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The incidence of infections from extended-spectrum β-lactamase (ESBL)–producing Enterobacterales (ESBL-E) is increasing in the United States. We describe the epidemiology of ESBL-E at 5 Emerging Infections Program (EIP) sites.
During October–December 2017, we piloted active laboratory- and population-based (New York, New Mexico, Tennessee) or sentinel (Colorado, Georgia) ESBL-E surveillance. An incident case was the first isolation from normally sterile body sites or urine of Escherichia coli or Klebsiella pneumoniae/oxytoca resistant to ≥1 extended-spectrum cephalosporin and nonresistant to all carbapenems tested at a clinical laboratory from a surveillance area resident in a 30-day period. Demographic and clinical data were obtained from medical records. The Centers for Disease Control and Prevention (CDC) performed reference antimicrobial susceptibility testing and whole-genome sequencing on a convenience sample of case isolates.
We identified 884 incident cases. The estimated annual incidence in sites conducting population-based surveillance was 199.7 per 100,000 population. Overall, 800 isolates (96%) were from urine, and 790 (89%) were E. coli. Also, 393 cases (47%) were community-associated. Among 136 isolates (15%) tested at the CDC, 122 (90%) met the surveillance definition phenotype; 114 (93%) of 122 were shown to be ESBL producers by clavulanate testing. In total, 111 (97%) of confirmed ESBL producers harbored a blaCTX-M gene. Among ESBL-producing E. coli isolates, 52 (54%) were ST131; 44% of these cases were community associated.
The burden of ESBL-E was high across surveillance sites, with nearly half of cases acquired in the community. EIP has implemented ongoing ESBL-E surveillance to inform prevention efforts, particularly in the community and to watch for the emergence of new ESBL-E strains.
Background: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a frequent cause of healthcare-associated infections (HAIs). The CDC Emerging Infections Program (EIP) conducted population and laboratory-based surveillance of CRPA in selected areas in 8 states from August 1, 2016, through July 31, 2018. We aimed to describe the molecular epidemiology and mechanisms of resistance of CRPA isolates collected through this surveillance. Methods: We defined a case as the first isolate of P. aeruginosa resistant to imipenem, meropenem, or doripenem from the lower respiratory tract, urine, wounds, or normally sterile sites identified from a resident of the EIP catchment area in a 30-day period; EIP sites submitted a systematic random sample of isolates to CDC for further characterization. Of 1,021 CRPA clinical isolates submitted, 707 have been sequenced to date using an Illumina MiSeq. Sequenced genomes were classified using the 7-gene multilocus sequence typing (MLST) scheme, and a core genome MLST (cgMLST) scheme was used to determine phylogeny. Antimicrobial resistance genes were identified using publicly available databases, and chromosomal mechanisms of carbapenem resistance were determined using previously validated genetic markers. Results: There were 189 sequence types (STs) among the 707 sequenced genomes (Fig. 1). The most frequently occurring were high-risk clones ST235 (8.5%) and ST298 (4.7%), which were found across all EIP sites. Carbapenemase genes were identified in 5 (<1%) isolates. Overall, 95.6% of the isolates had chromosomal mutations associated with carbapenem resistance: 93.2% had porinD-associated mutations that decrease membrane permeability to the drugs; 24.8% had mutations associated with overexpression of the multidrug efflux pump MexAB-OprM; and 22.9% had mutations associated with overexpression of the endogenous β-lactamase ampC. More than 1 such chromosomal resistance mutation type was present in 37.8% of the isolates. Conclusions: The diversity of the sequence types demonstrates that HAIs caused by CRPA can arise from a variety of strains and that high-risk clones are broadly disseminated across the EIP sites but are a minority of CRPA strains overall. Carbapenem resistance in P. aeruginosa was predominantly driven by chromosomal mutations rather than acquired mechanisms (ie, carbapenemases). The diversity of the CRPA isolates and the lack of carbapenemase genes suggest that this ubiquitous pathogen can readily evolve chromosomal resistance mechanisms, but unlike carbapenemases, these cannot be easily spread through horizontal transfer.
