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Among outpatients with coronavirus disease 2019 (COVID-19) due to the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) δ (delta) variant who did and did not receive 2 vaccine doses at 7 days after symptom onset, there was no difference in viral shedding (cycle threshold difference 0.59, 95% CI, −4.68 to 3.50; P = .77) with SARS-CoV-2 cultured from 2 (7%) of 28 and 1 (4%) of 26 outpatients, respectively.
The cultural landscape of London at the beginning of the twenty-first century was a very different land to the one that we currently inhabit. We slid into the year 2000, with bated breath, as we watched and waited for the potential crashing of computer programmes and the end of civilization as we knew it. Perhaps we did not really believe it, but there seemed to be a real possibility that something could go drastically wrong.
After living abroad for many years I returned to London in the late 1980s and spent much of the 1990s teaching and developing a creative writing portfolio, getting published in anthologies and magazines, and writing reviews for community, national, and international publications. In 2000 one of my poems and a short story were published in the iconic IC3: The Penguin Book of New Black Writing in Britain. In 2004 my poetry collection My Grandmother Sings to Me was published by Bogle-L’Ouverture Publications, a radical black publishing house owned by publishers and civil rights activists Eric and Jessica Huntley. I discovered the Huntleys through one of their major literary events, Salkey's Score: held at the Commonwealth Institute, it was a celebration of the life and work of author Andrew Salkey. As a writer working on an MA at Goldsmiths University, I was looking for a publisher. I came to be involved with the work of Eric and Jessica Huntley during the time they were concerned with finding somewhere to house their archive collection that would ensure its preservation and enable public access to it. Jessica especially wanted the collection to be used by schools and students.
The Huntleys had emigrated from British Guiana, now Guyana, to London between 1957 and 1958 and founded Bogle-L’Ouverture Publications Limited in 1969. It was established after Dr. Walter Rodney, an academic and political activist friend of the Huntleys, was banned from re-entering Jamaica in 1968. His crime was to teach Rastafarians and working-class Jamaicans outside of the University of the West Indies, where he was a lecturer, on African history. The Huntleys published Rodney's lectures in The Groundings with My Brothers and would go on to publish his How Europe Underdeveloped Africa.
To determine the scope, source, and mode of transmission of a multifacility outbreak of extensively drug-resistant (XDR) Acinetobacter baumannii.
SETTING AND PARTICIPANTS
Residents and patients in skilled nursing facilities, long-term acute-care hospital, and acute-care hospitals.
A case was defined as the incident isolate from clinical or surveillance cultures of XDR Acinetobacter baumannii resistant to imipenem or meropenem and nonsusceptible to all but 1 or 2 antibiotic classes in a patient in an Oregon healthcare facility during January 2012–December 2014. We queried clinical laboratories, reviewed medical records, oversaw patient and environmental surveillance surveys at 2 facilities, and recommended interventions. Pulsed-field gel electrophoresis (PFGE) and molecular analysis were performed.
We identified 21 cases, highly related by PFGE or healthcare facility exposure. Overall, 17 patients (81%) were admitted to either long-term acute-care hospital A (n=8), or skilled nursing facility A (n=8), or both (n=1) prior to XDR A. baumannii isolation. Interfacility communication of patient or resident XDR status was not performed during transfer between facilities. The rare plasmid-encoded carbapenemase gene blaOXA-237 was present in 16 outbreak isolates. Contact precautions, chlorhexidine baths, enhanced environmental cleaning, and interfacility communication were implemented for cases to halt transmission.
Interfacility transmission of XDR A. baumannii carrying the rare blaOXA-237 was facilitated by transfer of affected patients without communication to receiving facilities.
Liability to substance use disorder (SUD) is largely nonspecific to particular drugs and is related to behavior dysregulation, including reduced cognitive control. Recent data suggest that cognitive mechanisms may be influenced by exposure to neurotropic infections, such as human herpesviruses. In this study, serological evidence of exposure to human herpesvirus Herpes simplex virus Type 1 (HSV-1), cytomegalovirus (CMV), and Epstein–Barr virus (EBV) as well as Toxoplasma gondii was determined in childhood (age ~11 years) in 395 sons and 174 daughters of fathers with or without SUD. Its relationships with a cognitive characteristic (IQ) in childhood and with risk for SUD in adulthood were examined using correlation, regression, survival, and path analyses. Exposure to HSV-1, EBV, and T. gondii in males and females, and CMV in males, was associated with lower IQ. Independent of that relationship, EBV in females and possibly in males, and CMV and possibly HSV-1 in females were associated with elevated risk for SUD. Therefore, childhood neurotropic infections may influence cognitive development and risk for behavior disorders such as SUD. The results may point to new avenues for alleviating cognitive impairment and SUD risk.
