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 coreplatform@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.
Early in the coronavirus disease 2019 (COVID-19) pandemic, the CDC recommended collection of a lower respiratory tract (LRT) specimen for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) testing in addition to the routinely recommended upper respiratory tract (URT) testing in mechanically ventilated patients. Significant operational challenges were noted at our institution using this approach. In this report, we describe our experience with routine collection of paired URT and LRT sample testing. Our results revealed a high concordance between the 2 sources, and that all children tested for SARS-CoV-2 were appropriately diagnosed with URT testing alone. There was no added benefit to LRT testing. Based on these findings, our institutional approach was therefore adjusted to sample the URT alone for most patients, with LRT sampling reserved for patients with ongoing clinical suspicion for SARS-CoV-2 after a negative URT test.
Carbamazepine, an anticonvulsant also used as a mood stabilizer and for trigeminal neuralgia, is associated with serious, sometimes fatal cutaneous adverse drug reactions, including Stevens Johnson Syndrome and toxic epidermal necrolysis1. Current literature demonstrates a genetic predisposition linked to specific class I and II human leukocyte antigen (HLA) types in various ethnic populations2. HLA-A*31:01 is one such HLA type, and is routinely identified by the tag SNP rs1061235. However, rs1061235 has poor specificity for HLA*31:01 due to interference of HLA-A*33 types3. We investigated the false positive rate in our population and developed a novel real-time PCR assay that distinguishes HLA-A*31:01 from other HLA-A types including HLA-A*33.
Methods
120 unique samples were tested in triplicate during the validation of this assay and were sent to a reference lab for HLA next generation sequencing (NGS) typing, including 89 in-house samples and 31 Coriell samples with documented HLA typing results. The results from our real-time PCR assay were compared to the HLA typing results. HLA typing results were also compared to the tag SNP rs1061235 results to calculate the false positive rate.
Results
There was 100% concordance between our real-time PCR results and expected results based on HLA typing. 89 sample results for tag SNP rs1061235 were compared to HLA typing results. 75/89 samples had a rs1061235 variant, but 31/75 (41%) samples did not have the HLA-A*31:01 type, thus defining the false positive rate of the tag SNP for our population. We theorized there would be a small subset of rare HLA-A types that would interfere with the assay and we tested the three types available to us. We confirmed that 3 of the HLA types (HLA-A*31:04, 31:12, and 31:16) result falsely positive due to sequence homology with 31:01. There is no known literature indicating whether these rare HLA-A*31 subtypes are associated with cutaneous adverse reactions. These 3 HLA types and the other suspected interfering HLA types have limited frequency data sets and are expected to occur rarely in our patient population; we expect these HLA types make up less than 0.003% of the our population. Our assay specificity for the validation is >99%.
Conclusions
Our custom real-time PCR assay for detection of HLA-A*31:01 is significantly more specific than the commonly used tag SNP rs1061235. Clinicians considering carbamazepine therapy for their patients will have a better understanding of cutaneous adverse reaction risk and can make improved personalized treatment decisions. This quick, cost effective assay allows more patients in need of carbamazepine treatment to benefit from its use.
The magnetic resonance imaging (MRI) appearance of the brain and spinal cord in humans with neuroangiostrongyliasis (NA) due to Angiostrongylus cantonensis infection has been well reported. Equivalent studies in animals are lacking. This case series describes clinical and MRI findings in 11 dogs with presumptively or definitively diagnosed NA. MRI of the brain and/or spinal cord was performed using high-field (1.5 T) or low-field (0.25 T) scanners using various combinations of transverse, sagittal, dorsal and three-dimensional (3D) T1-weighted (T1W), transverse, sagittal and dorsal T2-weighted (T2W), T2W fluid-attenuated inversion recovery (FLAIR) and T2*-weighted (T2*W) gradient echo (GRE), dorsal T2W short tau inversion recovery (STIR) and post-gadolinium transverse, sagittal, dorsal and 3D T1W and transverse T2W FLAIR sequences. In 4/6 cases where the brain was imaged, changes consistent with diffuse meningoencephalitis were observed. Evidence of meningeal involvement was evident even when not clinically apparent. The spinal cord was imaged in 9 dogs, with evidence of meningitis and myelitis detected in regions consistent with the observed neuroanatomical localization. Pathognomonic changes of neural larva migrans, as described in some human patients with NA, were not detected. NA should be considered in the differential diagnosis of dogs with MRI evidence of focal or diffuse meningitis, myelitis and/or encephalitis, especially in areas where A. cantonensis is endemic. If not precluded by imaging findings suggestive of brain herniation, cerebrospinal fluid (CSF) collection for cytology, fluid analysis, real-time polymerase chain reaction (qPCR) and enzyme-linked immunosorbent assay (ELISA) testing should be considered mandatory in such cases after the MRI studies.
