranth interference within their fields, and may help justify the economic cost of incorporating additional Palmer amaranth management practices.
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
Garden loosestrife (Lysimachia vulgaris L.), is an invasive wetland plant that is subject to management in King County, WA, USA. Large-scale management efforts are generally conducted using herbicides. In this case study, we analyzed 17 yr of monitoring and treatment data in four riparian areas in King County to estimate the rate of spread of L. vulgaris and the efficacy of herbicidal treatments against L. vulgaris populations. In each area, herbicide treatments were applied annually. In three of the areas, the area infested with L. vulgaris did not change over time, while in the fourth area populations of L. vulgaris were spreading at a rate of 0.79 m2 yr−1. There were a greater number of sampled locations infested with L. vulgaris over the 17-yr period, and because populations were either not spreading or spreading slowly, it is possible that populations were becoming more fragmented. There was no relationship between the percentage of the infested area treated with herbicides and the area infested in the following year. However, there was a negative relationship between the area treated and the percent change in the invaded area; specifically, in years when <80% of the infested area was treated, there was an increase in the percent change of the invaded area between the year of treatment and the following year. The results of this study suggest that at the current level of management effort, the spatial extent of L. vulgaris did not retract over the 17-yr study period.
Gonorrhoea cases in women have been rising in Australia in the 2010s but the cause of the increase is not well understood. This cross-sectional study aimed to describe the characteristics of genital gonorrhoea infection in women attending the Melbourne Sexual Health Centre, Australia. Gonorrhoea cases were diagnosed by nucleic acid amplification test (NAAT) and/or culture. Genitourinary specimens were obtained in 12 869 clinic visits in women aged 16 years or above between August 2017 and August 2018. Genital gonorrhoea was detected in 142 (1.1%) of the visits. Almost half of the cases were asymptomatic, 47.9% [95% confidence interval (CI) 39.8–56.1%]; yellow, green or pus-like vaginal discharge was present in 11.3% (95% CI 7.0–17.6%) and other genital symptoms in 40.8% (95% CI 33.1–49.1%) of the cases. The mean time between last sexual contact and onset of symptoms was 7.3 days and between the onset of symptoms to presentation to the clinic was 12.1 days. Half of the cases of genital gonorrhoea among women are asymptomatic and these cases would have been missed by testing of only symptomatic women. Further epidemiological and behavioural research is required to understand the temporal changes in sexual practices among women in Australia.
Building on prior work regarding the potential for peer contagion or deviance training in group delivered interventions (Dishion & Dodge, 2005, 2006; Dodge, Dishion, & Lansford, 2006), we leveraged data from a randomized trial, testing the integration of two preventive interventions (Promoting Alternative THinking Strategies and PAX Good Behavior Game), to explore the extent to which classroom contextual factors served as either a barrier to or a motivator for teachers to implement the evidence-based PAX Good Behavior Game with high frequency or dosage. We included students’ baseline levels of behavior, measured with regard to both positive (i.e., engagement and social emotional skills) and negative (i.e., hyperactive and aggressive-disruptive) behaviors. Data were collected from 204 teachers in 18 urban elementary schools. A series of multilevel structural equation models were fit to the data. The analyses indicated that classrooms with higher classroom levels of aggressive behavior, on average, at baseline had teachers with lower implementation dosage (i.e., played fewer games) across the school year. In addition, teachers who reported higher baseline levels of emotional exhaustion, regardless of student behavior, also reported lower implementation dosage. Taken together, the results indicated that negative, but not positive, contextual factors at baseline were related to lower implementation dosage; this, in turn, suggests that negative contextual factors may serve as a barrier, rather than a motivator, of teachers’ implementation dosage of classroom-based preventive interventions.