Growing in a saline environment causes changes in important physiological processes that are directly related to plant growth and development. In this study we evaluated the effect of salinity on transpiration of sorghum plants in semi-arid conditions and found that the highest rates of transpiration were observed in the hottest hours of the day, between 10 a.m. and 3 p.m., with plants subjected to the saline environment having their transpiration reduced by up to 70% when compared to the non-saline environment. This behavior can be reflected in reductions in plant growth and development due to reduced water absorption by the roots, consequently causing an imbalance of nutrients in the plant due to low absorption rate and competition between nutrients and salts in the preferred routes of absorption in the roots.
To evaluate the impact of ‘holistic’ link-workers on service users’ well-being, activation and frailty, and their use of health and social care services and the associated costs.
UK policy is encouraging social prescribing (SP) as a means to improve well-being, self-care and reduce demand on the NHS and social services. However, the evidence to support this policy is generally weak and poorly conceptualised, particularly in relation to frail, older people and patient activation. Torbay and South Devon NHS Foundation Trust, an integrated care organisation, commissioned a Well-being Co-ordinator service to support older adults (≥50 years) with complex health needs (≥2 long-term conditions), as part of its service redesign.
A before-and-after study measuring health and social well-being, activation and frailty at 12 weeks and primary, community and secondary care service use and cost at 12 months prior and after intervention.
Most of the 86 participants achieved their goals (85%). On average health and well-being, patient activation and frailty showed a statistically significant improvement in mean score. Mean activity increased for all services (some changes were statistically significant). Forty-four per cent of participants saw a decrease in service use or no change. Thirteen high-cost users (>£5000 change in costs) accounted for 59% of the overall cost increase. This was largely due to significant, rapid escalation in morbidity and frailty. Co-ordinators played a valuable key-worker role, improving the continuity of care, reducing isolation and supporting carers. No entry-level participant characteristic was associated with change in well-being or service use. Larger, better conceptualised, controlled studies are needed to strengthen claims of causality and develop national policy in this area.
This article examines the tombstone of Meletios II, a native of Tenedos, who was briefly Ecumenical Patriarch in 1768–9. It also offers an account of his troubled patriarchate and sketches events in the rest of his ecclesiastical career. This hitherto unknown tombstone has rested for an indeterminate number of years in the garden of North Bank, a large Victorian mansion in Pages Lane in the North London suburb of Muswell Hill. It appears to have been in the grounds of North Bank before the house became an annexe of Muswell Hill Methodist Church. It is not known where in the Ottoman Empire Meletios' grave was originally situated, nor has it been possible to establish the circumstances in which the tombstone came to North Bank. On the basis of the inscription on the tombstone it is possible to establish Meletios' previously unknown date of death, 5 January 1780. It appears to be one of the earliest known tombstones of an Ecumenical Patriarch during the period of the Tourkokratia.
In 2016 the Archaeology Data Service (ADS) was 20 years old. Since its birth the ADS has had to respond to rapid changes in technology, as well as major cultural and organizational changes in the external operating environment, from which a sustainable business model for digital preservation has emerged. This article will take a retrospective look at challenges that have been faced and will review current and future priorities for those seeking to establish digital repositories. Digital preservation and open access to research data are now much higher up the agenda of funding bodies, but there is still lack of agreement on what constitutes a core digital archive from a fieldwork project. The paper will review what the significant properties of an archaeological archive are, and how reuse can be supported, linking data and publications. It will consider the challenge of dealing with the gray literature and of avoiding creating further data silos, featuring new initiatives to provide interoperability between digital repositories. It will review the role of data and metadata standards, and consider how the profession needs to address its responsibilities over the next 20 years.
