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In response to the COVID-19 pandemic, we rapidly implemented a plasma coordination center, within two months, to support transfusion for two outpatient randomized controlled trials. The center design was based on an investigational drug services model and a Food and Drug Administration-compliant database to manage blood product inventory and trial safety.
Methods:
A core investigational team adapted a cloud-based platform to randomize patient assignments and track inventory distribution of control plasma and high-titer COVID-19 convalescent plasma of different blood groups from 29 donor collection centers directly to blood banks serving 26 transfusion sites.
Results:
We performed 1,351 transfusions in 16 months. The transparency of the digital inventory at each site was critical to facilitate qualification, randomization, and overnight shipments of blood group-compatible plasma for transfusions into trial participants. While inventory challenges were heightened with COVID-19 convalescent plasma, the cloud-based system, and the flexible approach of the plasma coordination center staff across the blood bank network enabled decentralized procurement and distribution of investigational products to maintain inventory thresholds and overcome local supply chain restraints at the sites.
Conclusion:
The rapid creation of a plasma coordination center for outpatient transfusions is infrequent in the academic setting. Distributing more than 3,100 plasma units to blood banks charged with managing investigational inventory across the U.S. in a decentralized manner posed operational and regulatory challenges while providing opportunities for the plasma coordination center to contribute to research of global importance. This program can serve as a template in subsequent public health emergencies.
We report the discovery of a bow-shock pulsar wind nebula (PWN), named Potoroo, and the detection of a young pulsar J1638$-$4713 that powers the nebula. We present a radio continuum study of the PWN based on 20-cm observations obtained from the Australian Square Kilometre Array Pathfinder (ASKAP) and MeerKAT. PSR J1638$-$4713 was identified using Parkes radio telescope observations at frequencies above 3 GHz. The pulsar has the second-highest dispersion measure of all known radio pulsars (1 553 pc cm$^{-3}$), a spin period of 65.74 ms and a spin-down luminosity of $\dot{E}=6.1\times10^{36}$ erg s$^{-1}$. The PWN has a cometary morphology and one of the greatest projected lengths among all the observed pulsar radio tails, measuring over 21 pc for an assumed distance of 10 kpc. The remarkably long tail and atypically steep radio spectral index are attributed to the interplay of a supernova reverse shock and the PWN. The originating supernova remnant is not known so far. We estimated the pulsar kick velocity to be in the range of 1 000–2 000 km s$^{-1}$ for ages between 23 and 10 kyr. The X-ray counterpart found in Chandra data, CXOU J163802.6$-$471358, shows the same tail morphology as the radio source but is shorter by a factor of 10. The peak of the X-ray emission is offset from the peak of the radio total intensity (Stokes $\rm I$) emission by approximately 4.7$^{\prime\prime}$, but coincides well with circularly polarised (Stokes $\rm V$) emission. No infrared counterpart was found.
Interest in hydrotalcite-like compounds has grown due to their role in controlling the mobility of aqueous metals in the environment as well as their use as catalysts, catalyst precursors and specialty chemicals. Although these materials have been studied in a number of contexts, little is known of their thermodynamic properties. High-temperature oxide melt solution calorimetry was used to measure the standard enthalpy of formation for compounds M(II)1−xAlx(OH)2(CO3)x/2·mH2O (0.2 < x < 0.4, M(II) = Mg, Co, Ni and Zn). The enthalpy of formation of these compounds from the relevant single cation phases was also determined. The formation of HTLCs results in a 5–20 kJ/mol enthalpy stabilization from the single cation hydroxides and carbonates and water. The data are correlated to two variables: the ratio of divalent to trivalent cation in the solid (M(II)/Al) and the identity of the divalent cation. It was observed that the M(II)/Al ratio exerts a minor influence on the enthalpy of formation from single-cation phases, while greater differences in stabilization resulted from changes in the chemical nature of the divalent cation. However, the data do not support any statistically significant correlation between the composition of HTLCs and their heats of formation. Equilibrium geochemical calculations based upon the thermodynamic data illustrate the effect of HTLCs on the speciation of metals in natural waters. These calculations show that, in many cases, HTLCs form even in waters that are undersaturated with respect to the individual divalent metal hydroxides and carbonates. Phase diagrams and stability diagrams involving Ni-bearing HTLCs and the single-cation components are presented. The Ni(II) concentration as a function of pH as well as the stability diagram for the equilibrium among minerals in the CaO-NiO-Al2O3-SiO2-CO2-H2O system at 298 K are plotted.
