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Vaccination against hepatitis B virus (HBV) is effective at preventing vertical transmission. Sierra Leone, Liberia, and Guinea are hyperendemic West African countries; yet, childhood vaccination coverage is suboptimal, and the determinants of incomplete vaccination are poorly understood. We analyzed national survey data (2018–2020) of children aged 4–35 months to assess complete HBV vaccination (receiving 3 doses of the pentavalent vaccine) and incomplete vaccination (receiving <3 doses). Statistical analysis was conducted using the complex sample command in SPSS (version 28). Multivariate logistic regression was used to identify determinants of incomplete immunization. Overall, 11,181 mothers were analyzed (4,846 from Sierra Leone, 2,788 from Liberia, and 3,547 from Guinea). Sierra Leone had the highest HBV childhood vaccination coverage (70.3%), followed by Liberia (64.6%) and Guinea (39.3%). Within countries, HBV vaccination coverage varied by socioeconomic characteristics and healthcare access. In multivariate regression analysis, factors that were significantly associated with incomplete vaccination in at least one country included sex of the child, Muslim mothers, lower household wealth index, <4 antenatal visits, home delivery, and distance to health facility vaccination (all p < 0.05). Understanding and addressing modifiable determinants of incomplete vaccination will be essential to help achieve the 2030 viral hepatitis elimination goals.
This collection profiles understudied figures in the book and print trades of the seventeenth century. With an equal balance between women and men, it intervenes in the history of the trades, emphasising the broad range of material, cultural, and ideological work these people undertook. It offers a biographical introduction to each figure, placing them in their social, professional, and institutional settings. The collection considers varied print trade roles including that of the printer, publisher, paper-maker, and bookseller, as well as several specific trade networks and numerous textual forms. The biographies draw on extensive new archival research, with details of key sources for further study on each figure. Chronologically organised, this Element offers a primer both on numerous individual figures, and on the tribulations and innovations of the print trade in the century of revolution.
While cannabis use is a well-established risk factor for psychosis, little is known about any association between reasons for first using cannabis (RFUC) and later patterns of use and risk of psychosis.
We used data from 11 sites of the multicentre European Gene-Environment Interaction (EU-GEI) case–control study. 558 first-episode psychosis patients (FEPp) and 567 population controls who had used cannabis and reported their RFUC.
We ran logistic regressions to examine whether RFUC were associated with first-episode psychosis (FEP) case–control status. Path analysis then examined the relationship between RFUC, subsequent patterns of cannabis use, and case–control status.
Controls (86.1%) and FEPp (75.63%) were most likely to report ‘because of friends’ as their most common RFUC. However, 20.1% of FEPp compared to 5.8% of controls reported: ‘to feel better’ as their RFUC (χ2 = 50.97; p < 0.001). RFUC ‘to feel better’ was associated with being a FEPp (OR 1.74; 95% CI 1.03–2.95) while RFUC ‘with friends’ was associated with being a control (OR 0.56; 95% CI 0.37–0.83). The path model indicated an association between RFUC ‘to feel better’ with heavy cannabis use and with FEPp-control status.
Both FEPp and controls usually started using cannabis with their friends, but more patients than controls had begun to use ‘to feel better’. People who reported their reason for first using cannabis to ‘feel better’ were more likely to progress to heavy use and develop a psychotic disorder than those reporting ‘because of friends’.
Pompe disease results from lysosomal acid α-glucosidase deficiency, which leads to cardiomyopathy in all infantile-onset and occasional late-onset patients. Cardiac assessment is important for its diagnosis and management. This article presents unpublished cardiac findings, concomitant medications, and cardiac efficacy and safety outcomes from the ADVANCE study; trajectories of patients with abnormal left ventricular mass z score at enrolment; and post hoc analyses of on-treatment left ventricular mass and systolic blood pressure z scores by disease phenotype, GAA genotype, and “fraction of life” (defined as the fraction of life on pre-study 160 L production-scale alglucosidase alfa). ADVANCE evaluated 52 weeks’ treatment with 4000 L production-scale alglucosidase alfa in ≥1-year-old United States of America patients with Pompe disease previously receiving 160 L production-scale alglucosidase alfa. M-mode echocardiography and 12-lead electrocardiography were performed at enrolment and Week 52. Sixty-seven patients had complete left ventricular mass z scores, decreasing at Week 52 (infantile-onset patients, change −0.8 ± 1.83; 95% confidence interval −1.3 to −0.2; all patients, change −0.5 ± 1.71; 95% confidence interval −1.0 to −0.1). Patients with “fraction of life” <0.79 had left ventricular mass z score decreasing (enrolment: +0.1 ± 3.0; Week 52: −1.1 ± 2.0); those with “fraction of life” ≥0.79 remained stable (enrolment: −0.9 ± 1.5; Week 52: −0.9 ± 1.4). Systolic blood pressure z scores were stable from enrolment to Week 52, and no cohort developed systemic hypertension. Eight patients had Wolff–Parkinson–White syndrome. Cardiac hypertrophy and dysrhythmia in ADVANCE patients at or before enrolment were typical of Pompe disease. Four-thousand L alglucosidase alfa therapy maintained fractional shortening, left ventricular posterior and septal end-diastolic thicknesses, and improved left ventricular mass z score.
