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 [email protected]
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.
To understand healthcare workers’ (HCWs) beliefs and practices toward blood culture (BCx) use.
Design:
Cross-sectional electronic survey and semi-structured interviews.
Setting:
Academic hospitals in the United States.
Participants:
HCWs involved in BCx ordering and collection in adult intensive care units (ICU) and wards.
Methods:
We administered an anonymous electronic survey to HCWs and conducted semi-structured interviews with unit staff and quality improvement (QI) leaders in these institutions to understand their perspectives regarding BCx stewardship between February and November 2023.
Results:
Of 314 HCWs who responded to the survey, most (67.4%) were physicians and were involved in BCx ordering (82.3%). Most survey respondents reported that clinicians had a low threshold to culture patients for fever (84.4%) and agreed they could safely reduce the number of BCx obtained in their units (65%). However, only half of them believed BCx was overused. Although most made BCx decisions as a team (74.1%), a minority reported these team discussions occurred daily (42.4%). A third of respondents reported not usually collecting the correct volume per BCx bottle, half were unaware of the improved sensitivity of 2 BCx sets, and most were unsure of the nationally recommended BCx contamination threshold (87.5%). Knowledge regarding the utility of BCx for common infections was limited.
Conclusions:
HCWs’ understanding of best collection practices and yield of BCx was limited.
The Personalized Advantage Index (PAI) shows promise as a method for identifying the most effective treatment for individual patients. Previous studies have demonstrated its utility in retrospective evaluations across various settings. In this study, we explored the effect of different methodological choices in predictive modelling underlying the PAI.
Methods
Our approach involved a two-step procedure. First, we conducted a review of prior studies utilizing the PAI, evaluating each study using the Prediction model study Risk Of Bias Assessment Tool (PROBAST). We specifically assessed whether the studies adhered to two standards of predictive modeling: refraining from using leave-one-out cross-validation (LOO CV) and preventing data leakage. Second, we examined the impact of deviating from these methodological standards in real data. We employed both a traditional approach violating these standards and an advanced approach implementing them in two large-scale datasets, PANIC-net (n = 261) and Protect-AD (n = 614).
Results
The PROBAST-rating revealed a substantial risk of bias across studies, primarily due to inappropriate methodological choices. Most studies did not adhere to the examined prediction modeling standards, employing LOO CV and allowing data leakage. The comparison between the traditional and advanced approach revealed that ignoring these standards could systematically overestimate the utility of the PAI.
Conclusion
Our study cautions that violating standards in predictive modeling may strongly influence the evaluation of the PAI's utility, possibly leading to false positive results. To support an unbiased evaluation, crucial for potential clinical application, we provide a low-bias, openly accessible, and meticulously annotated script implementing the PAI.
The hippocampal formation represents a key region in the pathophysiology of schizophrenia. Aerobic exercise poses a promising add-on treatment to potentially counteract structural impairments of the hippocampal formation and associated symptomatic burden. However, current evidence regarding exercise effects on the hippocampal formation in schizophrenia is largely heterogeneous. Therefore, we conducted a systematic review and meta-analysis to assess the impact of aerobic exercise on total hippocampal formation volume. Additionally, we used data from a recent multicenter randomized-controlled trial to examine the effects of aerobic exercise on hippocampal formation subfield volumes and their respective clinical implications.
Methods
The meta-analysis comprised six studies that investigated the influence of aerobic exercise on total hippocampal formation volume compared to a control condition with a total of 186 people with schizophrenia (100 male, 86 female), while original data from 29 patients (20 male, 9 female) was considered to explore effects of six months of aerobic exercise on hippocampal formation subfield volumes.
Results
Our meta-analysis did not demonstrate a significant effect of aerobic exercise on total hippocampal formation volume in people with schizophrenia (g = 0.33 [−0.12 to 0.77]), p = 0.15), but our original data suggested significant volume increases in certain hippocampal subfields, namely the cornu ammonis and dentate gyrus.
Conclusions
Driven by the necessity of better understanding the pathophysiology of schizophrenia, the present work underlines the importance to focus on hippocampal formation subfields and to characterize subgroups of patients that show neuroplastic responses to aerobic exercise accompanied by corresponding clinical improvements.