The literature has documented a positive relationship between walkable built environments and outdoor mobility in older adults. Yet, surprisingly absent is any consideration of how weather conditions modify the impact of neighbourhood walkability. Using archived weather data linked to survey data collected from a sample of older adults in Vancouver, Canada, we found that car-dependent neighbourhoods (featuring longer block lengths, fewer intersections, and greater distance to amenities) became inaccessible in snow. Even older adults who lived in very walkable neighbourhoods walked to 25 per cent fewer destinations in snow. It is crucial to consider the impact of weather in the relationship between neighbourhood walkability and older adult mobility.
A well-preserved crocodyliform specimen from the Maastrichtian or Paleocene of Mali preserves the braincase and posterior dermatocranium. It is referred to Dyrosauridae on the basis of several derived features (a prominent anterior process of the postorbital, discrete occipital processes on the exoccipitals, significant quadratojugal contribution to jaw joint) and tentatively referred to Rhabdognathus on the basis of supratemporal fenestra shape. The lacrymal and prefrontal are relatively short compared with those published for other dyrosaurids. The palatines border the internal choanae anteriorly, and the choanae are divided by a midline septum derived from the pterygoids. The prefrontal pillars are mediolaterally broad and contact the palate ventrally. One stapes is preserved in place. The basicranial pneumatic system is very unusual, in that the anterior and posterior branches of the median eustachian canal are both separate at the palatal surface, and the pterygoids form part of the border for the anterior branch. The lateral eustachian openings lie within fossae on the lateral surface of the braincase and face laterally, with a descending process of the exoccipital nearly intersecting the opening. The braincase and surrounding dermal bones are elongate anteroposteriorly, and the postorbital's posterior ramus extends along the posterodorsal margin of the infratemporal fenestra. The quadrate ramus projects ventrally. These observations clarify character optimizations in previous phylogenetic analyses of Crocodyliformes.
The first reported case of lissencephaly resulting from a consanguinous union strengthens the supposition that in some cases, it is transmitted as an autosomal recessive trait. Comparison of this case with a sporadically occuring case of lissencephaly, with different cortical morphology, suggests that lissencephaly may be an example of either varying gene expressivity or gene-tic heterogeneity. Lissencephaly and pachygyria may eventually be shown to be due to different causes, some inherited, some acquired. The classical examples of lissencephaly are different morphologically from a case in which antenatal cytomegalovirus infection had produced a small smooth brain. This suggests that antenatal viral infections are destructive rather than teratogenic.
Two prospective studies in patient with brain tumours were performed comparing the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). The first assessed their feasibility and the second compared their diagnostic accuracy against a four-hour neuropsychological assessment (NPA). The introduction of the NPA decreased accrual and retention rates. We were therefore concerned regarding potential selection bias.
Ninety-two patients were prospectively accrued and subsequently divided into three categories: a) no NPA required b) withdrew consent to NPA c) completed NPA. In order to quantify any potential bias introduced by the NPA, patient demographics and cognitive test scores were compared between the three groups.
There were significant differences in age (p<0.001), education (p=0.034), dexamethasone use (p=0.002), MMSE (p=0.005), and MoCA scores (p<0.001) across the different study groups. Furthermore, with increasing involvement of the NPA, patients' cognitive scores and educational status increased, while their age, dexamethasone use, and opioid use all decreased. Individuals who completed the NPA had higher MoCA scores than individuals who were not asked to complete the NPA (24.7 vs. 20.5; p < 0.001). In addition, this relationship held when restricting the analyses to individuals with brain metastases (p < 0.001).
In this study, the lengthy NPA chosen introduced a statistically and clinically significant source of selection bias. These results highlight the importance of selecting brief and well tolerated assessments when possible. However, researchers are challenged by weighing the improved selection bias associated with brief assessments at the cost of reduced diagnostic accuracy.
To compare a specialized interprofessional team approach to community-based stroke rehabilitation with usual home care for stroke survivors using home care services.