We examine the environmental impacts of a cash transfer program in rural Zambia and investigate whether variation in market access is associated with heterogeneous impacts on natural resource use. We consider households’ use of firewood, charcoal, bushmeat and land for farming, as well as their ownership of non-farm businesses. We find that cash transfers increase the likelihood of charcoal consumption as well as the amount consumed for those living close to paved roads. The transfers also enable households to increase the size of their farms and establish non-farm businesses. These impacts are most pronounced for those living far from paved roads. While remoteness is associated with farm expansion in response to the cash transfer, more education causes those receiving the transfer to decrease the size of their farms. This impact heterogeneity has important implications for sustainable development.
To compare infant and toddler anthropometric measurements, feeding practices and mean nutrient intakes by race/ethnicity and income.
Design
Cross-sectional analysis using general linear modelling. Ten years of survey data (2003–2012) were combined to compare anthropometric measurements, feeding practices and mean nutrient intakes from a nationally representative US sample.
Setting
The 2003–2012 National Health and Nutrition Examination Survey (NHANES).
Subjects
Infants and toddlers (n 3669) aged 0–24 months.
Results
Rates of overweight were higher among Mexican-American infants and toddlers (P=0·002). There were also several differences in feeding practices among groups based on race/ethnicity. Cessation of breast-feeding occurred earlier for non-Hispanic black and Mexican-American v. non-Hispanic white infants (3·6 and 4·2 v. 5·3 months; P<0·0001; P=0·001). Age at first feeding of solids was earlier for white than Mexican-American infants (5·3 v. 5·7 months; P=0·02). There were differences in almost all feeding practices based on income, including the lowest-income infants stopped breast-feeding earlier than the highest-income infants (3·2 v. 5·8 months, P<0·0001). Several differences in mean nutrient intakes by both race/ethnicity and income were also identified.
Conclusions
Our study indicates that disparities in overweight, feeding practices and mean nutrient intakes exist among infants and toddlers according to race/ethnicity, which cannot be disentangled from income.
It has been proposed that cropping systems can be managed to promote the development of soil microbial communities that accelerate weed seed mortality. We examined soil fungal and bacterial communities, soil C:N ratio, soil particle size fractions, and weed seed mortality in soil from fields with over 10 yr of five contrasting management histories with the objective of determining if seed mortality could be explained by differences in soil properties. Seed mortality of giant foxtail and velvetleaf were greatest in soil from the conventionally managed systems and lowest in soil from a reduced input system. Principal-components analysis of soil microbial communities, as determined through denaturing gradient gel electrophoresis of polymerase chain reaction–amplified ribosomal RNA genes (PCR-DGGE), showed distinct differences in the composition of fungal and bacterial communities among the study soils. The first principal component of the 18S rDNA PCR-DGGE analysis of fungal community composition showed a strong negative correlation with both giant foxtail (− 0.52, P < 0.05) and velvetleaf (− 0.57, P < 0.01) seed mortality, as did ordination with nonmetric multidimensional scaling (NMS) [giant foxtail (− 0.54, P < 0.01) and velvetleaf (− 0.60, P < 0.01)], suggesting that seeds of the two species were affected similarly by changes in the soil fungal community. For giant foxtail, weed seed mortality was also positively correlated (r = 0.48, P < 0.05) with the first NMS axis of the bacterial 16S rDNA analysis. None of the other measured soil properties were significantly correlated with weed seed mortality. Thus, for the soils tested here, management history, microbial community composition, and weed seed mortality were linked. To extend these results to the field, more work is needed to identify components of the fungal and bacterial communities that are active in seed degradation, and to develop conservation biocontrol recommendations for these species.
