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To assess whether measurement and feedback of chlorhexidine gluconate (CHG) skin concentrations can improve CHG bathing practice across multiple intensive care units (ICUs).
A before-and-after quality improvement study measuring patient CHG skin concentrations during 6 point-prevalence surveys (3 surveys each during baseline and intervention periods).
The study was conducted across 7 geographically diverse ICUs with routine CHG bathing.
Adult patients in the medical ICU.
CHG skin concentrations were measured at the neck, axilla, and inguinal region using a semiquantitative colorimetric assay. Aggregate unit-level CHG skin concentration measurements from the baseline period and each intervention period survey were reported back to ICU leadership, which then used routine education and quality improvement activities to improve CHG bathing practice. We used multilevel linear models to assess the impact of intervention on CHG skin concentrations.
We enrolled 681 (93%) of 736 eligible patients; 92% received a CHG bath prior to survey. At baseline, CHG skin concentrations were lowest on the neck, compared to axillary or inguinal regions (P < .001). CHG was not detected on 33% of necks, 19% of axillae, and 18% of inguinal regions (P < .001 for differences in body sites). During the intervention period, ICUs that used CHG-impregnated cloths had a 3-fold increase in patient CHG skin concentrations as compared to baseline (P < .001).
Routine CHG bathing performance in the ICU varied across multiple hospitals. Measurement and feedback of CHG skin concentrations can be an important tool to improve CHG bathing practice.
Unoccupied aerial application systems (UAAS) are gaining popularity for weed management to increase applicator safety and to deliver herbicide treatments where treatment sites limit ground-based spray equipment. Several studies have documented UAAS application strategies and procedures for weed control in terrestrial settings, yet literature describing remote spray technology for use in aquatics remains limited. Currently, applicators seek guidance for UAAS deployment for aquatic weed management to overcome site access restrictions, deal with environmental limitations, and improve ground-based applicator safety in hazardous treatment scenarios. In the present case studies, we evaluate a consumer-available UAAS to deliver the herbicide, florpyrauxifen-benzyl, as both foliar and directed in-water spray applications. The first case study showed that the invasive floating-leaved plant, yellow floating heart, was controlled 80% to 99% by 6 wk after treatment (WAT) following UAAS foliar herbicide treatments. The second case study demonstrated that UAAS directed in-water herbicide application reduced variable-leaf watermilfoil visible plant material by 94% at 5 WAT. Likewise, directed in-water applications from UAAS eliminated the need to deploy watercraft, which improved overall operational efficiency. Data from both case studies indicate that UAAS can provide an effective and efficient treatment strategy for floating-leaved and submersed plant control among common herbicide treatment scenarios. Future integration of UAAS in aquatic weed control programs is encouraged, especially among smaller treatment sites (≤4 ha) or where access limits traditional spray operations.
Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.
To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.
Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.
AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.
Balloon valvuloplasty and surgical aortic valvotomy have been the treatment mainstays for congenital aortic stenosis in children. Choice of intervention often differs depending upon centre bias with limited relevant, comparative literature.
This study aims to provide an unbiased, contemporary matched comparison of these balloon and surgical approaches.
Retrospective analysis of patients with congenital aortic valve stenosis who underwent balloon valvuloplasty (Queensland Children’s Hospital, Brisbane) or surgical valvotomy (Royal Children’s Hospital, Melbourne) between 2005 and 2016. Patients were excluded if pre-intervention assessment indicated ineligibility to either group. Propensity score matching was performed based on age, weight, and valve morphology.
Sixty-five balloon patients and seventy-seven surgical patients were included. Overall, the groups were well matched with 18 neonates/25 infants in the balloon group and 17 neonates/28 infants in the surgical group. Median age at balloon was 92 days (range 2 days – 18.8 years) compared to 167 days (range 0 days – 18.1 years) for surgery (rank-sum p = 0.08). Mean follow-up was 5.3 years. There was one late balloon death and two early surgical deaths due to left ventricular failure. There was no significant difference in freedom from reintervention at latest follow-up (69% in the balloon group and 70% in the surgical group, p = 1.0).
Contemporary analysis of balloon aortic valvuloplasty and surgical aortic valvotomy shows no difference in overall reintervention rates in the medium term. Balloon valvuloplasty performs well across all age groups, achieving delay or avoidance of surgical intervention.