To provide comprehensive population-level estimates of the burden of healthcare-associated influenza.
Design:
Retrospective cross-sectional study.
Setting:
US Influenza Hospitalization Surveillance Network (FluSurv-NET) during 2012–2013 through 2018–2019 influenza seasons.
Patients:
Laboratory-confirmed influenza-related hospitalizations in an 8-county catchment area in Tennessee.
Methods:
The incidence of healthcare-associated influenza was determined using the traditional definition (ie, positive influenza test after hospital day 3) in addition to often underrecognized cases associated with recent post-acute care facility admission or a recent acute care hospitalization for a noninfluenza illness in the preceding 7 days.
Results:
Among the 5,904 laboratory-confirmed influenza-related hospitalizations, 147 (2.5%) had traditionally defined healthcare-associated influenza. When we included patients with a positive influenza test obtained in the first 3 days of hospitalization and who were either transferred to the hospital directly from a post-acute care facility or who were recently discharged from an acute care facility for a noninfluenza illness in the preceding 7 days, we identified an additional 1,031 cases (17.5% of all influenza-related hospitalizations).
Conclusions:
Including influenza cases associated with preadmission healthcare exposures with traditionally defined cases resulted in an 8-fold higher incidence of healthcare-associated influenza. These results emphasize the importance of capturing other healthcare exposures that may serve as the initial site of viral transmission to provide more comprehensive estimates of the burden of healthcare-associated influenza and to inform improved infection prevention strategies.
During the coronavirus disease 2019 (COVID-19) pandemic, navigating the implementation of public health measures in a politically charged environment for a large state entity was challenging. However, Louisiana State University (LSU) leadership developed and deployed an effective, multi-layered mitigation plan and successfully opened in-person learning while managing cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the fourth surge. We describe the plan to provide a framework for other institutions during this and future responses. The goals were 3-fold: maintain a quality learning environment, mitigate risk to the campus community, and ensure that LSU operations did not contribute to health-care stress. As of September 2022, LSU has achieved high compliance with interventions and relatively low virus activity on campus compared with peer institutions. This university model can serve as a template for similar implementation plans in the context of complex socio-political and economic considerations.
Background: Idiopathic Normal Pressure Hydrocephalus (iNPH) is a disorder of the elderly with progressive worsening of gait and balance, cognition, and urinary control which requires assessment using criteria recommended by International iNPH guidelines. Methods: Adult Hydrocephalus Clinical Research Network (AHCRN) prospective registry data from 5-centers over a 50-month interval included entry criteria; demographics; comorbidities; examination findings using standard AHCRN gait and neuropsychology assessments; shunt procedures, complications of CSF drainage, complications within 30 days of surgery, and 1-year postoperative follow-up. Results: 547 patients were referred for assessment of suspected-iNPH. 123 patients(21.6%) did not meet clinical criteria to proceed with further testing. 424 patients(74.4%;mean age 76.7 ± 6.0 years;males=269) underwent an LP or lumbar drain, and 193(45.6%) underwent insertion of a ventriculoperitoneal shunt. By 8-12 months after shunt surgery, gait velocity was 0.96±0.35m/s (54% faster than pre-CSF-drainage). Mean MoCA scores increased from 21.0 ± 5.0(median=22.0) at baseline to 22.6±5.5(median=24) 12-months post-surgery. Gait and cognitive improvements were clinically significant. No deaths occurred. 8% of shunt-surgery patients experienced minor complications. The 30-day reoperation rate was 4.1%. Conclusions: This AHCRN study demonstrated that CSF-drainage testing of patients with suspected-iNPH successfully identified those who could undergo CSF-shunt surgery with a high rate of improvement and a low rate of complications.
Background: To describe preliminary results of a multi-center, randomized, blinded, placebo-controlled, pilot trial of shunt surgery in idiopathic normal pressure hydrocephalus (iNPH). Methods: Five sites of the Adult Hydrocephalus Clinical Research Network (AHCRN) randomized 18 patients scheduled for ventriculoperitoneal shunting based on CSF-drainage response. Patients were randomized to a Codman® Certas® Plus valve with SiphonGuard at either setting 4 (Active, N=9) or setting 8/”virtual off” (Placebo, N=9). Patients and assessors were blinded to the shunt setting. Outcomes included 10-meter gait velocity, cognitive function, and bladder activity scores. The prespecified primary analysis compared changes in 4-month gait velocity in the Active versus Placebo groups. Placebo-set shunts were then blindly adjusted to the active setting and all patients underwent 8 and 12-month post-surgical assessment. Results: At 4-months, gait velocity increased by 0.28±0.28m/s in the Active Group and 0.04±0.17m/s in the Placebo Group (p=0.071). Overactive Bladder (OAB-q) scores significantly improved in the Active versus Placebo groups (p=0.007). At 8 months, Placebo gait velocity increased by 0.36±0.27m/s and was comparable to the Active Group (0.40±0.20m/s; p=0.56). Conclusions: This AHCRN study shows a trend suggesting gait velocity improves more at an Active shunt setting than a Placebo shunt setting and demonstrates the feasibility of a placebo-controlled trial in iNPH.