To determine the impact of total household decolonization with intranasal mupirocin and chlorhexidine gluconate body wash on recurrent methicillin-resistant Staphylococcus aureus (MRSA) infection among subjects with MRSA skin and soft-tissue infection.
DESIGN
Three-arm nonmasked randomized controlled trial.
SETTING
Five academic medical centers in Southeastern Pennsylvania.
PARTICIPANTS
Adults and children presenting to ambulatory care settings with community-onset MRSA skin and soft-tissue infection (ie, index cases) and their household members.
INTERVENTION
Enrolled households were randomized to 1 of 3 intervention groups: (1) education on routine hygiene measures, (2) education plus decolonization without reminders (intranasal mupirocin ointment twice daily for 7 days and chlorhexidine gluconate on the first and last day), or (3) education plus decolonization with reminders, where subjects received daily telephone call or text message reminders.
MAIN OUTCOME MEASURES
Owing to small numbers of recurrent infections, this analysis focused on time to clearance of colonization in the index case.
RESULTS
Of 223 households, 73 were randomized to education-only, 76 to decolonization without reminders, 74 to decolonization with reminders. There was no significant difference in time to clearance of colonization between the education-only and decolonization groups (log-rank P=.768). In secondary analyses, compliance with decolonization was associated with decreased time to clearance (P=.018).
CONCLUSIONS
Total household decolonization did not result in decreased time to clearance of MRSA colonization among adults and children with MRSA skin and soft-tissue infection. However, subjects who were compliant with the protocol had more rapid clearance
Burnout occurs among students when they suddenly lose interest in their studies due to feeling physically and emotionally drained. They experience further emotional depletion due to study demands, distrustfulness and detachment about their work. This study investigated the relationship between the Five-Factor Model (FFM) personality traits and burnout, as operationalised by Maslach's three dimensions of burnout, namely exhaustion, cynicism and reduced personal efficacy. Previous Western research was replicated in order to contribute to the cross-cultural literature on burnout. The Maslach Burnout Inventory – Student Survey University Form and the NEO – Personality Inventory Revised Form S were subjected to stepwise forward regression using FFM factors and facets to predict the scores on each burnout dimension. Five hundred and seventy-seven Filipino college students (age 17 to 24) from private universities and colleges within Metro Manila participated. Results revealed that neuroticism and conscientiousness predict all three burnout constructs. However, certain facets of neuroticism and conscientiousness are more important than others. At the facet level, facets of agreeableness and openness contributed to prediction of burnout as well.
The purpose of this pilot study was to determine whether macronutrient content (low-fat v. high-fat diet) influences an indicator of advanced glycation end products (AGE), Nε carboxymethyl-lysine (CML), in the context of a 1-d, high-AGE diet. The effect of the diets on inflammatory markers was also assessed. A total of nineteen overweight and obese adults (nine men and ten women) without known disease were recruited to participate in a crossover challenge of a high-fat, high-AGE (HFHA) and low-fat, high-AGE (LFHA) diet. In each phase patients had fasting blood drawn, followed by consumption of a high-fat or low-fat breakfast test meal, then three postprandial blood draws at 1, 2 and 3 h after consuming the test meal. After consuming high-AGE meals for the remainder of the day, participants returned the next day for a follow-up analysis. A different pattern in the 3-h post-meal CML and soluble receptor for AGE response to the two diets was observed (P=0·01 and 0·05, respectively). No change in serum CML was observed following consumption of a LFHA breakfast (535 (25th–75th percentile 451–790) to 495 (25th–75th percentile 391–682) ng/ml; P=0·36), whereas a rise in CML occurred after the HFHA breakfast (463 (25th–75th percentile 428–664) to 578 (25th–75th percentile 474–865) ng/ml; P=0·05). High sensitivity C-reactive protein and high molecular weight adiponectin were not affected by either diet. These findings suggest that dietary CML may not be as important in influencing serum CML as other dietary factors. In addition, acute exposure to dietary CML may not influence inflammation in adults without diabetes or kidney disease. This is contrary to previous findings.
