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We reviewed the electronic health records of 1,419 inpatients with anterior nares (AN) and oropharynx (OP) MRSA PCR tests. Concordance was 96.5%. In discordant cases, AN negative–OP positive results increased detection of probable MRSA pneumonia by only 0.3%. A dual testing approach has limited utility in detecting MRSA pneumonia and increases resource utilization.
IPCC predictions for Honduras indicate that temperature will increase by up to 3–6°C and precipitation will decrease by up to 7–13% by the year 2050. To better understand how fern and lycophyte communities might be affected by climate change, we comprehensively surveyed the community compositions of ferns and lycophytes at Celaque National Park, the highest mountain in Honduras. We surveyed a total of 80 20 × 20 m2 plots along an altitudinal gradient of 1249–2844 m a.s.l., identifying all species and estimating their abundances. We recorded a total of 11,098 individuals from 160 species and 61 genera. Community composition was strongly influenced by changes in altitude, precipitation and the abundance of bryophytes (a proxy for air humidity). Of the 160 species, 63 are expected, under a RCP2.6 scenario for the year 2050, to shift their range fully or partially above the maximum altitude of the mountain. Of these, 65.1% are epiphytes. We found that species with narrow altitudinal ranges at high altitudes were more at risk. Our study indicated that conservation efforts should prioritise higher altitudinal sites, focusing particularly on preserving the vulnerable epiphytic fern species, which are likely to be at greater risk.
This study obtained calendar dates by radiocarbon accelerator mass spectrometry (14C AMS) dating sequential tree-rings of wooden support posts from the buried remains of traditional Kitkahahki Pawnee earthlodges preserved at an archaeological site on the Central Great Plains, USA. The tree-ring segments from the site were dendrochronologically analyzed prior to this study, but the cross-matched site chronology could not be definitively cross-dated and was thus “floating” in time. Our study represents the first floating tree-ring chronology from the Great Plains to be anchored in time by means of independent radiocarbon analysis. Three specimens were analyzed and dated to 1724–1774 CE (82.0% probability), 1774–1794 CE (95.4% probability), and 1800–1820 CE (95.4% probability). These dates correspond to the hypothetical timing of Kitkahahki ethnogensis, the main phase of village growth in the area, and a later reoccupation during a turbulent period in regional history. The results of this study conform to a scenario in which chaotic social conditions correspond to an increase in residential mobility between the core of Pawnee territory and a southern frontier in the Republican River valley.
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.
Background: In the state of Wisconsin, 3%–4% of bats submitted for rabies testing are positive. Inpatient bat encounters at 2 affiliated healthcare facilities at nearly the same time were brought to the attention of the infection prevention and control (IPC) team. The first bat was captured in a patient room and was submitted for testing. Postexposure prophylaxis (PEP) was initiated for 1 patient before the bat testing results came back negative. The second bat was found in a transplant unit hallway and was released before we could request testing. We observed significant variations in responses, including decision to administer PEP and submission of bats for rabies testing. The IPC team developed a protocol to minimize unnecessary PEP, to prevent nosocomial rabies infection from bat exposure, and to limit associated panic. Methods: A systematic literature review of multiple databases was performed. A search of nonscientific articles using Google was also performed to assess unpublished inpatient bat encounters. A workgroup was established including IPC staff, physicians, and facilities management. The county animal services department and the state public health department veterinarian were consulted to aid in development of a protocol. Results: Literature review yielded a single report of a bat discovered in a neonatal intensive care unit (NICU). A lack of protocol resulted in PEP administration to 7 neonates without observed exposure after the bat was released instead of being submitted for testing. Of the first 100 articles retrieved via Google search of “bat in hospital,” 9 pertained to nosocomial discovery of bats in 5 different states over the past 7 years. Encounters included infestations requiring unit shutdowns and PEP administration. One tertiary-care referral center reported 10 encounters per year but did not elaborate on associated procedures. The county animal services staff assisted in training maintenance and engineering services (MES) personnel on how to secure bats for testing and helped develop a “bat kit” with protective gear and equipment to do so safely. In the new protocol, an inpatient bat encounter prompts personnel to capture the bat and begin an investigation into known or potential occult exposure. Known or potential exposures merit submission of the bat for rabies testing, the results of which guide PEP recommendations. All encounters are investigated for point of entry or roost. Conclusions: Inpatient bat encounters are not uncommon. Encounters should prompt systematic assessment for exposures and an investigation of the root cause. Following a protocol may limit unnecessary PEP administration, prevent nosocomial transmission of rabies from bat to patient, and attenuate associated anxiety.