The occurrence of nonlocal objects, raw materials, and ideas in the southwestern United States (U.S. SW) has long been recognized as evidence of interaction between prehispanic peoples of this region and those of greater Mesoamerica. Although many archaeologists have analyzed the directionality and potential means by which these objects and concepts moved across the landscape, few have assessed the degree to which Mesoamerican practices and traditional assemblages remained intact as the artifacts and ideas moved farther from their places of origin. The current study analyzes the distribution and deposition of blue-green stone mosaics, a craft technology that was well established in Mesoamerica by the Late Preclassic period (300 BC–AD 250) and spread to the U.S. SW by the start of the Hohokam Pioneer period (AD 475). We assess the spatial distribution, contextual deposition, and morphology of mosaics at sites within Hohokam Canal System 2, located in the Phoenix Basin of Arizona. We use these data to infer mosaics’ social value and function within Hohokam social structure. Analyses suggest that, although the technology of mosaic making may have originated in Mesoamerica, the contexts and ways in which mosaics were used in the Hohokam regional system were decidedly Hohokam.
Hill (Twin Research and Human Genetics, Vol. 21, 2018, 84–88) presented a critique of our recently published paper in Cell Reports entitled ‘Large-Scale Cognitive GWAS Meta-Analysis Reveals Tissue-Specific Neural Expression and Potential Nootropic Drug Targets’ (Lam et al., Cell Reports, Vol. 21, 2017, 2597–2613). Specifically, Hill offered several interrelated comments suggesting potential problems with our use of a new analytic method called Multi-Trait Analysis of GWAS (MTAG) (Turley et al., Nature Genetics, Vol. 50, 2018, 229–237). In this brief article, we respond to each of these concerns. Using empirical data, we conclude that our MTAG results do not suffer from ‘inflation in the FDR [false discovery rate]’, as suggested by Hill (Twin Research and Human Genetics, Vol. 21, 2018, 84–88), and are not ‘more relevant to the genetic contributions to education than they are to the genetic contributions to intelligence’.
Whether monozygotic (MZ) and dizygotic (DZ) twins differ from each other in a variety of phenotypes is important for genetic twin modeling and for inferences made from twin studies in general. We analyzed whether there were differences in individual, maternal and paternal education between MZ and DZ twins in a large pooled dataset. Information was gathered on individual education for 218,362 adult twins from 27 twin cohorts (53% females; 39% MZ twins), and on maternal and paternal education for 147,315 and 143,056 twins respectively, from 28 twin cohorts (52% females; 38% MZ twins). Together, we had information on individual or parental education from 42 twin cohorts representing 19 countries. The original education classifications were transformed to education years and analyzed using linear regression models. Overall, MZ males had 0.26 (95% CI [0.21, 0.31]) years and MZ females 0.17 (95% CI [0.12, 0.21]) years longer education than DZ twins. The zygosity difference became smaller in more recent birth cohorts for both males and females. Parental education was somewhat longer for fathers of DZ twins in cohorts born in 1990–1999 (0.16 years, 95% CI [0.08, 0.25]) and 2000 or later (0.11 years, 95% CI [0.00, 0.22]), compared with fathers of MZ twins. The results show that the years of both individual and parental education are largely similar in MZ and DZ twins. We suggest that the socio-economic differences between MZ and DZ twins are so small that inferences based upon genetic modeling of twin data are not affected.
In preliminary greenhouse evaluations and then in field studies, common cocklebur (Xanthium pensylvanicum Wallr.) and wild common sunflower (Helianthus annuus L.) were controlled by early postemergence applications of 3,5-dibromo-4-hydroxybenzonitrile (bromoxynil). Bromoxynil on young soybeans [Glycine max (L.) Merr.] caused temporary necrosis, retarded growth, and delayed maturity but did not reduce the stand of soybeans. Subsequent recovery and final yields of treated soybeans were such that selective control of common cocklebur and wild common sunflower appeared feasible. Treatments were applied as aqueous sprays over the tops of both the weeds and the crop. Rates of 140 or 196 g/ha were sufficient to control common cocklebur or wild common sunflower that was in the six true-leaf stage or smaller. In terms of soybean development, the optimum time for treatment appeared to be about the first trifoliolate stage.