Background: Despite significant morbidity and mortality, estimates of the burden of healthcare-associated viral respiratory infections (HA-VRI) for noninfluenza infections are limited. Of the studies assessing the burden of respiratory syncytial virus (RSV), cases are typically classified as healthcare associated if a positive test result occurred after the first 3 days following admission, which may miss healthcare exposures prior to admission. Utilizing an expanded definition of healthcare-associated RSV, we assessed the estimates of disease prevalence. Methods: This study included laboratory-confirmed cases of RSV in adult and pediatric patients admitted to acute-care hospitals in a catchment area of 8 counties in Tennessee identified between October 1, 2016, and April 30, 2019. Surveillance information was abstracted from hospital and state laboratory databases, hospital infection control databases, reportable condition databases, and electronic health records as a part of the Influenza Hospitalization Surveillance Network by the Emerging Infections Program. Cases were defined as healthcare-associated RSV if laboratory confirmation of infection occurred (1) on or after hospital day 4 (ie, “traditional definition”) or (2) between hospital day 0 and 3 in patients transferred from a chronic care facility or with a recent discharge from another acute-care facility in the 7 days preceding the current index admission (ie, “enhanced definition”). The proportion of laboratory-confirmed RSV designated as HA-VRI using both the traditional definition as well as with the added enhanced definition were compared. Results: We identified 900 cases of RSV in hospitalized patients over the study period. Using the traditional definition for HA-VRI, only 41 (4.6%) were deemed healthcare associated. Adding the cases identified using the enhanced definition, an additional 12 cases (1.3%) were noted in patients transferred from a chronic care facility for the current acute-care admission and 17 cases (1.9%) were noted in patients with a prior acute-care admission in the preceding 7 days. Using our expanded definition, the total proportion of healthcare-associated RSV in this cohort was 69 (7.7%) of 900 compared to 13.1% of cases for influenza (Figure 1). Although the burden of HA-VRI due to RSV was less than that of influenza, when stratified by age, the rate increased to 11.7% for those aged 50–64 years and to 10.1% for those aged ≥65 years (Figure 2). Conclusions: RSV infections are often not included in estimates of HA-VRI, but the proportion of cases that are healthcare associated are substantial. Typical surveillance methods likely underestimate the burden of disease related to RSV, especially for those aged ≥50 years.
Background: Healthcare-associated transmission of influenza leads to significant morbidity, mortality, and cost. Most studies classify healthcare-associated viral respiratory infections (HA-VRI) as those with a positive test result after the first 3 days following admission, which does not account for healthcare exposures prior to admission. Utilizing an expanded definition of healthcare-associated influenza, we aimed to improve the estimates of disease prevalence on a population level. Methods: This study included laboratory-confirmed cases of influenza in adult and pediatric patients admitted to any acute-care hospital in a catchment area of 8 counties Tennessee identified between October 1, 2012, and April 30, 2019. Surveillance information was abstracted from hospital and state laboratory databases, hospital infection control practitioner databases, reportable condition databases, and electronic health records as a part of the Influenza Hospitalization Surveillance Network (FluSurv-NET) by the Centers for Disease Control and Prevention (CDC) Emerging Infections Program (EIP). Cases were defined as healthcare-associated influenza laboratory confirmation of infection occurred (1) on or after hospital day 4 (“traditional definition”), or (2) between hospital days 0 and 3 in patients transferred from a chronic care facility or with a recent discharge from another acute-care facility in the 7 days preceding the current index admission (ie, enhanced definition). The proportion of laboratory-confirmed influenza designated as HA-VRI using both the traditional definition as well as with the added enhanced definition were compared. Data were imported into Stata software for analysis. Results: We identified 5,904 cases of laboratory-confirmed influenza in hospitalized patients over the study period. Using the traditional definition for HA-VRI, only 147 (2.5%, seasonal range 1.3%–3.4%) were deemed healthcare associated (Figure 1). Adding the cases identified using the enhanced definition, an additional 317 (5.4%, range 2.3%–6.7%) cases were noted in patients transferred from a chronic care facility for the current acute-care admission and 336 cases (5.7%; range, 4.1%–7.4%) were noted in patients with a prior acute-care facility admission in the preceding 7 days. Using our expanded definition, the total proportion of healthcare-associated influenza in this cohort was 772 of 5,904 (13.1%; range, 10.6%–14.8%). Conclusion: HA-VRI due to influenza is an underrecognized infection in hospitalized patients. Limiting surveillance assessment of this important outcome to just those patients with a positive influenza test after hospital day 3 captured only 19% of possible healthcare-associated influenza infections across 7 influenza seasons. These results suggest that the traditionally used definitions of healthcare-associated influenza underestimate the true burden of cases.
