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The incidence of COVID-19 exposures in shared patient rooms was low at our institution: 1.8/1,000 shared room patient-days. However, the secondary attack rate (21.6%) was comparable to that reported in household exposures. Lengthier exposures were associated with COVID-19 conversion. Hospitals should implement measures to decrease shared room exposures.
A simplified analytical form of the on-axis magnetic well and Mercier's criterion for interchange instabilities for arbitrary three-dimensional magnetic field geometries is derived. For this purpose, a near-axis expansion based on a direct coordinate approach is used by expressing the toroidal magnetic flux in terms of powers of the radial distance to the magnetic axis. For the first time, the magnetic well and Mercier's criterion are then written as a one-dimensional integral with respect to the axis arclength. When compared with the original work of Mercier, the derivation here is presented using modern notation and in a more streamlined manner that highlights essential steps. Finally, these expressions are verified numerically using several quasisymmetric and non-quasisymmetric stellarator configurations including Wendelstein 7-X.
Neurobehavioral decision profiles have often been neglected in chronic diseases despite their direct impact on major public health issues such as treatment adherence. This remains a major concern in diabetes, despite intensive efforts and public awareness initiatives regarding its complications. We hypothesized that high rates of low adherence are related to risk-taking profiles associated with decision-making phenotypes. If this hypothesis is correct, it should be possible to define these endophenotypes independently based both on dynamic measures of metabolic control (HbA1C) and multidimensional behavioral profiles.
In this study, 91 participants with early-stage type 1 diabetes fulfilled a battery of self-reported real-world risk behaviors and they performed an experimental task, the Balloon Analogue Risk Task (BART).
K-means and two-step cluster analysis suggest a two-cluster solution providing information of distinct decision profiles (concerning multiple domains of risk-taking behavior) which almost perfectly match the biological partition, based on the division between stable or improving metabolic control (MC, N = 49) v. unstably high or deteriorating states (NoMC, N = 42). This surprising dichotomy of behavioral phenotypes predicted by the dynamics of HbA1C was further corroborated by standard statistical testing. Finally, the BART game enabled to identify groups differences in feedback learning and consequent behavioral choices under ambiguity, showing distinct group choice behavioral patterns.
These findings suggest that distinct biobehavioral endophenotypes can be related to the success of metabolic control. These findings also have strong implications for programs to improve patient adherence, directly addressing risk-taking profiles.
ABSTRACT IMPACT: Current practice guidelines offer a variety of treatment options for sternal reconstruction but complications and infections remain a serious surgical problem. This work seeks to provide a comprehensive picture of the com-morbidities and reconstructive methods that lead to success and improve patient outcomes. OBJECTIVES/GOALS: Patients that undergo cardiac surgery via the median sternotomy approach are at risk of wound complications that require repair. We seek to evaluate how outcomes of sternal reconstruction are influenced by patient comorbidities, flap usage and internal mammary artery grafts and methods of sternal closure. METHODS/STUDY POPULATION: We identified patients between 2005 and 2020 who underwent sternotomy followed by debridement and flap coverage at our institution. Comorbidities, method of reconstruction, demographic data, surgical history, and other factors pertaining to mortality and morbidity were collected. The data will then be analyzed to identify population characteristics using logistic regression variables to determine univariate and adjusted multivariable measures of association with mortality. We present the pre-liminary data analyzed using chi-square and one-way anova in R. RESULTS/ANTICIPATED RESULTS: In this study we present a preliminary characterization of one institution’s sternal reconstruction patient outcomes with a variety of reconstruction methods including pectoralis advancement flaps, omental flaps and latissumus dorsi flaps. Notable preoperative comorbidities include 50% of patients > age 60, 18% with diabetes mellitus, 18 % with diagnosed hypertension, 18% with COPD, and 9% with a smoking history DISCUSSION/SIGNIFICANCE OF FINDINGS: In an evolving cardiothoracic landscape, clinical characteristics of patients being treated for sternal reconstructive surgery present a moving target. Understanding current risk factors, preoperative management and timing for aggressive surgical treatment offers an opportunity to update treatment protocol and maximize successful outcomes.