Social Media Statement: Post hoc analyses of the ADVANCE study cohort of 113 children support ongoing cardiac monitoring and concomitant management of children with Pompe disease on long-term alglucosidase alfa to functionally improve cardiomyopathy and/or dysrhythmia.
Alcohol use disorder (AUD) and schizophrenia (SCZ) frequently co-occur, and large-scale genome-wide association studies (GWAS) have identified significant genetic correlations between these disorders.
We used the largest published GWAS for AUD (total cases = 77 822) and SCZ (total cases = 46 827) to identify genetic variants that influence both disorders (with either the same or opposite direction of effect) and those that are disorder specific.
We identified 55 independent genome-wide significant single nucleotide polymorphisms with the same direction of effect on AUD and SCZ, 8 with robust effects in opposite directions, and 98 with disorder-specific effects. We also found evidence for 12 genes whose pleiotropic associations with AUD and SCZ are consistent with mediation via gene expression in the prefrontal cortex. The genetic covariance between AUD and SCZ was concentrated in genomic regions functional in brain tissues (p = 0.001).
Our findings provide further evidence that SCZ shares meaningful genetic overlap with AUD.
Understanding place-based contributors to health requires geographically and culturally diverse study populations, but sharing location data is a significant challenge to multisite studies. Here, we describe a standardized and reproducible method to perform geospatial analyses for multisite studies. Using census tract-level information, we created software for geocoding and geospatial data linkage that was distributed to a consortium of birth cohorts located throughout the USA. Individual sites performed geospatial linkages and returned tract-level information for 8810 children to a central site for analyses. Our generalizable approach demonstrates the feasibility of geospatial analyses across study sites to promote collaborative translational research.
Surgical antimicrobial prophylaxis (SAP) is commonly administered in orthopedic procedures. Research regarding SAP appropriateness for specific orthopedic procedures is limited and is required to facilitate targeted orthopedic prescriber behavior change.
To describe SAP prescribing and appropriateness for orthopedic procedures in Australian hospitals.
Design, setting, and participants:
Multicenter, national, quality improvement study with retrospective analysis of data collected from Australian hospitals via Surgical National Antimicrobial Prescribing Survey (Surgical NAPS) audits from January 1, 2016, to April 15, 2019, were analyzed.
Logistic regression identified hospital, patient and surgical factors associated with appropriateness. Adjusted appropriateness was calculated from the multivariable model. Additional subanalyses were conducted on smaller subsets to calculate the adjusted appropriateness for specific orthopedic procedures.
In total, 140 facilities contributed to orthopedic audits in the Surgical NAPS, including 4,032 orthopedic surgical episodes and 6,709 prescribed doses. Overall appropriateness was low, 58.0% (n = 3,894). This differed for prescribed procedural (n = 3,978, 64.7%) and postprocedural doses (n = 2,731, 48.3%). The most common reasons for inappropriateness, when prophylaxis was required, was timing for procedural doses (50.9%) and duration for postprocedural prescriptions (49.8%). The adjusted appropriateness of each orthopedic procedure group was low for procedural SAP (knee surgery, 54.1% to total knee joint replacement, 74.1%). The adjusted appropriateness for postprocedural prescription was also low (from hand surgery, 40.7%, to closed reduction fractures, 68.7%).
Orthopedic surgical specialties demonstrated differences across procedural and postprocedural appropriateness. The metric of appropriateness identifies targets for quality improvement and is meaningful for clinicians. Targeted quality improvement projects for orthopedic specialties need to be developed to support optimization of antimicrobial use.
Mexican Americans suffer from a disproportionate burden of modifiable risk factors, which may contribute to the health disparities in mild cognitive impairment (MCI) and Alzheimer’s disease (AD).
The purpose of this study was to elucidate the impact of comorbid depression and diabetes on proteomic outcomes among community-dwelling Mexican American adults and elders.