In field studies, bentazon [3-isopropyl-1H-2,1,3-benzothiadiazin-(4)3H-one 2,2-dioxide] was applied as postemergence sprays over the top of weeds and soybeans [Glycine max (L.) Merr.]. Bentazon at 0.84 to 1.68 kg/ha applied as an early postemergence treatment controlled wild mustard [Brassica kaber (DC.) L.C. Wheeler var. pinnatifida (Stokes) L.C. Wheeler], common ragweed (Ambrosia artemisiifolia L.), velvetleaf (Abutilon theophrasti Medic.), Pennsylvania smartweed, (Polygonum pensylvanicum L.), common cocklebur (Xanthium pensylvanicum Wallr.), and wild common sunflower (Helianthus annuus L.). Pigweeds (Amaranthus sp.) were controlled by applications in the three true-leaf stage but became more resistant at later stages. Control of common lambsquarters (Chenopodium album L.) was erratic. The optimum time for controlling weeds with bentazon was around the first trifoliolate stage of soybeans. Rainfall within several hours after treatment reduced weed control. Eight yield studies, two of which included eight cultivars, were conducted on weed-free soybeans. In none were yields reduced significantly by bentazon at 3.36 kg/ha (the highest rate studied). Eight yield studies were conducted on soybeans infested with common cocklebur or velvetleaf. Weed control was generally excellent with 0.84 kg/ha of bentazon. Where infestations were sufficient to reduce yields, bentazon treatments increased the yields to levels generally comparable with those of the handweeded checks. One exception was an application of bentazon to soybeans growing in a low area that was periodically flooded by heavy rains. In that experiment the benefit of controlling common cocklebur was offset by bentazon injury to the soybeans, and yields from the treated plots were about the same as those of the weedy check.
Eleven radiocarbon age determinations clearly show that a lens of Holocene fluvial organic debris on the Alaskan Arctic Coastal Plain contains mostly pre-Holocene organic material. Radio-carbon ages of identified plant macrofossils indicate the material was deposited about 9000 to 9500 yr B.P. Radiocarbon analyses of bulk samples from this deposit, however, range from 13,300 to 30,300 yr B.P. Most of the old organic matter seems to be in the smaller size fractions in the deposit, particularly in the fraction between 0.25 and 0.5 mm, but all size fractions are contaminated. Particular caution must be exercised in submitting bulk samples for radiocarbon dating from areas where conditions favor redeposition of isotopically “dead” carbon.
A new Middle Permian plant assemblage from South Ash Pasture in King County, Texas, may be the youngest and is certainly the most unusual flora known from the Permian of either West Texas or adjoining north-central Texas. Found serendipitously in the evaporite-rich upper Blaine Formation (Pease River Group, Guadalupian Series), the flora is of very low diversity despite intensive collecting efforts, and the affinities of nearly all taxa are enigmatic. The most common elements are parallel-veined leaves that resemble cordaites but that could be isolated pinnules of a pinnate leaf. Gigantopterid foliage is present but not assignable to any known taxon. A single foliar conifer specimen is too incomplete for assignment. Numerous reproductive organs, however, and an abundance of axes may represent conifers. Conchostracans, palaeoniscoid fish scales, and small heteropolar coprolites also occur in the deposit, which originated as a small, claystone-dominated channel fill in a coastal plain setting.
We analyzed birth order differences in means and variances of height and body mass index (BMI) in monozygotic (MZ) and dizygotic (DZ) twins from infancy to old age. The data were derived from the international CODATwins database. The total number of height and BMI measures from 0.5 to 79.5 years of age was 397,466. As expected, first-born twins had greater birth weight than second-born twins. With respect to height, first-born twins were slightly taller than second-born twins in childhood. After adjusting the results for birth weight, the birth order differences decreased and were no longer statistically significant. First-born twins had greater BMI than the second-born twins over childhood and adolescence. After adjusting the results for birth weight, birth order was still associated with BMI until 12 years of age. No interaction effect between birth order and zygosity was found. Only limited evidence was found that birth order influenced variances of height or BMI. The results were similar among boys and girls and also in MZ and DZ twins. Overall, the differences in height and BMI between first- and second-born twins were modest even in early childhood, while adjustment for birth weight reduced the birth order differences but did not remove them for BMI.
