bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of herbicides for paddy rice in Japan
Authors: Hamamura Kenshiro
Published: June 2018

The history of the development of herbicides for mechanized paddy rice production in Japan can be characterized by a combination of products with several ingredients, by large availability in formulation, and by application methods for labor saving in accordance with natural and social conditions of the country, for instance, around 40% of national land located in hilly and mountainous areas, small size paddy fields consolidated in approximately 0.3 ha on average and so on. As for combination products, one‐shot herbicides that can control both annual and perennial weeds, including grasses, sedges and broadleaved weeds, mainly with sulfonylureas have been a major means of rice production since the 1980s. One‐shot herbicides have been improved by using newly developed chemicals with excellent herbicidal efficacy, such as acetolactate synthase (ALS), 4‐hydroxyphenylpyruvate dioxygenase (4‐HPPD), protoporphyrinogen oxidase (PPO) and very‐long‐chain fatty acid elongase (VLCFAE) inhibitors, and by combining ingredients that are effective against sulfonylurea‐resistant (SU‐R) biotypes of lowland weeds. The latest type of one‐shot herbicides can control noxious species such as Eleocharis kuroguwai as well as other ordinal species. Regarding herbicide formulation, “1 kg granule,” “Jumbo,” “Flowable,” “Diffusion granule” and so on have been developed to save farmers the troubles of applying herbicides. As for application methods, “at‐transplanting application,” “at‐irrigation inlet application” and utilization of radio‐controlled helicopters or boats were put into practical use as labor‐saving technology. As a result, farmers were spared the severe hand‐weeding work under blazing heat during the summer season. Japan Association for Advancement of Phyto‐Regulators (JAPR) have promoted and contributed to the development of herbicides through collaboration with agrochemical companies and research organizations since it was founded in 1964. In this paper, I explain the development progress of herbicide using materials on the mode of action, the trend of one‐shot herbicides, the feature of a labor‐saving formulation and the working hours for weed management in rice production.
Tolerance to a haemorrhagic challenge during heat stress is improved with inspiratory resistance breathing
Authors: Huang Mu , Brothers R. Matthew , Ganio Matthew S. , Lucas Rebekah A. I. , Cramer Matthew N. , Moralez Gilbert , Convertino Victor A. , Crandall Craig G.
Published: June 2018

New Findings

What is the central question of this study?

Does inspiratory resistance breathing improve tolerance to simulated haemorrhage in individuals with elevated internal temperatures?

What is the main finding and its importance?

The main finding of this study is that inspiratory resistance breathing modestly improves tolerance to a simulated progressive haemorrhagic challenge during heat stress. These findings demonstrate a scenario in which exploitation of the respiratory pump can ameliorate serious conditions related to systemic hypotension.

Heat exposure impairs human blood pressure control and markedly reduces tolerance to a simulated haemorrhagic challenge. Inspiratory resistance breathing enhances blood pressure control and improves tolerance during simulated haemorrhage in normothermic individuals. However, it is unknown whether similar improvements occur with this manoeuvre in heat stress conditions. In this study, we tested the hypothesis that inspiratory resistance breathing improves tolerance to simulated haemorrhage in individuals with elevated internal temperatures. On two separate days, eight subjects performed a simulated haemorrhage challenge [lower‐body negative pressure (LBNP)] to presyncope after an increase in internal temperature of 1.3 ± 0.1°C. During one trial, subjects breathed through an inspiratory impedance device set at 0 cmH2O of resistance (Sham), whereas on a subsequent day the device was set at −7 cmH2O of resistance (ITD). Tolerance was quantified as the cumulative stress index. Subjects were more tolerant to the LBNP challenge during the ITD protocol, as indicated by a > 30% larger cumulative stress index (Sham, 520 ± 306 mmHg min; ITD, 682 ± 324 mmHg min; P < 0.01). These data indicate that inspiratory resistance breathing modestly improves tolerance to a simulated progressive haemorrhagic challenge during heat stress.
Study on the mechanisms of formation of aluminized diffusion coatings on a Ni-base superalloy using different pack aluminization procedures
Authors: Pauletti Ederson , d'Oliveira Ana Sofia Clímaco Monteiro
Published: June 2018

The mechanisms of formation and microstructure of pack aluminized diffusion coatings depend on a wide range of parameters. These impact coatings differently depending on the processing mode selected (out-of-pack or in-pack) and are still the subject of debate. The need to systematize data on the influence of processing mode on the mechanisms of the formation of aluminized coatings was the motivation for this study, which reviews the influence of processing mode based on an analysis of experimental data for aluminized coatings processed in-pack and out-of-pack on a Ni alloy with Al at unit activity at 800 °C [low temperature with high Al activity (LTHA)] and 1100 °C [high temperature with high Al activity (HTHA)]. The results show that processing mode determined the amount of Al deposited at the surface and that the formation of a larger halide-depleted zone during out-of-pack diffusion accounted for the reduced deposition of Al. Processing temperature and Al concentration at the surface of the alloy determined the mobility of the elements in the coating and, consequently, the coating thickness and dominant diffusion mechanisms. Aluminization with the specimen immersed in the pack resulted in a preferential inward diffusion of Al for both processing temperatures. In contrast, coatings processed by out-of-pack diffusion showed a dependence on processing temperature. When a HTHA process was used, the coatings were thinner and formed in a two-stage diffusion process, while a LTHA process failed to form aluminide diffusion coatings.
Acoustic features of auditory medical alarms—An experimental study of alarm volume
Authors: Schlesinger Joseph J. , Baum Miller Sarah H. , Nash Katherine , Bruce Marissa , Ashmead Daniel , Shotwell Matthew S. , Edworthy Judy R. , Wallace Mark T. , Weinger Matthew B.
Published: June 2018