Tiafenacil is a new nonselective protoporphyrinogen IX oxidase (PPO)–inhibiting herbicide with both grass and broadleaf activity labeled for preplant application to corn, cotton, soybean, and wheat. Early-season corn emergence and growth often coincides in the mid-South with preplant herbicide application in cotton and soybean, thereby increasing opportunity for off-target herbicide movement from adjacent fields. Field studies were conducted in 2022 to identify the impacts of reduced rates of tiafenacil (12.5% to 0.4% of the lowest labeled application rate of 24.64 g ai ha–1) applied to two- or four-leaf corn. Corn injury 1 wk after treatment (WAT) for the two- and four-leaf growth stages ranged from 31% to 6% and 37% to 9%, respectively, whereas at 2 WAT these respective ranges were 21.7% to 4% and 22.5% to 7.2%. By 4 WAT, visible injury following the two- and four-leaf exposure timing was no greater than 8% in all instances except the highest tiafenacil rate applied at the four-leaf growth stage (13%). Tiafenacil had no negative season-long impact, as the early-season injury observed was not manifested in a reduction in corn height 2 WAT or yield. Application of tiafenacil directly adjacent to corn in early vegetative stages of growth should be avoided. In cases where off-target movement does occur, however, affected corn should be expected to fully recover with no impact on growth and yield, assuming adequate growing conditions and agronomic/pest management practices are provided.
This manuscript addresses a critical topic: navigating complexities of conducting clinical trials during a pandemic. Central to this discussion is engaging communities to ensure diverse participation. The manuscript elucidates deliberate strategies employed to recruit minority communities with poor social drivers of health for participation in COVID-19 trials. The paper adopts a descriptive approach, eschewing analysis of data-driven efficacy of these efforts, and instead provides a comprehensive account of strategies utilized. The Accelerate COVID-19 Treatment Interventions and Vaccines (ACTIV) public–private partnership launched early in the COVID-19 pandemic to develop clinical trials to advance SARS-CoV-2 treatments. In this paper, ACTIV investigators share challenges in conducting research during an evolving pandemic and approaches selected to engage communities when traditional strategies were infeasible. Lessons from this experience include importance of community representatives’ involvement early in study design and implementation and integration of well-developed public outreach and communication strategies with trial launch. Centralization and coordination of outreach will allow for efficient use of resources and the sharing of best practices. Insights gleaned from the ACTIV program, as outlined in this paper, shed light on effective strategies for involving communities in treatment trials amidst rapidly evolving public health emergencies. This underscores critical importance of community engagement initiatives well in advance of the pandemic.
Caribbean health research has overwhelmingly employed measures developed elsewhere and rarely includes evaluation of psychometric properties. Established measures are important for research and practice. Particularly, measures of stress and coping are needed. Stressors experienced by Caribbean people are multifactorial, as emerging climate threats interact with existing complex and vulnerable socioeconomic environments. In the early COVID-19 pandemic, our team developed an online survey to assess the well-being of health professions students across university campuses in four Caribbean countries. This survey included the Perceived Stress Scale, 10-item version (PSS-10) and the Brief Resilient Coping Scale (BRCS). The participants were 1,519 health professions students (1,144 females, 372 males). We evaluated the psychometric qualities of the measures, including internal consistency, concurrent validity by correlating both measures, and configural invariance using confirmatory factor analysis (CFA). Both scales had good internal consistency, with omega values of 0.91 for the PSS-10 and 0.81 for the BRCS. CFA suggested a two-factor structure of the PSS-10 and unidimensional structure of the BRCS. These findings support further use of these measures in Caribbean populations. However, the sampling strategy limits generalizability. Further research evaluating these and other measures in the Caribbean is desirable.
Tiafenacil is a new non-selective protoporphyrinogen IX oxidase (PPO)-inhibiting herbicide with both grass and broadleaf activity labeled for preplant application to corn (Zea mays L.), cotton (Gossypium hirsutum L.), soybean [Glycine max (L.) Merr.], and wheat (Triticum aestivum L.). Early-season soybean emergence and growth often coincide in the U.S. Midsouth with preplant herbicide application in later-planted cotton and soybean, thereby increasing opportunity for off-target herbicide movement from adjacent fields. Field studies were conducted in 2022 to identify any deleterious impacts of reduced rates of tiafenacil (12.5% to 0.4% of the lowest labeled application rate of 24.64 g ai ha−1) applied to 1- to 2-leaf soybean. Visual injury at 1 wk after treatment (WAT) with 1/8×, 1/16×, 1/32×, and 1/64× rate of tiafenacil was 80%, 61%, 39%, and 21%, while at 4 WAT, these respective rates resulted in visual injury of 67%, 33%, 14%, and 4%. Tiafenacil at these respective rates reduced soybean height 55% to 2% and 53% to 5% at 1 and 4 WAT and soybean yield 53%, 24%, 5%, and 1%. Application of tiafenacil directly adjacent to soybean in early vegetative growth should be avoided, as severe visual injury will occur. In cases where off-target movement does occur, impacted soybean should not be expected to fully recover, and negative impact on growth and yield will be observed.