Extinctions have altered island ecosystems throughout the late Quaternary. Here, we review the main historic drivers of extinctions on islands, patterns in extinction chronologies between islands, and the potential for restoring ecosystems through reintroducing extirpated species. While some extinctions have been caused by climatic and environmental change, most have been caused by anthropogenic impacts. We propose a general model to describe patterns in these anthropogenic island extinctions. Hunting, habitat loss and the introduction of invasive predators accompanied prehistoric settlement and caused declines of endemic island species. Later settlement by European colonists brought further land development, a different suite of predators and new drivers, leading to more extinctions. Extinctions alter ecological networks, causing ripple effects for islands through the loss of ecosystem processes, functions and interactions between species. Reintroduction of extirpated species can help restore ecosystem function and processes, and can be guided by palaeoecology. However, reintroduction projects must also consider the cultural, social and economic needs of humans now inhabiting the islands and ensure resilience against future environmental and climate change.
This article presents the key results of a major survey carried out by the NEARCH project on the public perception of archaeology and heritage across Europe. The analysis focuses on three main points of significance for contemporary archaeological practice. The first is the image of archaeology and its definition in the perception of the general public. The second concerns the values that archaeology represents for the public. The third focuses on the social expectations placed on archaeologists and archaeology. The NEARCH survey clearly indicates that there is a significant public expectation by Europeans that archaeology should work comprehensively across a broad range of areas, and that cultural heritage management in general needs to engage more with different archaeological and heritage groups.
St Andrews was of tremendous significance in medieval Scotland. Its importance remains readily apparent in the buildings which cluster the rocky promontory jutting out into the North Sea: the towers and walls of cathedral, castle and university provide reminders of the status and wealth of the city in the Middle Ages. As a centre of earthly and spiritual government, as the place of veneration forScotland's patron saint and as an ancient seat of learning, St Andrews was the ecclesiastical capital of Scotland. This volume provides the first full study of this special and multi-faceted centre throughout its golden age. The fourteen chapters use St Andrews as a focus for the discussion of multiple aspects of medieval life in Scotland. They examine church, spirituality, urban society andlearning in a specific context from the seventh to the sixteenth century, allowing for the consideration of St Andrews alongside other great religious and political centres of medieval Europe.
Michael Brown is Professor of Medieval Scottish History, University of St Andrews; Katie Stevenson is Keeper of Scottish History and Archaeology, National Museums Scotland and Senior Lecturer in Late Medieval History, University of St Andrews.
Contributors: Michael Brown, Ian Campbell, David Ditchburn, Elizabeth Ewan, Richard Fawcett, Derek Hall, Matthew Hammond, Julian Luxford, Roger Mason, Norman Reid, Bess Rhodes, Catherine Smith, Katie Stevenson, Simon Taylor, Tom Turpie.
Viking graves and grave-goods in Ireland is the longawaited
outcome of the Irish Viking Graves Project, which ran from 1999–2005. The
project originated at a conference held in Dublin in 1995, at which the
limited understanding of Viking burials was identified as a significant
shortcoming of the Irish archaeological record. Stephen Harrison was
appointed as Research Assistant, and began the major task of making sense of
the antiquarian records of the Royal Irish Academy. The primary aim of this
work was the creation of the first accurate and comprehensive catalogue of
all Viking graves and grave-goods in Ireland. With this volume, that aim has
been handsomely achieved.
This paper presents the results of a multidisciplinary project that has revealed the location, extent and character of the winter camp of the Viking Great Army at Torksey, Lincolnshire, of ad 872–3. The camp lay within a naturally defended area of higher ground, partially surrounded by marshes and bordered by the River Trent on its western side. It is considerably larger than the Viking camp of 873–4 previously excavated at Repton, Derbyshire, and lacks the earthwork defences identified there. Several thousand individuals overwintered in the camp, including warriors, craftworkers and merchants. An exceptionally large and rich metalwork assemblage was deposited during the Great Army’s overwintering, and metal processing and trading was undertaken. There is no evidence for a pre-existing Anglo-Saxon trading site here; the site appears to have been chosen for its strategic location and its access to resources. In the wake of the overwintering, Torksey developed as an important Anglo-Saxon borough with a major wheel-thrown pottery industry and multiple churches and cemeteries. The Torksey evidence allows for a radical reappraisal of the character of Viking winter camps, and the legacy of the Viking Great Army for Anglo-Saxon England.