Audible alarms are a ubiquitous feature of all high-paced, high-risk domains such as aviation and nuclear power where operators control complex systems. In such settings, a missed alarm can have disastrous consequences. It is conventional wisdom that for alarms to be heard, “louder is better,” so that alarm levels in operational environments routinely exceed ambient noise levels. Through a robust experimental paradigm in an anechoic environment to study human response to audible alerting stimuli in a cognitively demanding setting, akin to high-tempo and high-risk domains, clinician participants responded to patient crises while concurrently completing an auditory speech intelligibility and visual vigilance distracting task as the level of alarms were varied as a signal-to-noise ratio above and below hospital background noise. There was little difference in performance on the primary task when the alarm sound was −11 dB below background noise as compared with +4 dB above background noise—a typical real-world situation. Concurrent presentation of the secondary auditory speech intelligibility task significantly degraded performance. Operator performance can be maintained with alarms that are softer than background noise. These findings have widespread implications for the design and implementation of alarms across all high-consequence settings.
Development of a magnetic microrobot for carrying and delivering targeted cells
Authors: Li Junyang , Li Xiaojian , Luo Tao , Wang Ran , Liu Chichi , Chen Shuxun , Li Dongfang , Yue Jianbo , Cheng Shuk-han , Sun D.
Published: June 2018

A three-dimensional magnetically driven microrobot can carry and deliver cells to targeted areas in vivo.
Predictors of Peripherally Inserted Central Catheter Occlusion in the Outpatient Parenteral Antimicrobial Therapy Setting
Authors: Lam Philip W. , Graham Christopher , Leis Jerome A. , Daneman Nick
Published: June 2018

In this retrospective study of 285 patients receiving outpatient parenteral antibiotic therapy (OPAT), the duration of antibiotic, use of double-lumen catheters, and receipt of penicillin G and cloxacillin appeared to increase the risk of peripherally inserted central catheter (PICC) occlusion. Physicians should consider these factors when prescribing long-term antibiotic therapy.
Widely Used Benzalkonium Chloride Disinfectants Can Promote Antibiotic Resistance
Authors: Kim Minjae , Weigand Michael R. , Oh Seungdae , Hatt Janet K. , Krishnan Raj , Tezel Ulas , Pavlostathis Spyros G. , Konstantinidis Konstantinos T.
Published: June 2018

Benzalkonium chlorides (BAC) are biocides broadly used in disinfectant solutions. Disinfectants are widely used in food processing lines, domestic households, and pharmaceutical products and are typically designed to have a different mode of action than antibiotics to avoid interfering with the use of the latter. Whether exposure to BAC makes bacteria more resistant to antibiotics remains an unresolved issue of obvious practical consequences for public health. Using an integrated approach that combines metagenomics of natural microbial communities with gene cloning experiments with isolates and experimental evolution assays, we show that the widely used benzalkonium chloride disinfectants promote clinically relevant antibiotic resistance. Therefore, more attention should be given to the usage of these disinfectants, and their fate in nontarget environments should be monitored more tightly.
Whole-Genome Sequence of Salmonella enterica subsp. enterica Serovar Typhimurium Strain WG49 and Escherichia coli Strain WG5 Used in South Africa for Phage Detection in Water Samples
Authors: Bothma L. , Gonzalez-Ibeas D. , Mienie C. , Bezuidenhout C. C. , Adeleke R.
Published: June 2018

Salmonella enterica
subsp.
enterica
serovar Typhimurium WG49 is widely used for enumeration of F-specific RNA (F-RNA) coliphages in water.
Closed Genome Sequence of Clostridium botulinum Strain CFSAN064329 (62A)
Authors: Wentz Travis G. , Yao Kuan , Schill Kristin M. , Reddy N. Rukma , Skinner Guy E. , Morrissey Travis R. , Wang Yun , Muruvanda Tim , Manickam Gowri , Pillai Christine A. , Thirunavukkarasu Nagarajan , Hoffmann Maria , Hammack Thomas S. , Brown Eric W. , Allard Marc W. , Sharma Shashi K.
Published: June 2018

Clostridium botulinum
is a strictly anaerobic, Gram-positive, spore-forming bacterium that produces botulinum neurotoxin, a potent and deadly proteinaceous exotoxin.
Clostridium botulinum
strain CFSAN064329 (62A) produces an A1 serotype/subtype botulinum neurotoxin and is frequently utilized in food challenge and detection studies.
Complete Genome Sequence of Acinetobacter schindleri SGAir0122 Isolated from Singapore Air
Authors: Kee Carmon , Junqueira Ana Carolina M. , Uchida Akira , Purbojati Rikky W. , Houghton James N. I. , Chénard Caroline , Wong Anthony , Clare Megan E. , Kushwaha Kavita K. , Panicker Deepa , Putra Alexander , Gaultier Nicolas E. , Premkrishnan Balakrishnan N. V. , Heinle Cassie E. , Vettath Vineeth Kodengil , Drautz-Moses Daniela I. , Schuster Stephan C.
Published: June 2018