Post-traumatic stress disorder (PTSD) and personality disorders are highly comorbid. There is some evidence that trauma-focused treatment normalises activation in brain areas involved in the fear circuit and regions involved in emotion regulation in people with PTSD. Although we assume that working mechanism of personality disorder treatments relies on improving emotion regulation and associated brain regions, there is as of yet little evidence of neurobiological effects of personality treatment on people with PTSD and comorbid PD.
Objectives
To 1) study the effect of trauma-focused and/or trauma-focused and personality disorder treatment n brain activation in participants with PTSD and comorbid personality disorders and 2) relate change in brain activation to symptom improvement.
Methods
Participants with PTSD and comorbid borderline and/or cluster c personality disorders from the PROSPER-trials (Prediction and Outcome Study for PTSD and personality disorders) were randomized to either trauma-focused treatment (TFT) or TFT with personality disorder treatment (TFT+PT). Brain activation was measured with an emotional face task during functional magnetic resonance imaging scanning before and after treatment. Regions of interest for the analyses were the amygdala, dorsal ACC, insula, ventromedial prefrontal cortex (PFC), ventrolateral PFC and dorsolateral PFC. Bayesian multilevel analyses were conducted to analyze change in brain activation. Clinical measures were clinician-administered PTSD severity, self-rated emotion regulation problems, depression severity and dissociation severity.
Results
We included 42 participants with a pre- and posttreatment scan (24 with TFT, 18 TFT+PT). Analyses on the pre-post data are currently being run and will be presented in April.
Conclusions
This is one of the first studies to conduct functional MRI analyses on treatment in participants with both PTSD and personality disorders.
Posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD) often co-occur. There is growing motivation among clinicians to offer trauma-focused treatments, such as Eye Movement Desensitization and Reprocessing (EMDR), to patients with PTSD and comorbid BPD. However, a large subgroup of these patients does not sufficiently respond to trauma-focused treatment and is more likely to be excluded or dropout from treatment. Dialectical Behaviour Therapy (DBT) for BPD is well established and although there is some evidence that DBT combined with prolonged exposure is twice as effective in reducing PTSD symptoms than DBT alone, the comparative efficacy of trauma-focused treatment with and without concurrent PD treatment has not been investigated yet.
Objectives
The current study will therefore evaluate the comparative clinical efficacy of EMDR with and without concurrent DBT in patients with PTSD and comorbid BPD.
Methods
Adult patients were randomly assigned to EMDR with (n = 63) or without concurrent DBT (n = 63). A wide range of clinician-administered and self-report assessments were conducted before, during and up to six months after treatment. The longitudinal change in PTSD severity as the primary outcome was measured using multilevel mixed regression in SPSS. The present study is part of the overarching Prediction and Outcome Study in comorbid PTSD and Personality Disorders (PROSPER), which consists of a second RCT comparing trauma-focused treatment with and without concurrent PD treatment in patients with PTSD and cluster C PD.
Results
Results, available in January 2024, will reveal which treatment works best for this difficult-to-treat group of patients.
Conclusions
This is the first study to compare the clinical efficacy of EMDR with and without concurrent DBT in patients with PTSD and comorbid BPD. Results will reveal which treatment works best for this difficult-to-treat group of patients.
Land expansion by existing smallholder farmers (SHFs), aka stepping-up, is a major pathway to the rise of medium-scale farmers (MSFs) in Africa. In this paper, we investigate if and how armed conflicts constrain the ability of SHFs to transition to MSFs. We find that increased conflict intensity reduces the likelihood that a SHF will expand to a larger scale, especially for farmers who rely mostly on farm incomes, rather than off-farm incomes, for their livelihoods. These findings uphold other evidence that peace and stability influence private investment, including land-based investments, that are associated with economic transformation.