Randomized controlled trial of 101 community-living stroke survivors (<18 months post-stroke) using home care services. Subjects were randomized to intervention (n=52) or control (n=49) groups. The intervention was a 12-month specialized, evidence-based rehabilitation strategy involving an interprofessional team. The primary outcome was change in health-related quality of life and functioning (SF-36) from baseline to 12 months. Secondary outcomes were number of strokes during the 12-month follow-up, and changes in community reintegration (RNLI), perceived social support (PRQ85-Part 2), anxiety and depressive symptoms (Kessler-10), cognitive function (SPMSQ), and costs of use of health services from baseline to 12 months.
A total of 82 subjects completed the 12-month follow-up. Compared with the usual care group, stroke survivors in the intervention group showed clinically important (although not statistically significant) greater improvements from baseline in mean SF-36 physical functioning score (5.87, 95% CI -3.98 to 15.7; p=0.24) and social functioning score (9.03, CI-7.50 to 25.6; p=0.28). The groups did not differ for any of the secondary effectiveness outcomes. There was a higher total per-person costs of use of health services in the intervention group compared to usual home care although the difference was not statistically significant (p = 0.76).
A 12-month specialized, interprofessional team is a feasible and acceptable approach to community-based stroke rehabilitation that produced greater improvements in quality of life compared to usual home care. Clinicaltrials.gov identifier: NCT00463229
Patient emotion, behaviour, and symptoms may explain avoidance of the daily programming on an acute psychiatric inpatient treatment milieu. We compared changes of emotion, behaviour, and symptoms among acutely ill psychiatric inpatients assigned to Behavioural Activation Communication (BAC), a newly designed milieu program, and those assigned to a unit representing treatment as usual (TAU).
Participants included 144 adult inpatients treated between January 2011 and July 2011 at two similar psychiatric units at a medical centre. Psychiatric patients were assigned to either the BAC or the TAU unit based bed availability. At admission and discharge, patients completed the Brief Symptom Inventory, Positive Affect and Negative Affect Scale, and the Checklist of Unit Behaviors.
A comparison of BAC and TAU patients showed greater relative change on positive affect and of behavioural activation with the daily programming.
The BAC program is associated with a significant increase of positive emotion and activation of inpatients.
This study determined the effects and costs of a multifactorial, interdisciplinary team approach to falls prevention. Randomized controlled trial of 109 older adults who are at risk for falls. This was a six-month multifactorial and evidence-based prevention strategy involving an interdisciplinary team. The primary outcome was number of falls during the six-month follow-up. At six months, no difference in the mean number of falls between groups. Subgroup analyses showed that the intervention effectively reduced falls in men (75–84 years old) with a fear of falling or negative fall history. Number of slips and trips was greatly reduced; and emotional health had a greater improvement in role functioning related to emotional health in the intervention group. Quality of life was improved, slips and trips were reduced, as were falls among males (75–84 years old) with a fear of falling or negative fall history.
This study examined the six-month prevalence, risk factors, and costs of falls in older people using home support services who are at risk of falling. Of the 109 participants, 70.6 per cent reported ≥ one fall in the previous six months, and 27.5 per cent experienced multiple falls. Although there was no statistically significant difference in any fall-related risk factor between fallers (1+ falls) and non-fallers (0 falls), fallers had clinically important trends towards lower levels of physical, social, and psychological functioning. There was no statistically significant difference between fallers and non-fallers in the total per-person costs of use of health services in the previous six months; however, there were significant differences between groups in specific types of health services. The multivariate analysis revealed the presence of five risk factors for falls: neurological disorder (e.g., cognitive impairment, Parkinson’s disease), age ≥ 85 years, environmental hazards, previous slip or trip, and visual impairment.
A circadian clock modulates the structure and function of the lateral eyes of Limulus polyphemus, greatly increasing their sensitivity at night. During the mating season, male Limulus are visually attracted both day and night to females and objects that resemble females. This paper asks how well Limulus can see day and night, and whether the circadian changes in retinal sensitivity might influence the ability of these animals to find mates. We recorded the visual behavior of male and female horseshoe crabs in the vicinity of an object – a cement hemisphere (29.5 cm diameter) similar in size and shape to a female horseshoe crab – placed in a mating area near Mashnee Dike, Bourne, Massachusetts. Males oriented toward this target from an average distance of 0.94 m during the day and 0.88 m at night; and females appeared to avoid the target. We conclude that males can see potential mates at night almost as well as they can during the day. Apparently the circadian changes in the retina help compensate for the daily changes in illumination in the animal's normal environment. This study provides the first evidence for a role of visual circadian rhythms in an animal's natural behavior.