Acinetobacter schindleri
strain SGAir0122 was isolated from tropical air samples collected in Singapore. The prevalence of nosocomial infection caused by this Gram-negative bacterium indicates its clinical significance as an opportunistic human pathogen.
Genome Sequence of Acetomicrobium hydrogeniformans OS1
Authors: Cook Lauren E. , Gang Spencer S. , Ihlan Alicia , Maune Matthew , Tanner Ralph S. , McInerney Michael J. , Weinstock George , Lobos Elizabeth A. , Gunsalus Robert P.
Published: June 2018

Acetomicrobium hydrogeniformans
, an obligate anaerobe of the phylum
Synergistetes
, was isolated from oil production water. It has the unusual ability to produce almost 4 molecules H
2
/molecule glucose.
Genome Sequence of the Soybean Cyst Nematode (Heterodera glycines) Endosymbiont “Candidatus Cardinium hertigii” Strain cHgTN10
Authors: Showmaker Kurt C. , Walden Kimberly K. O. , Fields Christopher J. , Lambert Kris N. , Hudson Matthew E.
Published: June 2018

In this study, we present the genome sequence of the “
Candidatus
Cardinium hertigii” strain cHgTN10, an endosymbiotic bacterium of the plant-parasitic nematode
Heterodera glycines
. This is the first genome assembly reported for an endosymbiont directly sequenced from a tylenchid nematode.
Draft Genome Sequences of Chryseobacterium lactis NCTC11390
T
Isolated from Milk, Chryseobacterium oncorhynchi 701B-08
T
from Rainbow Trout, and Chryseobacterium viscerum 687B-08
T
from Diseased Fish
Authors: Jeong Jin-Ju , Lee Ye Ji , Pathiraja Duleepa , Park Byeonghyeok , Choi In-Geol , Kim Ki Deok
Published: June 2018

The genus
Chryseobacterium
, belonging to the family
Flavobacteriaceae
, contains Gram-negative, yellow-pigmented, rod-shaped, and non-spore-forming bacterial species, which may be free living or parasitic. Here, we report draft genome sequences of type strains of three species of
Chryseobacterium
containing genes related to biological control and plant growth promotion.
Within-a-Day Detection and Rapid Characterization of Carbapenemase by Use of a New Carbapenem Inactivation Method-Based Test, CIMplus
Authors: Caméléna François , Cointe Aurélie , Mathy Vincent , Hobson Claire , Doit Catherine , Bercot Béatrice , Decré Dominique , Podglajen Isabelle , Dortet Laurent , Monjault Audrey , Bidet Philippe , Bonacorsi Stéphane , Birgy André
Published: June 2018

The dissemination of carbapenemase-producing
Enterobacteriaceae
(CPE) is a major threat to public health. Rapid and accurate detection of CPE is essential for initiating appropriate antimicrobial treatment and establishing infection control measures.
Impact of a modified version of baby-led weaning on iron intake and status: a randomised controlled trial
Authors: Daniels Lisa , Taylor Rachael W , Williams Sheila M , Gibson Rosalind S , Fleming Elizabeth A , Wheeler Benjamin J , Taylor Barry J , Haszard Jillian J , Heath Anne-Louise M
Published: June 2018

Objective

To determine the iron intake and status of infants following a version of baby-led weaning (BLW) modified to prevent iron deficiency (Baby-Led Introduction to SolidS; BLISS) compared with those of infants following traditional spoon-feeding.

Design, participants and intervention

This randomised controlled trial included 206 participants assigned to control (n=101) or BLISS (n=105) groups. Both groups received standard midwifery and ‘Well Child’ care. BLISS participants received eight additional visits (from before birth to 9 months) providing education and support on the BLISS approach to complementary feeding (ie, BLW modified to increase iron intake). The primary outcome of the BLISS study (growth) has been previously reported. This paper reports the key prespecified secondary outcomes, iron intake and iron status.

Outcome measures

Intake of iron and key absorption modifiers were assessed using weighed 3-day diet records at 7 and 12 months. A venipuncture blood sample was collected at 12 months to determine plasma ferritin, haemoglobin, soluble transferrin receptor, C-reactive protein and α1-acid glycoprotein concentrations; and body iron was calculated.

Results

Differences in median dietary iron intakes between the control and BLISS groups were not significant at 7 (difference 0.6 mg/day; 95% CI −1.0 to 2.3) or 12 (−0.1 mg/day; −1.6 to 1.4) months of age. Similarly, there were no significant differences in plasma ferritin concentration (difference −2.6 µg/L; 95% CI −10.9 to 5.8), body iron (0.04 mg/kg; −1.1 to 1.2) or the prevalence of depleted iron stores, early functional iron deficiency or iron deficiency anaemia (all p≥0.65) at 12 months of age.

Conclusions

A baby-led approach to complementary feeding does not appear to increase the risk of iron deficiency in infants when their parents are given advice to offer ‘high-iron’ foods with each meal.

Trial registration number

ACTRN12612001133820; Pre-results.
Health system costs of potentially inappropriate prescribing in Ontario, Canada: a protocol for a population-based cohort study
Authors: Black Cody D , Thavorn Kednapa , Coyle Douglas , Smith Glenys , Bjerre Lise M
Published: June 2018

Introduction

Adverse drug events (ADEs) are common in older persons and contribute significantly to emergency department visits, hospitalisations and mortality. ADEs are often due to potentially inappropriate prescriptions (PIP) or potentially inappropriate omissions (PIO), and are avoidable if inappropriate prescriptions or omissions are identified and prevented. Identifying PIP/PIO at the population level through the application of PIP/PIO assessment tools to health administrative data can provide a unique opportunity to assess the economic burden of PIP/PIO on the healthcare system beyond medication costs which is yet to be done. The objective of this study is to assess the economic burden associated with PIP/PIO and to estimate the incremental costs associated with distinct PIP/PIO in the province of Ontario.