Displacement ventilation, where cool external air enters a room through low-level vents and warmer air leaves through high-level vents, is characterised by vertical gradients in pressure arising from the warmer indoor temperatures. Models usually assume that horizontal variations of temperature difference are small in comparison and are, therefore, unimportant. Small-scale laboratory experiments and computational fluid dynamics were used to examine these flows, driven by a uniformly heated floor. These experiments and simulations show that the horizontal variations of temperature difference can be neglected for predictions of the bulk ventilation rate; however, they also evidence that these horizontal variations can be significant and play a critical role in establishing the pattern of flow within the room – this renders the horizontal position of the low- and high-level vents (relative to one another) important. We consider two cases: single-ended (where inlet and outlet are at the same end of the room) and opposite-ended. In both cases the ventilation flow rate is the same. However, in the opposite-ended case a dead zone is established in the upper part of the room which results in significant horizontal variations. We consider the formation of this dead zone by examining the streamline patterns and the age of air within the room. We discuss the implications for occupant exposure to pollutants and airborne disease.
Infants and children born with CHD are at significant risk for neurodevelopmental delays and abnormalities. Individualised developmental care is widely recognised as best practice to support early neurodevelopment for medically fragile infants born premature or requiring surgical intervention after birth. However, wide variability in clinical practice is consistently demonstrated in units caring for infants with CHD. The Cardiac Newborn Neuroprotective Network, a Special Interest Group of the Cardiac Neurodevelopmental Outcome Collaborative, formed a working group of experts to create an evidence-based developmental care pathway to guide clinical practice in hospital settings caring for infants with CHD. The clinical pathway, “Developmental Care Pathway for Hospitalized Infants with Congenital Heart Disease,” includes recommendations for standardised developmental assessment, parent mental health screening, and the implementation of a daily developmental care bundle, which incorporates individualised assessments and interventions tailored to meet the needs of this unique infant population and their families. Hospitals caring for infants with CHD are encouraged to adopt this developmental care pathway and track metrics and outcomes using a quality improvement framework.
The interaction of relativistically intense lasers with opaque targets represents a highly non-linear, multi-dimensional parameter space. This limits the utility of sequential 1D scanning of experimental parameters for the optimization of secondary radiation, although to-date this has been the accepted methodology due to low data acquisition rates. High repetition-rate (HRR) lasers augmented by machine learning present a valuable opportunity for efficient source optimization. Here, an automated, HRR-compatible system produced high-fidelity parameter scans, revealing the influence of laser intensity on target pre-heating and proton generation. A closed-loop Bayesian optimization of maximum proton energy, through control of the laser wavefront and target position, produced proton beams with equivalent maximum energy to manually optimized laser pulses but using only 60% of the laser energy. This demonstration of automated optimization of laser-driven proton beams is a crucial step towards deeper physical insight and the construction of future radiation sources.
Multi-messenger observations of the transient sky to detect cosmic explosions and counterparts of gravitational wave mergers critically rely on orbiting wide-FoV telescopes to cover the wide range of wavelengths where atmospheric absorption and emission limit the use of ground facilities. Thanks to continuing technological improvements, miniaturised space instruments operating as distributed-aperture constellations are offering new capabilities for the study of high-energy transients to complement ageing existing satellites. In this paper we characterise the performance of the upcoming joint SpIRIT and HERMES-TP/SP constellation for the localisation of high-energy transients through triangulation of signal arrival times. SpIRIT is an Australian technology and science demonstrator satellite designed to operate in a low-Earth Sun-synchronous Polar orbit that will augment the science operations for the equatorial HERMES-TP/SP constellation. In this work we simulate the improvement to the localisation capabilities of the HERMES-TP/SP constellation when SpIRIT is included in an orbital plane nearly perpendicular (inclination = 97.6°) to the HERMES-TP/SP orbits. For the fraction of GRBs detected by three of the HERMES satellites plus SpIRIT, we find that the combined constellation is capable of localising 60% of long GRBs to within ${\sim}30\,\textrm{deg}^{2}$ on the sky, and 60% of short GRBs within ${\sim}1850\,\textrm{deg}^{2}$ ($1\sigma$ confidence regions), though it is beyond the scope of this work to characterise or rule out systematic uncertainty of the same order of magnitude. Based purely on statistical GRB localisation capabilities (i.e., excluding systematic uncertainties and sky coverage), these figures for long GRBs are comparable to those reported by the Fermi Gamma Burst Monitor instrument. These localisation statistics represents a reduction of the uncertainty for the burst localisation region for both long and short GRBs by a factor of ${\sim}5$ compared to the HERMES-TP/SP alone. Further improvements by an additional factor of 2 (or 4) can be achieved by launching an additional 4 (or 6) SpIRIT-like satellites into a Polar orbit, respectively, which would both increase the fraction of sky covered by multiple satellite elements, and also enable localisation of ${\geq} 60\%$ of long GRBs to within a radius of ${\sim}1.5^{\circ}$ (statistical uncertainty) on the sky, clearly demonstrating the value of a distributed all-sky high-energy transient monitor composed of nano-satellites.