Strong competitive ability of introduced plant species has been frequently stated as a key factor promoting successful invasion. The dynamics of invasive species may depend on their abilities to compete for resources and exploit disturbances relative to native species. This study compares the growth performance of the invasive blackberry (Rubus niveus Thunb.) with four of the most common woody native species of the Scalesia forest in the Galapagos Islands. Using a series of greenhouse and field studies, the growth rate and biomass production of native species alone and in competition with R. niveus was compared under different water and light stress conditions. Rubus niveus showed a faster growth rate and biomass production than the native species as well as a broad tolerance to light and water stress conditions. Competitive ability was also assessed by looking at the seedbank and regeneration processes after herbicide control in the field. Although the number of R. niveus seedlings that germinated from the soil samples was considerably larger than that of native species, recruitment of the invasive on the experimental plots was limited. Overall, R. niveus showed superior competitive ability over native species with comparable growth forms, suggesting a possible mechanism that enables R. niveus to successfully invade a wide range of habitats in the Galapagos Islands. Implementing an integrated management strategy including biological control, seedbank reduction, and active revegetation, should improve the efficiency of R. niveus management, enabling the restoration of degraded vegetation in the Galapagos.
Recent studies have acknowledged the many benefits of including fossils in phylogenetic inference (e.g., reducing long-branch attraction). However, unstable taxa are known to be problematic, as they can reduce either the resolution of the strict consensus or branch support. In this study, we evaluate whether unstable taxa that reduce consensus resolution affect support values, and the extent of such impact, under equal and extended implied weighting. Two sets of analyses were conducted across 30 morphological datasets to evaluate complementary aspects. The first focused on the analytical conditions incrementing the terminal instability, while the second assessed whether pruning wildcards improves support. Changes in support were compared with the “number of nodes collapsed by unstable terminals,” their “distance to the root,” the “proportion of missing data in a dataset,” and the “proportion of sampled characters.” Our results indicate that the proportion of missing entries distributed among closely related taxa (for a given character) might be as detrimental for stability as those distributed among characters (for a given terminal). Unstable terminals that (1) collapse few nodes or (2) are closely located to the root node have more influence on the estimated support values. Weighting characters according to their extra steps while assuming that missing entries contribute to their homoplasy reduced the instability of wildcards. Our results suggest that increasing character sampling and using extended implied weighting decreases the impact of wildcard terminals. This study provides insights for designing future research dealing with unstable terminals, a typical problem of paleontological data.
We report an 11-year-old male with intermittent palpitations episodes, and no other pathological findings were found. With the standard Holter electrocardiogram, there is only the option of 24 to 72 hours monitoring of the patient. A Holter Nuubo ™ Vest was placed for 33 days and a supraventricular tachycardia was found.
The northern bald ibis Geronticus eremita was once widespread throughout the Middle East, northern Africa, and southern and central Europe. Habitat destruction, persecution and the impacts of pesticides have led to its disappearance from most of its former range. It disappeared from central Europe > 400 years ago, but has persisted as a relict and slowly growing breeding population in Morocco, where c. 700 wild birds of all ages remain. In Algeria, the last confirmed breeding was in 1984; in Turkey the fully wild population disappeared in 1989, but a population remains in semi-wild conditions. In Syria a small population was rediscovered in 2002, only to subsequently decline to functional extinction. Restoration programmes have been initiated independently in several locations, with over 300 free-flying birds resulting from reintroduction projects in Austria, Germany, Spain and Turkey, to restore both sedentary and fully migratory populations. Maintaining current efforts in Morocco remains a high conservation priority.
Stochastic plateau production functions provide improved fertilizer recommendations based on multi-year agronomic experiments where weather and other stochastic variables change over time. This research assesses the profitability of no-tillage corn production in northeastern Colorado and determines economically optimal nitrogen fertilizer rates. It also proposes an alternative parameterization of the linear response stochastic plateau model which provides a robustness check against traditional parameterizations. Results show the current use of nitrogen fertilizer in the area exceeds estimated economically optimal levels. This suggests that a reduction in nitrogen use could increase expected profits and simultaneously reduce environmental costs.