Methods and analysis

We will conduct a retrospective cohort study using Ontario’s health administrative databases. Eligible patients aged 66 years and older who were prescribed at least one medication between 1 April 2003 and 31 March 2014 (approximately 2.4 million patients) will be included. Population attributable fraction methodology will be used to assess the overall burden of PIP in Ontario, while regression analyses will be used to estimate the incremental costs of having specific PIP criteria and aid in prioritising targets for intervention.

Ethics and dissemination

This study was approved by the Institutional Review Board at Sunnybrook Health Sciences Centre, Toronto, Canada. Dissemination will occur via publication, presentation at national and international conferences, and knowledge exchange with various stakeholders.
Economic cost of substandard and falsified human medicines and cosmetics with banned ingredients in Tanzania from 2005 to 2015: a retrospective review of data from the regulatory authority
Authors: Mori Amani Thomas , Meena Estella , Kaale Eliangiringa A
Published: June 2018

Objective

To estimate the economic cost of substandard and falsified human medicines and cosmetics with banned ingredients in Tanzania from 2005 to 2015.

Design

A retrospective review of data.

Setting

Tanzania Food and Drugs Authority and premises dealing with importations and distributions of pharmaceuticals.

Eligibility criteria

Confiscation reports of substandard human medicines, falsified human medicines and cosmetics with banned ingredients.

Primary and secondary outcome measures

Quantities and costs of pharmaceutical products, costs of transportation, storage, court cases and disposal of products.

Results

The economic cost of substandard and falsified human medicines and cosmetics with banned ingredients was estimated at US$16.2 million, that is, value of substandard medicines US$13.7 million (84.4%), falsified medicines US$0.1 million (1%), cosmetics with banned ingredients US$1.3 million (8%) and other/operational costs US$1.1 million (6.6%). Some of the identified substandard and falsified human medicines include commonly used antibiotics such as phenoxymethylpenicillin, amoxicillin, cloxacillin and co-trimoxazole; antimalarials such quinine, sulfadoxine–pyrimethamine, sulfamethoxypyrazine–pyrimethamine and artemether–lumefantrine; antiretroviral drugs; antipyretics and vitamins among others.

Conclusion

The economic cost of substandard and falsified human medicines and cosmetics with banned ingredients represent a relatively large loss of scarce resources for a poor country like Tanzania. We believe that the observed increase in the quantities and the economic cost of these products over time could partly be due to the improvement in the regulatory capacity in terms of human resources, infrastructure and frequency of inspections.
Characteristics and the average 30-day and 6-month clinical outcomes of patients hospitalised with coronary artery disease in a poor South-East Asian setting: the first cohort from Makassar Cardiac Center, Indonesia
Authors: Qanitha Andriany , Uiterwaal Cuno S P M , Henriques Jose P S , Alkatiri Abdul Hakim , Mappangara Idar , Mappahya Ali Aspar , Patellongi Ilhamjaya , de Mol Bastianus A J M
Published: June 2018

Objective

To provide a detailed description of characteristics at hospital admission and clinical outcomes at 30-day and 6-month follow-up in patients hospitalised with coronary artery disease (CAD) in a poor South-East Asian setting.

Design

Prospective observational cohort study.

Setting

From February 2013 to December 2014, in Makassar Cardiac Center, Indonesia.

Participants

477 patients with CAD (acute coronary syndrome and stable CAD).

Outcome measures

All-cause mortality and major adverse cardiovascular events (MACE).

Results

Out of 477 patients with CAD, the proportion of young age (<60 years) was 53.9% and 72.7% were male. At admission, 44.2% of patients were diagnosed with ST-segment elevation myocardial infarction (STEMI), 38.6% with diagnosis or signs of heart failure and 75.1% had previous hypertension. Out of 211 patients with STEMI, only 4.7% had been treated with primary percutaneous coronary intervention (PCI) and 6.2% received thrombolysis. The time lapse from symptom onset to hospital admission was 26.8 (IQR 10.0–48.0) hours, and 19.1% of all patients had undergone either PCI or coronary artery bypass graft. The survival rate at 6 months was 78.9%. The rates of all-cause mortality at 30 days and 6 months were 13.4% and 7.3%, respectively; the rate of composite MACE at 30 days was 26.2% and 18.0% at 6 months.

Conclusions

Patients with CAD from a poor South-East Asian setting present themselves with predominantly unstable conditions of premature CAD. These patients show relatively severe illness, have significant time delay from symptom onset to admission or intervention, and most do not receive the guidelines-recommended treatment. Awareness of symptoms, prompt initial management of acute CVD, well-established infrastructures and resources both in primary and secondary hospital for CVD should be improved to reduce the high rates of 30-day and 6-month mortality and adverse outcomes in this population.
Factors influencing early and late readmissions in Australian hospitalised patients and investigating role of admission nutrition status as a predictor of hospital readmissions: a cohort study
Authors: Sharma Yogesh , Miller Michelle , Kaambwa Billingsley , Shahi Rashmi , Hakendorf Paul , Horwood Chris , Thompson Campbell
Published: June 2018

Objectives

Limited studies have identified predictors of early and late hospital readmissions in Australian healthcare settings. Some of these predictors may be modifiable through targeted interventions. A recent study has identified malnutrition as a predictor of readmissions in older patients but this has not been verified in a larger population. This study investigated what predictors are associated with early and late readmissions and determined whether nutrition status during index hospitalisation can be used as a modifiable predictor of unplanned hospital readmissions.