Increased post-traumatic stress disorder (PTSD) rates have been documented in children exposed to war. However, the contribution of childhood adversities and environmental sensitivity to children's responses to adversities and trauma are still far from settled.
To evaluate the relative roles of war, childhood adversities and sensitivity in the genesis of PTSD.
Data on childhood adversities and sensitivity was collected from 549 Syrian refugee children in Lebanon. PTSD symptoms were assessed using the PTSD Reaction Index.
Although childhood adversities, war events and sensitivity were all significantly related to PTSD in bivariate analyses, multivariate analyses showed that childhood adversities were the most important variable in predicting PTSD. The effect of war on PTSD was found to be dependent on the interplay between childhood adversities and sensitivity, and was most prominent in highly sensitive children with lower levels of adversities; in sensitive children experiencing high levels of adversities, the effects of war exposure on PTSD were less pronounced.
When considering the effects of war on PTSD in refugee children, it is important to take account of the presence of other adversities as well as of children's sensitivity. Sensitive children may be more vulnerable to the negative effects of war exposure, but only in contexts that are characterised by low childhood adversities.
Computerised cognitive–behavioural therapy (cCBT) for depression has the potential to be efficient therapy but engagement is poor in primary care trials.
We tested the benefits of adding telephone support to cCBT.
We compared telephone-facilitated cCBT (MoodGYM) (n = 187) to minimally supported cCBT (MoodGYM) (n = 182) in a pragmatic randomised trial (trial registration: ISRCTN55310481). Outcomes were depression severity (Patient Health Questionnaire (PHQ)-9), anxiety (Generalized Anxiety Disorder Questionnaire (GAD)-7) and somatoform complaints (PHQ-15) at 4 and 12 months.
Use of cCBT increased by a factor of between 1.5 and 2 with telephone facilitation. At 4 months PHQ-9 scores were 1.9 points lower (95% CI 0.5–3.3) for telephone-supported cCBT. At 12 months, the results were no longer statistically significant (0.9 PHQ-9 points, 95% CI −0.5 to 2.3). There was improvement in anxiety scores and for somatic complaints.
Telephone facilitation of cCBT improves engagement and expedites depression improvement. The effect was small to moderate and comparable with other low-intensity psychological interventions.
Major depressive disorder (MDD) is a leading cause of disability worldwide.
To examine the: (a) 12-month prevalence of DSM-IV MDD; (b) proportion aware that they have a problem needing treatment and who want care; (c) proportion of the latter receiving treatment; and (d) proportion of such treatment meeting minimal standards.
Representative community household surveys from 21 countries as part of the World Health Organization World Mental Health Surveys.
Of 51 547 respondents, 4.6% met 12-month criteria for DSM-IV MDD and of these 56.7% reported needing treatment. Among those who recognised their need for treatment, most (71.1%) made at least one visit to a service provider. Among those who received treatment, only 41.0% received treatment that met minimal standards. This resulted in only 16.5% of all individuals with 12-month MDD receiving minimally adequate treatment.
Only a minority of participants with MDD received minimally adequate treatment: 1 in 5 people in high-income and 1 in 27 in low-/lower-middle-income countries. Scaling up care for MDD requires fundamental transformations in community education and outreach, supply of treatment and quality of services.