There are currently no guidelines for central-line insertion site evaluation. Our study revealed an association between insertion site inflammation (ISI) and the development of central-line–associated bloodstream infections (CLABSIs). Automated surveillance for ISI is feasible and could help prevent CLABSI.
Evaluate associations between orange juice (OJ) consumption and anthropometric parameters.
Prospective cohort study assessing the association between OJ intake and changes in BMI and height-for-age Z-score (HAZ) using mixed linear regression.
Children from the Growing Up Today Study II (n 7301), aged 9–16 years at enrollment.
OJ consumption was positively associated with 2-year change in HAZ in girls (mean (se)): 0·03 (0·01) for non-consumers, 0·03 (0·02) for 1–3 glasses/month, 0·06 (0·01) for 1–6 glasses/week and 0·09 (0·02) for ≥1 glass/d after full adjustment (Ptrend = 0·02). However, OJ consumption was not associated with 2-year change in BMI percentile (kg/m2, mean (se)): –0·44 (0·36) for non-consumers, 0·20 (0·41) for 1–3 glasses/month, –0·04 (0·34) for 1–6 glasses/week and –0·77 (0·62) for ≥1 glass/d in girls, Ptrend = 0·81; –0·94 (0·53) for non-consumers, –1·68 (0·52) for 1–3 glasses/month, –0·81 (0·38) for 1–6 glasses per week and –1·12 (0·61) for ≥1 glass/d in boys, Ptrend = 0·49.
OJ consumption was favourably associated with height growth but unrelated to excess weight gain. OJ may be a useful alternative to whole fruit in the event that whole fruit intake is insufficient.
Unlike well-known global patterns of plant species richness along altitudinal gradients, in the mountainous areas of the Brazilian Caatinga, species richness and diversity reach their maxima near mountain tops. The causes of this unusual pattern are not well understood, and in particular the role of edaphic factors on plant community assembly along these gradients has not been investigated. Our goal was to assess the role of edaphic factors (fertility and soil texture) on plant community composition and structure on two mountains of the Brazilian semi-arid region. In 71 plots (Bodocongó site, twenty-one 200-m2 plots, 401–680 m asl; Arara site, fifty 100-m2 plots, 487–660 m asl) we recorded 3114 individuals representing 61 plant species; in addition, at each plot we collected composite soil samples from 0–20 cm depth. Significant altitude-related changes were observed both for community structure and composition, and edaphic variables. A canonical correspondence analysis allowed the distinction of two groups of plots according to species abundances, indicating a preferential habitat distribution of species depending both on altitude and soil variables. Although soil fertility was lowest at the highest altitudes, these areas had high richness and diversity. Conversely, the more fertile foothills were characterized by the dominance of generalist pioneer species. Despite the relatively short altitudinal range that characterizes the studied mountains, this study elucidates the role of edaphic factors on the floristic composition and species richness patterns on the mountains of the Brazilian semi-arid region.
Pelagic seabird populations have declined strongly worldwide. In the North Atlantic there was a huge reduction in seabird populations following the European colonization of the Azores, Madeira and Canary archipelagos but information on seabird status and distribution for the subtropical region of Cabo Verde is scarce, unavailable or dispersed in grey literature. We compiled and compared the historical and current distribution of all seabird species breeding in the Cabo Verde archipelago, updated their relative abundance, investigated their inland habitat preferences, and reviewed their threats. Currently, the breeding seabird community in Cabo Verde is composed of Bulwer’s Petrel Bulweria bulwerii, White-faced Storm-petrel Pelagodroma marina aedesorum, Cape Verde Shearwater Calonectris edwardsii, Cape Verde Storm-petrel Hydrobates jabejabe, Cape Verde Petrel Pterodroma feae, Boyd's Shearwater Puffinus lherminieri boydi, Brown Booby Sula leucogaster, and Red-billed Tropicbird Phaethon aethereus. One breeding species is currently extinct, the Magnificent Frigatebird Fregata magnificens. The relative abundance of Cape Verde Shearwater, Boyd’s Shearwater, Cape Verde Petrel, and Cape Verde Storm-petrel was determined from counts of their nocturnal calls in Santo Antão, São Vicente, Santa Luzia, Branco, Raso and São Nicolau. Cape Verde Petrel occurred only on mountainous islands (Santo Antão, São Nicolau, Santiago, and Fogo) from mid-to high elevations. Larger species such as the Cape Verde Shearwater and Boyd’s Shearwater exhibited a wider distribution in the archipelago, occurring close to the coastline but at lower densities on populated islands. Small procellariforms such as the Cape Verde Storm-petrel occurred at high densities only on rat-free islets and in steep areas of main islands where introduced cats and rats are unlikely to occur. The main threats to seabird populations in Cabo Verde range from predation by introduced predators, habitat alteration or destruction, and some residual human persecution.