Design

A retrospective cohort study.

Setting

Two tertiary-level hospitals in Australia.

Participants

All medical admissions ≥18 years over a period of 1 year.

Outcomes

Primary objective was to determine predictors of early (0–7 days) and late (8–180 days) readmissions. Secondary objective was to determine whether nutrition status as determined by malnutrition universal screening tool (MUST) can be used to predict readmissions.

Results

There were 11 750 (44.8%) readmissions within 6 months, with 2897 (11%) early and 8853 (33.8%) late readmissions. MUST was completed in 16.2% patients and prevalence of malnutrition during index admission was 31%. Malnourished patients had a higher risk of both early (OR 1.39, 95% CI 1.12 to 1.73) and late readmissions (OR 1.23, 95% CI 1.06 to 128). Weekend discharges were less likely to be associated with both early (OR 0.81, 95% CI 0.74 to 0.91) and late readmissions (OR 0.91, 95% CI 0.84 to 0.97). Indigenous Australians had a higher risk of early readmissions while those living alone had a higher risk of late readmissions. Patients ≥80 years had a lower risk of early readmissions while admission to intensive care unit was associated with a lower risk of late readmissions.

Conclusions

Malnutrition is a strong predictor of unplanned readmissions while weekend discharges are less likely to be associated with readmissions. Targeted nutrition intervention may prevent unplanned hospital readmissions.

Trial registration

ANZCTRN 12617001362381; Results.
Retirement ages of senior UK doctors: national surveys of the medical graduates of 1974 and 1977
Authors: Smith Fay , Goldacre Michael J , Lambert Trevor W
Published: June 2018

Objective

To report on retirement ages of two cohorts of senior doctors in the latter stages of their careers.

Design

Questionnaires sent in 2014 to all medical graduates of 1974 and 1977.

Setting

UK.

Participants

3695 UK medical graduates.

Main outcome measures

Retirement status by age at the time of the survey and age at retirement if retired. Planned retirement ages and retirement plans if not retired.

Results

Of contactable doctors, 85% responded. 43.7% of all responding doctors had fully retired, 25.9% had ‘retired and returned’ for some medical work, 18.3% had not retired and were working full-time in medicine, 10.7% had not retired and were working part-time in medicine and 1.4% were either doing non-medical work or did not give details of their employment status. The average actual retirement age (including those who had retired but subsequently returned) was 59.6 years (men 59.9, women 58.9). Psychiatrists (58.3) and general practitioners (GPs) (59.5) retired at a slightly younger age than radiologists (60.4), surgeons (60.1) and hospital specialists (60.0). More GPs (54%) than surgeons (26%) or hospital medical specialists (34%) were fully retired, and there were substantial variations in retirement rates in other specialties. Sixty-three per cent of women GPs were fully retired.

Conclusions

Gender and specialty differences in retirement ages were apparent and are worthy of qualitative study to establish underlying reasons in those specialties where earlier retirement is more common. There is a general societal expectation that people will retire at increasingly elderly ages; but the doctors in this national study retired relatively young.
Study protocol for a multicentre, cluster randomised, superiority trial evaluating the impact of computerised decision support, audit and feedback on antibiotic use: the COMPuterized Antibiotic Stewardship Study (COMPASS)
Authors: Catho Gaud , De Kraker Marlieke , Waldispühl Suter Brigitte , Valotti Roberta , Harbarth Stephan , Kaiser Laurent , Elzi Luigia , Meyer Rodolphe , Bernasconi Enos , Huttner Benedikt D
Published: June 2018

Introduction

Inappropriate use of antimicrobials in hospitals contributes to antimicrobial resistance. Antimicrobial stewardship (AMS) interventions aim to improve antimicrobial prescribing, but they are often resource and personnel intensive. Computerised decision supportsystems (CDSSs) seem a promising tool to improve antimicrobial prescribing but have been insufficiently studied in clinical trials.

Methods and analysis

The COMPuterized Antibiotic Stewardship Study trial, is a publicly funded, open-label, cluster randomised, controlled superiority trial which aims to determine whether a multimodal CDSS intervention integrated in the electronic health record (EHR) reduces overall antibiotic exposure in adult patients hospitalised in wards of two secondary and one tertiary care centre in Switzerland compared with ‘standard-of-care’ AMS. Twenty-four hospital wards will be randomised 1:1 to either intervention or control, using a ‘pair-matching’ approach based on baseline antibiotic use, specialty and centre. The intervention will consist of (1) decision support for the choice of antimicrobial treatment and duration of treatment for selected indications (based on indication entry), (2) accountable justification for deviation from the local guidelines (with regard to the choice of molecules and duration), (3) alerts for self-guided re-evaluation of treatment on calendar day 4 of antimicrobial therapy and (4) monthly ward-level feedback of antimicrobial prescribing indicators. The primary outcome will be the difference in overall systemic antibiotic use measured in days of therapy per admission based on administration data recorded in the EHR over the whole intervention period (12 months), taking into account clustering. Secondary outcomes include qualitative and quantitative antimicrobial use indicators, economic outcomes and clinical, microbiological and patient safety indicators.

Ethics and dissemination

Ethics approval was obtained for all participating sites (Comission Cantonale d'Éthique de la Recherche (CCER)2017–00454). The results of the trial will be submitted for publication in a peer-reviewed journal. Further dissemination activities will be presentations/posters at national and international conferences.