Data from participants enrolled in the Health and Aging Brain among Latino Elders study was utilized. Participants were 50 or older and identified as Mexican American (N = 514). Cognition was assessed via neuropsychological test battery and diagnoses of MCI and AD adjudicated by consensus review. The sample was stratified into four groups: Depression only, Neither depression nor diabetes, Diabetes only, and Comorbid depression and diabetes. Proteomic profiles were created via support vector machine analyses.
In Mexican Americans, the proteomic profile of MCI may change based upon the presence of diabetes. The profile has a strong inflammatory component and diabetes increases metabolic markers in the profile.
Medical comorbidities may impact the proteomics of MCI and AD, which lend support for a precision medicine approach to treating this disease.
We developed a decision analytic model to evaluate the impact of a preoperative Staphylococcus aureus decolonization bundle on surgical site infections (SSIs), health-care–associated costs (HCACs), and deaths due to SSI.
Our model population comprised US adults undergoing elective surgery. We evaluated 3 self-administered preoperative strategies: (1) the standard of care (SOC) consisting of 2 disinfectant soap showers; (2) the “test-and-treat” strategy consisting of the decolonization bundle including chlorhexidine gluconate (CHG) soap, CHG mouth rinse, and mupirocin nasal ointment for 5 days) if S. aureus was found at any of 4 screened sites (nasal, throat, axillary, perianal area), otherwise the SOC; and (3) the “treat-all” strategy consisting of the decolonization bundle for all patients, without S. aureus screening. Model parameters were derived primarily from a randomized controlled trial that measured the efficacy of the decolonization bundle for eradicating S. aureus.
Under base-case assumptions, the treat-all strategy yielded the fewest SSIs and the lowest HCACs, followed by the test-and-treat strategy. In contrast, the SOC yielded the most SSIs and the highest HCACs. Consequently, relative to the SOC, the average savings per operation was $217 for the treat-all strategy and $123 for the test-and-treat strategy, and the average savings per per SSI prevented was $21,929 for the treat-all strategy and $15,166 for the test-and-treat strategy. All strategies were sensitive to the probability of acquiring an SSI and the increased risk if SSI if the patient was colonized with SA.
We predict that the treat-all strategy would be the most effective and cost-saving strategy for preventing SSIs. However, because this strategy might select more extensively for mupirocin-resistant S. aureus and cause more medication adverse effects than the test-and-treat approach or the SOC, additional studies are needed to define its comparative benefits and harms.
To determine the efficacy in eradicating Staphylococcus aureus (SA) carriage of a 5-day preoperative decolonization bundle compared to 2 disinfectant soap showers, with both regimens self-administered at home.
Open label, single-center, randomized clinical trial.
Ambulatory orthopedic, urologic, neurologic, colorectal, cardiovascular, and general surgery clinics at a tertiary-care referral center in the United States.
Patients at the University of Minnesota Medical Center planning to have elective surgery and not on antibiotics.
Consenting participants were screened for SA colonization using nasal, throat, axillary, and perianal swab cultures. Carriers of SA were randomized, stratified by methicillin resistance status, to a decolonization bundle group (5 days of nasal mupirocin, chlorhexidine gluconate [CHG] bathing, and CHG mouthwash) or control group (2 preoperative showers with antiseptic soap). Colonization status was reassessed preoperatively. The primary endpoint was absence of SA at all 4 screened body sites.
Of 427 participants screened between August 31, 2011, and August 9, 2016, 127 participants (29.7%) were SA carriers. Of these, 121 were randomized and 110 were eligible for efficacy analysis (57 decolonization bundle group, 53 control group). Overall, 90% of evaluable participants had methicillin-susceptible SA strains. Eradication of SA at all body sites was achieved for 41 of 57 participants (71.9%) in the decolonization bundle group and for 13 of 53 participants (24.5%) in the control group, a difference of 47.4% (95% confidence interval [CI], 29.1%–65.7%; P<.0001).
An outpatient preoperative antiseptic decolonization bundle aimed at 4 body sites was significantly more effective in eradicating SA than the usual disinfectant showers (ie, the control).
This study explored the combined impact of depression and inflammation on memory functioning among Mexican-American adults and elders.
Data were analyzed from 381 participants of the Health and Aging Brain study among Latino Elders (HABLE). Fasting serum samples were collected and assayed in duplicate using electrochemiluminesce on the SECTOR Imager 2400A from Meso Scale Discovery. Positive DepE (depression endophenotype) was codified as any score >1 on a five-point scale based on the GDS-30. Inflammation was determined by TNFα levels and categorized by tertiles (1st, 2nd, 3rd). WMS-III LMI and LMII as well as CERAD were utilized as measures of memory. ANOVAs examined group differences between positive DepE and inflammation tertiles with neuropsychological scale scores as outcome variables. Logistic regressions were used to examine level of inflammation and DepE positive status on the risk for MCI.