In what would prove to be his last interview, Bolaño named for Monica Maristain the books that had marked his life. Alongside works in Spanish, English, French, and Latin, he also named Franz Kafka’s novels, the Aphorisms of Lichtenberg, and the Tractatus by Wittgenstein. This troika can be supplemented with Russian authors mentioned repeatedly in works and essays, for example Anton Chekhov and Fyodor Dostoevsky. This chapter enumerates and analyzes Roberto Bolaño’s deep and persistent engagement with German and Russian literatures, and tries to make sense of a fundamental difference in the two repertoires: most of the Russian authors mentioned or alluded to in Bolaño’s work are recognized names in world literature read and appreciated by non-specialists, whereas his chosen German authors range from immortals such as J. W. von Goethe to long-forgotten names like Heinrich Lersch and Max Barthel. It is no surprise that these two literary traditions join in dialectical fashion in Bolaño’s magnum opus, 2666, where a German, Hans Reiter, derives literary inspiration from the diary of a Russian Jew, Boris Abramovich Ansky. The two literatures struggle with each other as do the two armies to cognitively map the evils of the 20th century.
Utilization of a smart phone application paired with a time-spaced learning curriculum was investigated to determine its impact on antimicrobial stewardship practice among internal medicine trainees. Stewardship behaviors increased, barriers decreased, and trainees had increased confidence in managing common infectious disease syndromes after the intervention.
Poultry manure (PM) has been shown to boost crop productivity. However, little is known about its favorable interactions with wood biochar (B) on sweet potato (Ipomoea batatas L.) growth and yield, and soil qualities. Hence, a 2-year field trial was conducted in the southwest Nigeria at two locations (Owo – site A and Obasooto – site B) to co-apply PM and wood B as soil amendments to boost sweet potato productivity and soil quality. The experiment consisted of a 3 × 4 factorial layout with three replications. PM and B significantly reduced soil bulk density and improved porosity and moisture content with their rate of application when compared to the control. As PM and B applications increased from 0 to 10.0 t ha−1 and 0 to 30.0 t ha−1, respectively, soil chemical properties and sweet potato growth and tuber yield increased. Co-application of 10.0 t ha−1 PM and 30.0 t ha−1 B increased tuber yield by 220% compared to treatments without PM or B. Significant synergistic interactions between PM and B were observed for all parameters. In comparison with other treatments, co-applying PM and B to sweet potato soils is a viable sustainable option for increasing sweet potato productivity and soil sustainability.
Reaction time variability (RTV) has been estimated using Gaussian, ex-Gaussian, and diffusion model (DM) indices. Rarely have studies examined interrelationships among these performance indices in childhood, and the use of reaction time (RT) computational models has been slow to take hold in the developmental psychopathology literature. Here, we extend prior work in adults by examining the interrelationships among different model parameters in the ABCD sample and demonstrate how computational models of RT can clarify mechanisms of time-on-task effects and sex differences in RTs.
Method:
This study utilized trial-level data from the stop signal task from 8916 children (9–10 years old) to examine Gaussian, ex-Gaussian, and DM indicators of RTV. In addition to describing RTV patterns, we examined interrelations among these indicators, temporal patterns, and sex differences.
Results:
There was no one-to-one correspondence between DM and ex-Gaussian parameters. Nonetheless, drift rate was most strongly associated with standard deviation of RT and tau, while nondecisional processes were most strongly associated with RT, mu, and sigma. Performance worsened across time with changes driven primarily by decreasing drift rate. Boys were faster and less variable than girls, likely attributable to girls’ wide boundary separation.
Conclusions:
Intercorrelations among model parameters are similar in children as has been observed in adults. Computational approaches play a crucial role in understanding performance changes over time and can also clarify mechanisms of group differences. For example, standard RT models may incorrectly suggest slowed processing speed in girls that is actually attributable to other factors.