Trial registration number

NCT03120975; Pre-results.
Developing a hospital-wide quality and safety dashboard: a qualitative research study
Authors: Weggelaar-Jansen Anne Marie J W M , Broekharst Damien S E , de Bruijne Martine
Published: June 2018

Background

Several countries have national policies and programmes requiring hospitals to use quality and safety (QS) indicators. To present an overview of these indicators, hospital-wide QS (HWQS) dashboards are designed. There is little evidence how these dashboards are developed. The challenges faced to develop these dashboards in Dutch hospitals were retrospectively studied.

Methods

24 focus group interviews were conducted: 12 with hospital managers (n=25; 39.7%) and 12 support staff (n=38; 60.3%) in 12 of the largest Dutch hospitals. Open and axial codings were applied consecutively to analyse the data collected.

Results

A heuristic tool for the general development process for HWQS dashboards containing five phases was identified. In phase 1, hospitals make inventories to determine the available data and focus too much on quantitative data relevant for accountability. In phase 2, hospitals develop dashboard content by translating data into meaningful indicators for different users, which is not easy due to differing demands. In phase 3, hospitals search for layouts that depict the dashboard content suited for users with different cognitive abilities and analytical skills. In phase 4, hospitals try to integrate dashboards into organisational structures to ensure that data are systematically reviewed and acted on. In phase 5, hospitals want to improve the flexibility of their dashboards to make this adaptable under differing circumstances.

Conclusion

The literature on dashboards addresses the technical and content aspects of dashboards, but overlooks the organisational development process. This study shows how technical and organisational aspects are relevant in development processes.
Do GPs accurately record date of death? A UK observational analysis
Authors: Harshfield Amelia , Abel Gary A , Barclay Stephen , Payne Rupert A
Published: June 2018

Objective

To examine the concordance between dates of death recorded in UK primary care and national mortality records.

Methods

UK primary care data from the Clinical Practice Research Datalink were linked to Office for National Statistics (ONS) data, for 118 571 patients who died between September 2010 and September 2015. Logistic regression was used to examine factors associated with discrepancy in death dates between data sets.

Results

Death dates matched in 76.8% of cases with primary care dates preceding ONS date in 2.9%, and following in 20.3% of cases; 92.2% of cases differed by <2 weeks. Primary care date was >4 weeks later than ONS in 1.5% of cases and occurred more frequently with deaths categorised as ‘external’ (15.8% vs 0.8% for cancer), and in younger patients (15.9% vs 1% for 18–29 and 80–89 years, respectively). General practices with the greatest discrepancies (97.5th percentile) had around 200 times higher odds of recording substantially discordant dates than practices with the lowest discrepancies (2.5th percentile).

Conclusion

Dates of death in primary care records often disagree with national records and should be treated with caution. There is marked variation between practices, and studies involving young patients, unexplained deaths and where precise date of death is important are particularly vulnerable to these issues.
Vulnerability as practice in diagnosing multiple conditions
Authors: Coyle Lindsay-Ann , Atkinson Sarah
Published: June 2018

The paper contributes to contemporary understandings of vulnerability by expanding their scope with an understanding of vulnerability as generated through institutionalised practices. The argument draws on experiential accounts of navigating the practices of diagnosis by people living with multiple conditions of ill-health and disability. Vulnerability as a concept is used widely across different domains and conveys a multitude of meanings. Contemporary biomedicine, and its associated health systems and services, understands vulnerability mostly as inherent to particular physical and mental bodily conditions that put people at risk of ill-health or emotionally fragility. This may combine with a more epidemiological understanding of vulnerability as the experience of certain population groups subject to entrenched structural inequalities. Philosophers and feminists have argued that vulnerability is a universal experience of being human while political commentators have explored its potential as a resource for resistance and action. Diagnosis within medicine and psychiatry has been the subject of extensive social analysis, critique and activism. The paper draws on first-hand experiential accounts collected through face-to-face interviews with people living with multiple conditions about their experiences of diagnosis, mostly at the primary care level. We identify five aspects to diagnostic practice that are harmful and exacerbate the experience of vulnerability: temporal sequencing; diagnostic authority; medical specialisation; strategic symptom selection; medical isolation. However, these diagnostic practices are not best understood only in terms of the power asymmetries inherent to the medical consultation, but are embedded into the very institution of diagnosis. The paper thus proposes a combined approach to vulnerability that recognises it as a universal condition of humanity but one that becomes animated or amplified for some bodies, through their own inherent incapacities or the external structures of inequality, and through the practices of medicine as situated in particular times and places.
Efficacy and safety of dabigatran versus warfarin from the RE-LY trial
Authors: Avezum Alvaro , Oliveira Gustavo Bernardes de Figueiredo , Diaz Rafael , Hermosillo Jesus Antonio Gonzalez , Oldgren Jonas , Ripoll Ernesto Ferreiros , Noack Herbert , Piegas Leopoldo Soares , Connolly Stuart J
Published: June 2018

Background

Current data for atrial fibrillation (AF) and stroke are predominantly derived from North American and European patients. Although the burden of AF is high in Latin America (LA), little is known about current management of AF in the region.

Methods

We aimed to assess the consistency of efficacy and safety outcomes associated with dabigatran etexilate (DE) versus warfarin in patients with AF in LA from the RE-LY (Randomised Evaluation of Long-Term Anticoagulant Therapy) trial. Data from 956 LA patients and 17 157 non-LA patients were included in this analysis. χ2test and Cox proportional regression analysis were performed. The primary efficacy outcome included all strokes or systemic embolism (SE). Main safety outcome was major bleeding.