Positive DepE as well as higher inflammation were both independently found to be associated with lower memory scores. Among DepE positive, those who were high in inflammation (3rd tertile) were found to perform significantly worse on WMS-III LM I (F = 4.75, p = 0.003), WMS-III LM II (F = 8.18, p < 0.001), and CERAD List Learning (F = 17.37, p < 0.001) when compared to those low on inflammation (1st tertile). The combination of DepE positive and highest tertile of inflammation was associated with increased risk for MCI diagnosis (OR = 6.06; 95% CI = 3.9–11.2, p < 0.001).
Presence of elevated inflammation and positive DepE scores increased risk for worse memory among Mexican-American older adults. Additionally, the combination of DepE and high inflammation was associated with increased risk for MCI diagnosis. This work suggests that depression and inflammation are independently associated with worse memory among Mexican-American adults and elders; however, the combination of both increases risk for poorer memory beyond either alone.
In field studies, sprinkler irrigation application of the butyl ester of fluazifop-P, the methyl ester of haloxyfop, and the ethyl ester of quizalofop controlled large crabgrass as well as conventional spray applications. In greenhouse investigations, root uptake of the herbicides from sprinkler irrigation applications injured large crabgrass more than root uptake from conventional applications, but large crabgrass injury from shoot uptake was equal with sprinkler irrigation and conventional applications. Droplets with dilute concentrations of herbicide and crop oil, simulating sprinkler irrigation, were more active when applied to the whorl or second leaf than to the first leaf of large crabgrass. An increase in concentration of nonemulsified oil in the treatment solution increased herbicide deposition and retention.
Diclosulam is registered for residual and postemergence control of several broadleaf weeds and suppression of annual sedges in peanut in the southeastern United States. Many producers apply herbicides and other pesticides simultaneously to increase the spectrum of pest control or to increase efficiency of operations. However, compatibility of coapplication of pesticides is a concern. Field trials were conducted to evaluate the compatibility of diclosulam with other herbicides and fungicides. Horseweed control by diclosulam in combination with glyphosate, sulfosate, or paraquat was compared to combinations of these herbicides with flumioxazin, tribenuron plus thifensulfuron, or 2,4-D. All treatments that contained diclosulam controlled horseweed at least 86%. Broadleaf signalgrass control by clethodim and sethoxydim was not affected by diclosulam; however, large crabgrass control was reduced when graminicides were coapplied with diclosulam. Common ragweed control was reduced when diclosulam was applied with chlorothalonil and pyraclostrobin but not by azoxystrobin or tebuconazole.
Research was conducted in North Carolina to compare weed control by various rates of imazapic POST alone or following diclosulam PRE. In a second experiment, weed control by imazapic applied POST alone or with acifluoren, diclosulam, or 2,4-DB was compared. In a final experiment, yellow nutsedge control by imazapic alone and with the fungicides azoxystrobin, chlorothalonil, pyraclostrobin, and tebuconazole was compared. Large crabgrass was controlled more effectively by imazapic POST than diclosulam PRE. Common lambsquarters, common ragweed, and eclipta were controlled more effectively by diclosulam PRE than imazapic POST. Nodding spurge was controlled similarly by both herbicides. Few differences in control were noted when comparing imazapic rates after diclosulam PRE. Applying either diclosulam PRE or imazapic POST alone or in combination increased peanut yield over nontreated peanut in five of six experiments. Few differences in pod yield were noted when comparing imazapic rates. Acifluorfen, diclosulam, and 2,4-DB did not affect entireleaf morningglory, large crabgrass, nodding spurge, pitted morningglory, and yellow nutsedge control by imazapic. Eclipta control by coapplication of imazapic and diclosulam exceeded control by imazapic alone. The fungicides azoxystrobin, chlorothalonil, pyraclostrobin, and tebuconazole did not affect yellow nutsedge control by imazapic.