Nicotine has been proposed to be a cognitive enhancer, particularly in schizophrenia patients. So far, the published studies of nicotine effects on antisaccade performance in schizophrenia patients only tested participants who were deprived smokers. Thus, we aimed to test both smoking and non-smoking patients as well as healthy controls in order to extend previous findings. Moreover, we employed a paradigm using standard and delayed trials. We hypothesized that, if nicotine is a genuine cognitive enhancer, its administration would improve antisaccade performance both in smoking and non-smoking participants. A total of 22 patients with schizophrenia (12 smokers and 10 non-smokers) and 26 controls (14 smokers and 12 non-smokers) completed the study. The effects of a nicotine patch (14 mg for smokers, 7 mg for non-smokers) on antisaccade performance were tested in a randomized, double-blind, placebo-controlled, cross-over trial. Schizophrenia patients made significantly more antisaccade errors than controls (p = 0.03). Both patients and controls made fewer antisaccade errors in the delayed trials than in the standard trials (p < 0.0001). Nicotine significantly reduced antisaccade error rate in the standard trials, but not in the delayed trials (p = 0.02). Smoking status did not influence the nicotine effect on antisaccade error rate (p = 0.10) indicating an equal procognitive effect of nicotine in smokers and non-smokers. Overall the present findings indicate that beneficial effects of nicotine on antisaccade performance are not confined to smoking schizophrenia patients. Instead, the findings likely represent genuine nicotine-induced enhancement of cognitive performance.
Epiphytes are known to respond sensitively to environmental changes. Because of the tight coupling of epiphytes to atmospheric conditions, changes in the chemical and physical conditions of the atmosphere may be expected to have direct effects on epiphytes (Farmer et al. 1992; Benzing 1998; Zotz & Bader 2009). In temperate regions, non-vascular epiphytes (bryophytes, lichens) have frequently been used as bioindicators of air quality (Hawksworth & Rose 1970). Owing to the lack of a protective cuticle in many bryophytes and lichens, solutions and gases may enter freely into the living tissues of these plants causing sensitive reactions to changes in the environment. By mapping and monitoring the distribution and abundance of non-vascular epiphytes, changes in environmental conditions can be assessed (Van Dobben & De Bakker 1996; Szczepaniak & Biziuk 2003).
Tropical moist forests, especially mountain forests, are very rich in epiphytes, both vascular and non-vascular. In the Reserva Biológica San Francisco, a small mountain rain forest reserve of approximately 1000 hectares in the Andes of southern Ecuador, about 1200 species of epiphytes have been recorded, with more than half of these bryophytes and lichens (Liede-Schumann & Breckle 2008). About one of every two species of plant in the forests is an epiphyte. The almost constantly saturated air in these mountain forests, due to orographic clouds, mist, and frequent rainfall, allows the epiphytic plants to thrive year-round high up on the trees, favoring high species diversity.
Although significant associations of childhood adversities with adult mental disorders are widely documented, most studies focus on single childhood adversities predicting single disorders.
To examine joint associations of 12 childhood adversities with first onset of 20 DSM–IV disorders in World Mental Health (WMH) Surveys in 21 countries.
Nationally or regionally representative surveys of 51 945 adults assessed childhood adversities and lifetime DSM–IV disorders with the WHO Composite International Diagnostic Interview (CIDI).
Childhood adversities were highly prevalent and interrelated. Childhood adversities associated with maladaptive family functioning (e.g. parental mental illness, child abuse, neglect) were the strongest predictors of disorders. Co-occurring childhood adversities associated with maladaptive family functioning had significant subadditive predictive associations and little specificity across disorders. Childhood adversities account for 29.8% of all disorders across countries.
Childhood adversities have strong associations with all classes of disorders at all life-course stages in all groups of WMH countries. Long-term associations imply the existence of as-yet undetermined mediators.