To define or describe the middle ages is to take a political stance, wittingly or not. Controversy accompanies any period definition, of course, as recent skirmishes over the early modern, the modern, and modernity attest. But the politics of the Middle Ages has generally gone under the radar of literary and cultural critique, precisely because of the nature of its formation and its relation to the modern. In fact “the Middle Ages” is a colonial category, developed in the eighteenth and nineteenth centuries as (primarily western) Europeans worked to legitimize, classify, and make sense of colonial policies, practices, and encounters. The formation of medieval studies as a discipline, vital to the then incipient discipline of history, was also fully integrated with colonial bureaucracy and administration (Frantzen; Biddick; Dagenais and Greer; Ganim; Kabir; Davis; Davis and Altschul; Lampert-Weissig). As a form of temporal spacing, the category of the Middle Ages enabled the thought of Europe's difference from itself, thus making it possible not only to define European nations across time but also to establish a scale of comparison by which to measure others and to deny them coeval status—that is, equal standing as human beings in regard to law, trade, the capacity for self-rule, and so on.
To identify risk factors for recurrent methicillin-resistant Staphylococcus aureus (MRSA) colonization.
DESIGN
Prospective cohort study conducted from January 1, 2010, through December 31, 2012.
SETTING
Five adult and pediatric academic medical centers.
PARTICIPANTS
Subjects (ie, index cases) who presented with acute community-onset MRSA skin and soft-tissue infection.
METHODS
Index cases and all household members performed self-sampling for MRSA colonization every 2 weeks for 6 months. Clearance of colonization was defined as 2 consecutive sampling periods with negative surveillance cultures. Recurrent colonization was defined as any positive MRSA surveillance culture after clearance. Index cases with recurrent MRSA colonization were compared with those without recurrence on the basis of antibiotic exposure, household demographic characteristics, and presence of MRSA colonization in household members.
RESULTS
The study cohort comprised 195 index cases; recurrent MRSA colonization occurred in 85 (43.6%). Median time to recurrence was 53 days (interquartile range, 36–84 days). Treatment with clindamycin was associated with lower risk of recurrence (odds ratio, 0.52; 95% CI, 0.29–0.93). Higher percentage of household members younger than 18 was associated with increased risk of recurrence (odds ratio, 1.01; 95% CI, 1.00–1.02). The association between MRSA colonization in household members and recurrent colonization in index cases did not reach statistical significance in primary analyses.
CONCLUSION
A large proportion of patients initially presenting with MRSA skin and soft-tissue infection will have recurrent colonization after clearance. The reduced rate of recurrent colonization associated with clindamycin may indicate a unique role for this antibiotic in the treatment of such infection.
Infect. Control Hosp. Epidemiol. 2015;36(7):786–793
Without question, the most controversial yet persistent effort to assign a generic label to Old English poems has been the identification of ‘elegies’ associated with lament and longing for a lost past. Despite common knowledge that this designation grew out of nineteenth-century nationalism as part of an ‘often idealized and romanticized picture of pre-Christian German life’, and despite repeated admission that the label is technically and historically inappropriate for the Old English poems in question, this generic distinction has steadily grown rigid in critical and editorial practice. In part, critics have sidestepped the inherent problems of this label by expanding from ‘elegy’ as a poetic term to the idea of an ‘elegiac mood’, defined long ago as ‘the sense of the vanity of life, the melancholy regret for departed glories’, and this idea has gradually extended to a general association with lament and nostalgia. The odd result is that the more doubtful the Old English genre became, the more flexible and disparate its definitions, so that – despite nearly a century of study and much evidence to the contrary – the nine poems named as elegies by Ernst Sieper in 1915 are still considered to determine the field: The Wanderer, The Seafarer, The Ruin, The Wife’s Lament, Deor, Wulf and Eadwacer, The Husband’s Message, Resignation and The Riming Poem. All of these poems appear in the famous Exeter Book, the first anthology of poetry in English, and together with Beowulf (which is often said to contain elegies and/or to be elegiac) they include the most studied Old English texts.
Most studies of the mental health of UK armed forces focus on
retrospective accounts of deployment and few sample personnel while they
are deployed.
Aims
This study reports the results of a survey of deployed personnel,
examining the perceived impact of events at home and military support for
the family on current mental health during the deployment.