Results

LA patients were more often female, had higher proportion of permanent AF and lower creatinine clearance, among other characteristics. Vitamin K antagonist use at randomisation and time in therapeutic range were lower in LA than in non-LA patients (44% vs 63%, p<0.001; and 61.3±22.6% vs 64.6±19.6%, p=0.015, respectively). Efficacy endpoints were 0.91% versus 1.68% for DE 150 mg twice daily versus warfarin, respectively. Stroke/SE risk was lower in LA patients treated with DE 150 mg twice daily compared with warfarin, although not significant (HR 0.54; 95% CI 0.18 to 1.62). The annual stroke/SE rates for DE 110 mg twice daily versus warfarin were 1.82 versus 1.68, also not significantly different (HR 1.09; CI 0.44 to 2.67). There were no treatment-by-region interactions for either dose of DE on efficacy and safety outcomes.

Conclusion

Despite differences in the clinical profile and AF management, the efficacy and safety benefits of dabigatran over warfarin in LA patients relative to non-LA patients are consistent with those observed in the main RE-LY trial.
Employment and the role of personal factors among patients with ankylosing spondylitis: a Dutch cross-sectional case-control study
Authors: Webers Casper , Vanhoof Laura , van Genderen Simon , Heuft Liesbeth , van de Laar Mart , Luime Jolanda , van der Heijde Désirée , van Gaalen Floris A , Spoorenberg Anneke , Boonen Annelies
Published: June 2018

Objectives

To update the knowledge on employment and the role of mastery, a personal factor reflecting the level of control over life and disease, among Dutch patients with ankylosing spondylitis (AS) compared to general population subjects.

Methods

Data of persons ≤65 years participating in a Dutch cross-sectional multicentre study on social participation in AS were used. Being employed was the main outcome. Standardised employment ratios (SERs) were calculated using indirect standardisation after adjusting for age, gender and education and repeated after stratification by symptom duration tertiles. Modified Poisson regressions were performed to understand the role of mastery (Pearlin’s scale) independent of sociodemographic and health-related factors.

Results

214 patients and 470 controls (127 (59.3%) and 323 (68.7%) males; mean age 48.3 (SD 10.4) and 39.3 (SD 12.7) years, respectively) completed an online questionnaire. SER (95%CI) in patients was 0.83 (0.69–0.98); 0.84 (0.67–1.04) in males; 0.83 (0.59–1.07) in females. Adjusted absolute employment of patients compared to controls was 69% versus 84%; 73% versus 86% for males; 62% versus 78% for females. In multivariable analyses stratified for patients and controls, mastery was associated with being employed in patients, but only in those with low education. In controls, not mastery but higher education was associated with being employed.

Conclusion

Our study reveals that patients suffering from AS compared to population controls are less likely to be employed. Mastery is an important personal factor associated with employment in patients but not in controls. Interventions aimed at improving employment of patients with AS should likely account for mastery.
Identity, environment and mental wellbeing in the veterinary profession
Authors: Armitage‐Chan Elizabeth , May Stephen A
Published: June 2018

Mental health and career dissatisfaction are of increasing concern to the veterinary profession. The influence of identity on the psychological wellbeing of veterinarians has not been widely explored. Twelve recent veterinary graduates were enrolled in a private social media discussion group, and their identities investigated through narrative inquiry: a methodology which enables identity priorities to be extrapolated from stories of experience. Two distinct variants of the veterinary identity were identified: an academic, ‘diagnosis‐focused’ identity, which prioritised definitive diagnosis and best‐evidence treatment; and a broader ‘challenge‐focused’ identity, where priorities additionally included engaging with the client, challenging environment or veterinary business. Contextual challenges (such as a client with limited finances or difficult interpersonal interactions) were seen as a source of frustration for those with a diagnosis‐focused identity, as they obstructed the realisation of identity goals. Overcoming these challenges provided satisfaction to those with a challenge‐focused identity. The employment environment of the graduates (general veterinary practice) provided more opportunities for those with a challenge‐focused identity to realise identity goals, and more markers of emotional wellbeing were apparent in their stories. Markers of poor emotional health were evident in the stories of those with a diagnosis‐focused identity.
A composite and deformable honeycomb acoustic metamaterial
Authors: Gao Nansha , Hou Hong , Wu Jiu Hui
Published: June 2018

This paper reports the design of a deformable honeycomb acoustic metamaterial, which consists of honeycomb structures and ethylene-vinyl acetate (EVA) copolymer films stacked on each other. The FEA results agree well with the experiment analysis, and it is proved that the proposed structure can break the acoustic mass law below 1000 Hz. This paper reveals that dislocation, compression, and tensile deformation can regulate the sound transmission loss (STL) in a wider frequency range. It is concluded that the STL of a bilayer structure is, on average, 10 dB higher than that of a monolayer structure at low-frequencies. When the dislocation distance b = 1.5 mm, the corresponding STLs reach their maximum values. The FEA and experiment results prove that compression and tensile deformation can considerably improve the sound insulation effect. Such a deformable honeycomb acoustic metamaterial with high STL provides a new concept for engineering noise control.
A Study of the Impact of Base Traditional Learners on Transfer Learning Algorithms
Authors: Weiss Karl R. , Khoshkoftaar Taghi M.
Published: June 2018