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.
In this study, we use aerial photographs, satellite imagery and field observations to quantify changes in the area, terminus length, snowline elevation and surface elevation of eight glaciers in the Alexandra Fiord region, eastern Ellesmere Island, between 1959 and 2019. Comparisons to written and pictorial descriptions from the British Arctic Expedition extend the record of change in terminus position and surface elevation to 1875 for Twin Glacier. Glacier area at Alexandra Fiord decreased by a total of 15.77 ± 0.65 km2 (11.77 ± 0.49%) between 1959 and 2019, the mean end of summer snowline increased in elevation by 360 ± 84 m (8 ± 2 m a−1) between 1974 and 2019, and the glaciers thinned at an average rate of 0.60 ± 0.06 m a−1 between 2001 and 2018. Annual rates of terminus retreat were ~3–5 times higher over the period 1974–2019 compared to 1875–1974, and rates of thinning were ~2–3 times higher over 2001–18 compared to 1875–2001. Our results are consistent with rates of change determined for other glaciers of similar size on Ellesmere Island, and with accelerated rates of ice loss coincident with regional increases in air temperature of ~1.5°C since the early 1980s.
Psychotropic prescription rates continue to increase in the United States (USA). Few studies have investigated whether social-structural factors may play a role in psychotropic medication use independent of mental illness. Food insecurity is prevalent among people living with HIV in the USA and has been associated with poor mental health. We investigated whether food insecurity was associated with psychotropic medication use independent of the symptoms of depression and anxiety among women living with HIV in the USA.
Methods
We used cross-sectional data from the Women's Interagency HIV Study (WIHS), a nationwide cohort study. Food security (FS) was the primary explanatory variable, measured using the Household Food Security Survey Module. First, we used multivariable linear regressions to test whether FS was associated with symptoms of depression (Center for Epidemiologic Studies Depression [CESD] score), generalised anxiety disorder (GAD-7 score) and mental health-related quality of life (MOS-HIV Mental Health Summary score; MHS). Next, we examined associations of FS with the use of any psychotropic medications, including antidepressants, sedatives and antipsychotics, using multivariable logistic regressions adjusting for age, race/ethnicity, income, education and alcohol and substance use. In separate models, we additionally adjusted for symptoms of depression (CESD score) and anxiety (GAD-7 score).
Results
Of the 905 women in the sample, two-thirds were African-American. Lower FS (i.e. worse food insecurity) was associated with greater symptoms of depression and anxiety in a dose–response relationship. For the psychotropic medication outcomes, marginal and low FS were associated with 2.06 (p < 0.001; 95% confidence interval [CI] = 1.36–3.13) and 1.99 (p < 0.01; 95% CI = 1.26–3.15) times higher odds of any psychotropic medication use, respectively, before adjusting for depression and anxiety. The association of very low FS with any psychotropic medication use was not statistically significant. A similar pattern was found for antidepressant and sedative use. After additionally adjusting for CESD and GAD-7 scores, marginal FS remained associated with 1.93 (p < 0.05; 95% CI = 1.16–3.19) times higher odds of any psychotropic medication use. Very low FS, conversely, was significantly associated with lower odds of antidepressant use (adjusted odds ratio = 0.42; p < 0.05; 95% CI = 0.19–0.96).
Conclusions
Marginal FS was associated with higher odds of using psychotropic medications independent of depression and anxiety, while very low FS was associated with lower odds. These complex findings may indicate that people experiencing very low FS face barriers to accessing mental health services, while those experiencing marginal FS who do access services are more likely to be prescribed psychotropic medications for distress arising from social and structural factors.