Method
Surveys were conducted with 2042 British forces personnel serving in Iraq
and Afghanistan. Prevalence of common mental disorders was assessed with
the 12-item General Health Questionnaire (GHQ-12) and post-traumatic
stress disorder (PTSD) was assessed with the PTSD Checklist – Civilian
version (PCL-C).
Results
The prevalence of common mental disorders was 17.8% and of probable PTSD
was 2.8%. Perceived home difficulties significantly influenced the mental
health of deployed personnel; the greater the perception of negative
events in the home environment, the greater the reporting of adverse
mental health effects. This finding was independent of combat exposure
and was only partially mitigated by being well led and reporting
subjectively good unit cohesion; however, the effect of the totality of
home-front events was not improved by the latter. Poor perceived military
support for the family had a detrimental impact on deployment mental
health.
Conclusions
The armed forces offer many support services to the partners and families
of deployed personnel and ensuring that the efforts being made on their
behalf are well communicated might improve the mental health of deployed
personnel.
The absence of engineering from K-12 curricula and mainstream media often causes students to refer back to historical stereotypes regarding what engineers look like and the type of work they do. Such misconceptions may prevent high school students from pursuing engineering as a field of study and increase the need for engineering educational programs [1]. Nano-Challenge is an outreach program that orients high school students to engineering through a one-year research internship. The program is held at the Center for Nanoscale Chemical, Electrical, Mechanical Manufacturing Systems (Nano-CEMMS) at the University of Illinois at Urbana-Champaign. A major focus of the program is to involve students from groups traditionally underrepresented in STEM fields and inform them about engineering earlier in their careers. An external program evaluation provides anecdotal information about the students’ experiences and gives feedback to inform program improvement.
Material science can be used to enrich secondary school curriculum and illuminate for students the connection between science and technology. Based on materials research being conducted at the University of Illinois, we have developed an interdisciplinary activity that integrates engineering with chemistry and material science.
Students investigate the behaviors of polymers by creating 3-dimensional (3-D) objects. Students can design objects that they “print” on the order of a cubic inch in about 20 minutes. The process students use to create these objects shows the application of engineering to material science in a novel and engaging way.
A photoactive chemical is initiated by the UV and blue light emitted from a data projector. This causes the formation of free radicals, which interact with molecules of a monomer and cause a polymerization reaction. The visual result of this reaction is that a liquid solidifies where students shine light. With black-and-white images, a data projector can direct the light to form any shape. This process can be easily modified to create true 3-D objects by adding another layer of the liquid to the top of the object and then shining the light again. With about 20 dollars worth of supplies from a hardware store, a simple staging device can be created to greatly simplify the process to create a 3-D printer in the classroom. Fabrication of this device can be done by students because the projector controls the x and y array of pixels; the object only needs to move in the z direction, unlike traditional rapid prototyping machines which control movement in the x, y, and z directions.
Results of integration into high school and college curriculum are discussed, and methods of integration and student perceptions of the activity are reported.
Most research on the mental health of UK armed forces personnel has been conducted either before or after deployment; there is scant evidence concerning personnel while they are on deployment.
Aims
To assess the mental health of UK armed forces personnel deployed in Iraq and identify gaps in the provision of support on operations.
Method
Personnel completed a questionnaire about their deployment experiences and health status. Primary outcomes were psychological distress (General Health Questionnaire–12, GHQ–12), symptoms of post-traumatic stress disorder (PTSD) and self-rating of overall health.
Results
Of 611 participants, 20.5% scored above the cut-off on the GHQ–12 and 3.4% scored as having probable PTSD. Higher risk of psychological distress was associated with younger age, female gender, weaker unit cohesion, poorer perceived leadership and non-receipt of a pre-deployment stress brief. Perceived threat to life, poorer perceived leadership and non-receipt of a stress brief were risk factors for symptoms of PTSD. Better self-rated overall health was associated with being a commissioned officer, stronger unit cohesion and having taken a period of rest and recuperation. Personnel who reported sick for any reason during deployment were more likely to report psychological symptoms. Around 11% reported currently being interested in receiving help for a psychological problem.
Conclusions
In an established operational theatre the prevalence of common psychopathology was similar to rates found in non-deployed military samples. However, there remains scope for further improving in-theatre support mechanisms, raising awareness of the link between reporting sick and mental health and ensuring implementation of current policy to deliver pre-deployment stress briefs.