A trend toward greater body size in dizygotic (DZ) than in monozygotic (MZ) twins has been suggested by some but not all studies, and this difference may also vary by age. We analyzed zygosity differences in mean values and variances of height and body mass index (BMI) among male and female twins from infancy to old age. Data were derived from an international database of 54 twin cohorts participating in the COllaborative project of Development of Anthropometrical measures in Twins (CODATwins), and included 842,951 height and BMI measurements from twins aged 1 to 102 years. The results showed that DZ twins were consistently taller than MZ twins, with differences of up to 2.0 cm in childhood and adolescence and up to 0.9 cm in adulthood. Similarly, a greater mean BMI of up to 0.3 kg/m2 in childhood and adolescence and up to 0.2 kg/m2 in adulthood was observed in DZ twins, although the pattern was less consistent. DZ twins presented up to 1.7% greater height and 1.9% greater BMI than MZ twins; these percentage differences were largest in middle and late childhood and decreased with age in both sexes. The variance of height was similar in MZ and DZ twins at most ages. In contrast, the variance of BMI was significantly higher in DZ than in MZ twins, particularly in childhood. In conclusion, DZ twins were generally taller and had greater BMI than MZ twins, but the differences decreased with age in both sexes.
Early Permian (late Leonardian Series) plant assemblages from King, Knox, and Stonewall Counties of North-Central Texas are dominated by seed plants, some apparently congeneric with taxa heretofore known only from the Late Permian or the Mesozoic. Conifers are the dominant elements, including one or more species of Ullmannia, Pseudovoltzia liebeana, both known from the Late Permian Zechstein flora of Germany and England, Podozamites sp., characteristic of the Mesozoic, and Walchia sp., abundant in Early Permian floras. Locally common are Taeniopteris cf. eckardtii, a Zechstein species, an unidentified plant represented by pinnulelike laminae with fine parallel veins, similar to pinnules of some Mesozoic cycads, and calamite stems. Rarely encountered are leaf fragments of the Paleozoic ginkgophyte Dicranophyllum, flabellate ginkgophyte leaves, leaves with a broad midvein and narrow, fimbriate lamina, and Wattia, typical of the Early Permian. Associated with these foliar remains are ovulate reproductive structures including the presumed cycad megasporophyll Dioonitocarpidium, known only from the Mesozoic, a voltzialean cone scale similar to Swedenborgia, and a variety of seeds, some remarkably similar to Agathis, of Cretaceous age. The assemblage includes only rare scraps of foliage and seeds possibly attributable to the pteridophyllous elements (gigantopterids, callipterids, and ferns) that dominate the Permian. The fossil plants occur in multistorey, fining-upwards, tidal-channel deposits that also include pelecypods and fragmentary palaeoniscoid fish. The occurrence of derived lineages in xeric habitats during the Early Permian indicates that some supposed Mesozoic groups actually preceded and survived the end-Permian extinction, reappearing in basinal lowlands during the mid-Mesozoic.
For over 100 years, the genetics of human anthropometric traits has attracted scientific interest. In particular, height and body mass index (BMI, calculated as kg/m2) have been under intensive genetic research. However, it is still largely unknown whether and how heritability estimates vary between human populations. Opportunities to address this question have increased recently because of the establishment of many new twin cohorts and the increasing accumulation of data in established twin cohorts. We started a new research project to analyze systematically (1) the variation of heritability estimates of height, BMI and their trajectories over the life course between birth cohorts, ethnicities and countries, and (2) to study the effects of birth-related factors, education and smoking on these anthropometric traits and whether these effects vary between twin cohorts. We identified 67 twin projects, including both monozygotic (MZ) and dizygotic (DZ) twins, using various sources. We asked for individual level data on height and weight including repeated measurements, birth related traits, background variables, education and smoking. By the end of 2014, 48 projects participated. Together, we have 893,458 height and weight measures (52% females) from 434,723 twin individuals, including 201,192 complete twin pairs (40% monozygotic, 40% same-sex dizygotic and 20% opposite-sex dizygotic) representing 22 countries. This project demonstrates that large-scale international twin studies are feasible and can promote the use of existing data for novel research purposes.