Accurate quantification of rates of glacier mass loss is critical for managing water resources and for assessing hazards at ice-clad volcanoes, especially in arid regions like southern Peru. In these regions, glacier and snow melt are crucial dry season water resources. In order to verify previously reported rates of ice area decline at Nevado Coropuna in Peru, which are anomalously rapid for tropical glaciers, we measured changes in ice cap area using 259 Landsat images acquired from 1980 to 2014. We find that Coropuna Ice Cap is presently the most extensive ice mass in the tropics, with an area of 44.1 km2, and has been shrinking at an average area loss rate of 0.409 km2 a−1 (~0.71% a−1) since 1980. Our estimated rate of change is considerably lower than previous studies (1.4 km2 a−1 or ~2.43% a−1), but is consistent with other tropical regions, such as the Cordillera Blanca located ~850 km to the NW (~0.68% a−1). Thus, if glacier recession continues at its present rate, our results suggest that Coropuna Ice Cap will likely continue to contribute to water supply for agricultural and domestic uses until ~2120, which is nearly 100 years longer than previously predicted.
As part of a project to investigate the flow of ice at low effective stress, two independent strain-gauge systems were used to measure vertical strain rate as a function of depth and time at Siple Dome, Antarctica. The measurements were made from January 1998 until January 2002 at the ice divide and a site 7km to the northeast on the flank. The strain-rate profiles place constraints on the rheology of ice at low stress, show the expected differences between divide and flank flow (with some structure due to firn compaction and probably ice stratigraphy), and suggest that the flow of the ice sheet has not changed much in the last 8.6 kyr. The strain rates show an unexpected time dependence on scales ranging from several months to hours, including discrete summer events at the divide. Time dependence in strain rate, water pressure, seismicity, velocity and possibly basal motion has been seen previously on the Siple Coast ice streams, but it is especially surprising on Siple Dome because the bed is cold.
We document changes for Mittivakkat Gletscher, the peripheral glacier in Greenland with the longest field-based observed mass-balance and surface velocity time series. Between 1986 and 2011, this glacier changed by −15% in mean ice thickness and −30% in volume. We attribute these changes to summer warming and lower winter snow accumulation. Vertical strain compensated for ∼60% of the elevation change due to surface mass balance (SMB) in the lower part, and ∼25% in the upper part. The annual mean ice surface velocity changed by −30%, which can be fully explained by the dynamic effect of ice thinning, within uncertainty. Mittivakkat Gletscher summer surface velocities were on average 50–60% above winter background values, and up to 160% higher during peak velocity events. Peak velocity events were accompanied by uplift of a few centimeters.
Hairy nightshade is the most widespread nightshade species in North America. Increased knowledge of hairy nightshade germination biology would facilitate development of an optimum control program. Germination of hairy nightshade seeds as affected by environmental and chemical factors was studied under greenhouse and controlled-environment growth chamber conditions. Hairy nightshade seeds were in an innate dormant state when initially separated from the berries. Moist compared with dry storage was more effective for breaking dormancy at 4 C, but dry storage was more effective at 17 C. Hairy nightshade seeds germinated equally well under both a 14-h photoperiod and continuous darkness. These germinated at constant temperatures ranging from 19 to 39 C, with optimum germination attained between 27 and 33 C. Germination markedly declined as osmotic potential of the germination medium decreased. The optimum pH range for germination of hairy nightshade seeds was between 6 and 8, although some seeds germinated at pH 4 and 9. Maximum hairy nightshade emergence occurred with seeding depths of 2 cm or less. No emergence occurred when seeding depth reached 8 cm.
Archaeological data and research results are essential to addressing such fundamental questions as the origins of human culture; the origin, waxing, and waning of civilizations and cities; the response of societies to long-term climate changes; and the systemic relationships implicated in human-induced changes in the environment. However, we lack the capacity for acquiring, managing, analyzing, and synthesizing the data sets needed to address important questions such as these. We propose investments in computational infrastructure that would transform archaeology’s ability to advance research on the field’s most compelling questions with an evidential base and inferential rigor that have heretofore been impossible. At the same time, new infrastructure would make archaeological data accessible to researchers in other disciplines. We offer recommendations regarding data management and availability, cyberinfrastructure tool building, and social and cultural changes in the discipline. We propose funding synthetic case studies that would demonstrate archaeology’s ability to contribute to transdisciplinary research on long-term social dynamics and serve as a context for developing computational tools and analytical workflows that will be necessary to attack these questions. The case studies would explore how emerging research in computer science could empower this research and would simultaneously provide productive challenges for computer science research.