Research using single-word paradigms has established that forced language switching incurs processing costs for some bilinguals, yet, less research has addressed this phenomenon at the utterance level or considered real-world applications. The current study examined the impacts of forced language switching on spoken output and stress using a simulated virtual meeting. Twenty Spanish–English heritage bilinguals responded to general work-oriented questions in monolingual English (control) or language-switching (experimental) conditions. Responses were analyzed for mean length of utterance (MLU) and type-token-ratio (TTR). Multilevel modeling revealed an interaction effect of Condition (control vs. experimental) and question order on MLU, such that participants in the experimental condition produced significantly shorter utterances by the end of the task. Participants also had significantly lower lexical variation (TTR) overall in the experimental than the control condition. A 2 × 2 ANOVA revealed a significant effect of Condition and an interaction of Task (pre- vs. posttask) and Condition, such that participants in the control condition reported significantly lower stress after the activity. Results demonstrated the impact of a forced switching condition on production at the utterance level. Findings have implications for theory and scenarios in which heritage bilinguals are asked to use multiple languages in the workplace.
Studies in the general population show cannabis use has a beneficial effect on metabolic disorders. Given the increased cardiometabolic risk in patients with psychotic disorders, as well as their prevalent use of cannabis, we aim to investigate whether such effects are also evident in these patients.
3176 patients with chronic psychotic disorders from mental health institutions in the Netherlands were included in the study. With multivariate regression analyses we examined the effects of cannabis use on metabolic risk factors; BMI, waist circumference, blood pressure (BP), cholesterol, HDL-C, LDL-C, triglycerides, glucose and HbA1c. Age, sex, smoking, alcohol use and antipsychotic drugs were included as confounders. Next, we examined change in metabolic risk factors after one-year follow up for cannabis users, non-users, discontinuers and starters.
We found a significant negative association between cannabis use and BMI (p=0.003), waist circumference (p>0.001), diastolic BP (p=0.015) and HbA1c (0.004). One year later, patients who had discontinued their cannabis use had a greater increase of BMI (p=0.002) and waist circumference (p=0.011) than other patients. They also had a greater increase of diastolic BP than non-users (p=0.036) or starters (p=0.004).
Discontinuation of cannabis use increased metabolic risk. To stop cannabis use is often an important treatment goal, because it reduces psychotic symptoms. However, physicians should be aware of the increased metabolic risk in patients who discontinue the use of cannabis. Extra attention should be paid to monitoring and treatment of metabolic parameters in these patients to prevent cardiovascular diseases and premature cardiovascular mortality.
inhaled loxapine has shown efficiency in the treatment of the mild-moderate agitation syndrome of schyzophrenia and mania patients. Its rapid response and calming effect non-sedative allow to hypothesize reasonable efficiency and tolerability in borderline personality disorder diagnosed patients.
analyze the efficiency and tolerability of inhaled loxapine as a pharmacological approach in the treatment of agitation in borderline personality disorder (BPD) clinical diagnosed patients.
Materials and method
an application was administered for every agitation episode in BPD patients treated with inhaled loxapine in the emergency room or the psychiatric ward, which included B aRS and CGI-S scales for the evaluation of each episode and its severity, before and after its use. Other secondary measures of efficiency were taken into account, such as requirement of physical restrain.
in the majority of evaluated episodes inhaled loxapine decreased notably initial B aRS and CGI-S values and no serious clinical side effects attributable to this medication were observed.
in our sample, inhaled loxapine was efficiency and well tolerated pharmacological intervention for agitation in BPD patients.
Disclosure of interest
The authors have not supplied their declaration of competing interest.