A transfer learning environment is characterized by not having sufficient labeled training data from the domain of interest (target domain) to build a high-performing machine learner. Transfer learning algorithms use labeled data from an alternate domain (source domain), that is similar to the target domain, to build high-performing learners. The design of a transfer learning algorithm is typically comprised of a domain adaptation step following by a learning step. The domain adaptation step attempts to align the distribution differences between the source domain and the target domain. Then, the aligned data from the domain adaptation step is used in the learning step, which is typically implemented with a traditional machine learning algorithm. Our research studies the impact of the learning step on the performance of various transfer learning algorithms. In our experiment, we use five unique domain adaptation methods coupled with seven different traditional machine learning methods to create 35 different transfer learning algorithms. We perform comparative performance analyses of the 35 transfer learning algorithms, along with the seven stand-alone traditional machine learning methods. This research will aid machine learning practitioners in the algorithm selection process for a transfer learning environment in the absence of reliable validation techniques.
Enhancement of third-order nonlinear optical properties of HMTA stabilized pure and doped ZnS nanoparticles and their electronic structures
Authors: Anand K. Vijai , Vinitha G. , Gautam Sanjeev , Chae K. H. , Mohan R. , Asokan K. , Ravindran T. R. , Jayavel R.
Published: June 2018

This study reports the third-order nonlinear optical (NLO) properties of hexamethylenetetramine (HMTA) stabilized pure and transition metals (Cu, Co and Mn) doped ZnS nanoparticles (NPs) and their electronic structures. The third-order NLO properties of pure and transition metals (Cu, Co and Mn) doped ZnS NPs were measured by [Formula: see text]-scan technique. From these measurements, the pure and doped ZnS samples exhibit negative nonlinearity i.e., self-defocusing. The open aperture [Formula: see text]-scan measurement shows saturated absorption within the medium. The prepared pure and doped ZnS samples exhibit nonlinear refractive index of the order of 10[Formula: see text][Formula: see text](cm2/W), nonlinear absorption (NLA) coefficient of the order of 10[Formula: see text][Formula: see text]cm/W and nonlinear optical susceptibility of the order of 10[Formula: see text][Formula: see text]esu. The electronic structures of these ZnS NPs were investigated using near edge X-ray absorption fine structure (NEXAFS) measurements at the C K-, N K- and Co L[Formula: see text]-edges. The C K- and N K-edges XANES spectra reveal the appearance of several spectral features in the range 285–290[Formula: see text]eV and 390–430[Formula: see text]eV respectively. The Co L[Formula: see text]-edge NEXAFS spectrum exhibits multiplet absorption lines similar to those of Co[Formula: see text] ions coordinated in tetrahedral symmetry with four sulfur nearest neighbors. These results clearly demonstrate that divalent Co ions substitute Zn sites. From the Raman spectra, the appearance of multiple resonance Raman peaks indicates that the prepared ZnS samples have good optical quality.
More insight into microscopic properties of RN-AdS black hole surrounded by quintessence via an alternative extended phase space
Authors: Chabab M. , El Moumni H. , Iraoui S. , Masmar K. , Zhizeh S.
Published: June 2018

In this work, we study the phase transition of the charged-AdS black hole surrounded by quintessence via an alternative extended phase space defined by the charge square [Formula: see text] and her conjugate [Formula: see text], a quantity proportional to the inverse of horizon radius, while the cosmological constant is kept fixed. The equation of state is derived under the form [Formula: see text] and the critical behavior of such black hole analyzed. In addition, we examine the role of the quintessence parameter and its effects on phase transitions. Besides that, we explore the connection between the microscopic structure and Ruppeiner geothermodynamics. We also find that, at certain points of the phase space, the Ruppeiner curvature is characterised by the presence of singularities that are interpreted as a signal of the occurrence of the phase transitions.
Common spectral properties of linear operators A and B satisfying AkBkAk = Ak+1 and BkAkBk = Bk+1
Authors: Gupta Anuradha , Kumar Ankit
Published: June 2018

Let [Formula: see text] and [Formula: see text] be two bounded linear operators on a Banach space [Formula: see text] and [Formula: see text] be a positive integer such that [Formula: see text] and [Formula: see text], then [Formula: see text], [Formula: see text], [Formula: see text] and [Formula: see text] have some common spectral properties. Drazin invertibility and polaroidness of these operators are also discussed. Cline’s formula for Drazin inverse in a ring with identity is also studied under the assumption that [Formula: see text] for some positive integer [Formula: see text].
Ni-MOF in-situ Decorating ZnO photoelectrode for photoelectrochemical water splitting
Authors: Liu Zhen Qian , Qiu Kejia , Bai Hongye , Wang Fagen , Ge Yilin , Cui Weicheng , Zheng Guoli , Cui Jianguo , Fan Weiqiang
Published: June 2018

The Ni-MOF as co-catalyst has been in-situ introduced on the surface of ZnO photoelectrode by chemical etching method for the first time, and the unique organic/inorganic heterostructure (Ni-MOF/ZnO) was applied for photoelectrochemical water splitting. The Ni-MOF could work as special co-catalyst to improve the kinetic and charges separation of ZnO electrode, and the photocurrent density of Ni-MOF/ZnO has increased to about 1.8 times than that of bare ZnO. The IPCE value of Ni-MOF/ZnO has been enhanced up to 11% (355[Formula: see text]nm, 0.5[Formula: see text]V vs Ag/AgCl). The proposed mechanism of charges transfer has been also discussed in-depth, according to the photoelectrochemical performance.