Variation in crop–weed interference relationships has been shown for a number of crop–weed mixtures and may have an important influence on weed management decision-making. Field experiments were conducted at seven locations over 2 yr to evaluate variation in common lambsquarters interference in field corn and whether a single set of model parameters could be used to estimate corn grain yield loss throughout the northcentral United States. Two coefficients (I and A) of a rectangular hyperbola were estimated for each data set using nonlinear regression analysis. The I coefficient represents corn yield loss as weed density approaches zero, and A represents maximum percent yield loss. Estimates of both coefficients varied between years at Wisconsin, and I varied between years at Michigan. When locations with similar sample variances were combined, estimates of both I and A varied. Common lambsquarters interference caused the greatest corn yield reduction in Michigan (100%) and had the least effect in Minnesota, Nebraska, and Indiana (0% yield loss). Variation in I and A parameters resulted in variation in estimates of a single-year economic threshold (0.32 to 4.17 plants m−1 of row). Results of this study fail to support the use of a common yield loss–weed density function for all locations.
Research was conducted in North Carolina to determine peanut response to flumioxazin as influenced by rate and timing of application and cultivar. Delaying application of flumioxazin from 1 d after planting until peanut emergence increased injury regardless of rate. The Virginia market-type cultivar ‘NC-V 11’ was injured more by flumioxazin than the cultivars ‘Gregory’ or ‘Perry’. However, pod yield was not affected by flumioxazin even though significant injury was observed early in the season regardless of flumioxazin rate, application timing, or cultivar. Diclosulam was more effective than flumioxazin in controlling eclipta when these herbicides were applied PRE with metolachlor or following pendimethalin PPI. However, control by flumioxazin prevented yield loss when compared with metolachlor alone.
Diclosulam is generally applied either PPI or PRE to peanut to control certain broadleaf weeds and suppress sedges. Research was conducted to determine efficacy and peanut response to POST applications of diclosulam at 9, 13, 18, and 27 g ai/ha. Efficacy of diclosulam was affected by application rate and environment. Common ragweed control ranged from 60 to 100%, entireleaf morningglory control from 56 to 100%, marestail control from 78 to 85%, and nodding spurge from 50 to 97%. Smooth pigweed and common lambsquarters were both controlled less than 35%. Diclosulam controlled yellow nutsedge and eclipta less than 70 and 80%, respectively. In separate experiments, diclosulam and imazapic controlled dogfennel more effectively than acifluorfen, bentazon, imazethapyr, lactofen, paraquat, or 2,4-DB. Visual estimates of peanut injury were 15% or less for all rates during both years. Peanut yield ranged from 3,340 to 3,730 kg/ha in 2002 and 5,230 to 5,820 kg/ha in 2003. Foliar injury and peanut pod yield were influenced by diclosulam rate, although no clear relation was evident. Cultivar and diclosulam rate did not interact with respect to visual injury or pod yield.
Research was conducted to evaluate structure–function relationships of citric acid esters that varied in alkyl chain number (mono-, di-, and tri-), ethylene oxide number (EO 4,7,9,25,35,52), and alkyl chain length (C8, C12/14, C16/18). Adjuvant efficacy was evaluated on two weed species for each of the four herbicides. The experimental adjuvants were applied with glyphosate and glufosinate on giant foxtail and common lambsquarters, imazamox on velvetleaf and common lambsquarters, and nicosulfuron on giant foxtail and large crabgrass. Adjuvant efficacy was weed and herbicide specific. EO number and alkyl chain length and number influenced adjuvant efficacy with the effectiveness of various combinations dependent on both herbicide and weed species. EO numbers as high as 52 were shown to be effective for glyphosate, glufosinate, and imazamox.
Kochia poses a challenge to vegetation management in both agricultural and noncrop areas. This species has developed widespread resistance to several herbicides with differing modes of action, including acetolactate synthase inhibitors and photosynthesis inhibitors. Resistance is also beginning to appear against the synthetic auxins and glycines. Therefore, alternative PRE and POST herbicides are needed for effective kochia management, especially in roadside bare-ground zones. Both PRE and POST herbicides were screened on rights-of-way in Pennsylvania. Mixtures containing diuron, flumioxazin, sulfentrazone, pendimethalin, prodiamine, and bromacil were evaluated for PRE activity in combination with glyphosate. POST kochia control was assessed for 15 noncrop herbicides. Results from all trials varied with kochia size and vigor at time of treatment. Although diuron is the current industry standard for PRE control in tank mixes, sulfentrazone appeared to have the most POST activity against vigorously growing kochia. All PRE herbicides evaluated performed better than the standard, sulfometuron plus chlorsulfuron alone. Dicamba, dicamba plus diflufenzopyr, fluroxypyr, and glyphosate performed best against kochia when applied POST. The recently available chemistries saflufenacil and aminocyclopyrachlor require further evaluation of application timing and use rates, respectively, for POST activity on kochia.