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We calculated the human resources required for an antimicrobial stewardship program (ASP) in Korean hospitals.
Multicenter retrospective study.
Eight Korean hospitals ranging in size from 295 to 1,337 beds.
The time required for performing ASP activities for all hospitalized patients under antibiotic therapy was estimated and converted into hours per week. The actual time spent on patient reviews of each ASP activity was measured with a small number of cases, then the total time was estimated by applying the determined times to a larger number of cases. Full-time equivalents (FTEs) were measured according to labor laws in Korea (52 hours per week).
In total, 225 cases were reviewed to measure time spent on patient reviews. The median time spent per patient review for ASP activities ranged from 10 to 16 minutes. The total time spent on the review for all hospitalized patients was estimated using the observed number of ASP activities for 1,534 patients who underwent antibiotic therapy on surveillance days. The most commonly observed ASP activity was ‘review of surgical prophylactic antibiotics’ (32.7%), followed by ‘appropriate antibiotics recommendations for patients with suspected infection without a proven site of infection but without causative pathogens’ (28.6%). The personnel requirement was calculated as 1.20 FTEs (interquartile range [IQR], 1.02–1.38) per 100 beds and 2.28 FTEs (IQR, 1.93–2.62) per 100 patients who underwent antibiotic therapy, respectively.
The estimated time required for human resources performing extensive ASP activities on all hospitalized patients undergoing antibiotic therapy in Korean hospitals was ~1.20 FTEs (IQR, 1.02–1.38) per 100 beds.
The oxidation behavior of the selective laser melting (SLM)–fabricated Inconel 718 was investigated through isothermal oxidation testing at 650 °C for 500 h and compared with that of the as-cast and as-forged specimens at the same testing conditions. The effect of microstructure and surface roughness on the oxidation behavior of the SLM-fabricated, as-cast, and as-forged Inconel 718 specimens was examined. The result shows that Inconel 718 fabricated by SLM with the unique layer structure exhibited a better resistance to the 500 h oxidation at 650 °C compared with as-cast and as-forged 718 with coarse dendritic structure and uniform equiaxed grain microstructure, respectively. The influence of the surface roughness on the long-time oxidation resistance of SLM specimens is not pronounced compared with that of as-cast and as-forged specimens. The tiny dendrites instead of grain boundaries are a major influencing factor for the oxidation process of SLM specimens. The surface roughness has more evident influence on the oxidation resistance of as-forged specimens than that of the as-cast ones subjected to the 500 h oxidation at 650 °C.
Internationalization plays an important role in Huawei’s transformation from a fledgling Chinese start-up to a powerful multinational company. Huawei’s internationalization is characterized by repeated failures, difficult struggles and unceasing learning by doing. In this chapter, we divide the whole internationalization process of Huawei into three stages based on the different challenges at each stage. They are (1) overcoming the liability of foreignness, (2) managing complexity to achieve synergy from a global perspective, and (3) changing from a latecomer mindset to that of a global leader. For each stage, we summarize and discuss how Huawei adopts routinization and de-routinization strategies to efficiently overcome different challenges. The managerial implications derived from Huawei’s internationalization will be useful for other multinational firms.
To solve the poor cyclability of faradic supercapacitors (SCs), the authors reported a unique porous carbon (PC) coating with “gap shell” structure on carbon fiber cloth (CFC)/NiS2 materials. This gap shell PC coating was fabricated by combining atomic layer deposition (ALD) Al2O3 and molecular layer deposition alucone, followed by carbonization and etching. The as-prepared CFC/NiS2/PC composites were directly used as binder-free electrodes for SCs. Benefited from its novel nanostructure, the CFC/NiS2/PC electrode shows a large specific capacitance of 1034.6 F/g at 1 A/g and considerable rate capability of 67% capacitance, retaining ratio within 1–20 A/g. The cyclability of the CFC/NiS2/PC electrode is enhanced by 50% relative to the mere CFC/NiS2 after 2000 cycles, which is attributed to the gap and electrically conductive PC coating. Hence, this work provides a promising approach to design gap shell layer for improved cyclability of faradic SCs and other practical applications in energy storage electronics.
To describe the epidemiologic features of an outbreak of an acute respiratory tract infection (ARI) caused by β-lactamase-negative ampicillin-resistant (BLNAR) nontypeable Haemophilus influenzae (NTHi) in an acute-care ward.
Cross-sectional case-control study.
An acute-care ward (ward A) in a general hospital of Kochi in western Japan.
Patients who shared a room with an index patient and all staff in ward A were screened and followed from July 1 to August 31, 2015. Sputum or throat swab samples were collected from participants and tested by culture and polymerase chain reaction (PCR). The association between detected pathogens and ARI development among all participants was examined. A case-control study was conducted to identify risk factors for disease.
In total, 78 participants, including the index patient, were enrolled. Of all participants, 27 (34.6%) developed mild respiratory symptoms during a 3-week period: 24 were diagnosed as upper respiratory tract infections, and 3 were diagnosed as lower respiratory tract infections. The presence of BLNAR NTHi was confirmed in 13 participants, and multilocus sequence typing demonstrated that these isolates belonged to sequence type 159. All isolates showed identical pulsed-field gel electrophoresis patterns. The presence of BLNAR NTHi was strongly associated with ARI development, whereas viruses were not associated with the disease. Multivariate analyses demonstrated that a history of contact with the index patient was independently associated with ARI caused by BLNAR NTHi.
BLNAR NTHi has the potential to cause upper respiratory tract infections among adults and to spread rapidly in hospital settings.
The present study was carried out to evaluate dietary Mn requirements of broilers from 22 to 42 d of age using molecular biomarkers. Chickens were fed a conventional basal maize–soyabean meal diet supplemented with Mn as Mn sulphate in graded concentrations of 20 mg Mn/kg from 0 to 140 mg Mn/kg of diet for 21 d (from 22 to 42 d of age). The Mn response curves were fitted for ten parameters including heart Mn-containing superoxide dismutase (MnSOD) mRNA and its protein expression levels and the DNA-binding activities of specificity protein 1 (Sp1) and activating protein-2 (AP-2). Heart MnSOD mRNA and protein expression levels showed significant quadratic responses (P<0·01), and heart MnSOD activity showed a broken-line response (P<0·01), whereas Mn content and DNA-binding activities of Sp1 and AP-2 in the heart displayed linear responses (P<0·01) to dietary Mn concentrations, respectively. The estimates of dietary Mn requirements were 101, 104 and 94 mg/kg for full expressions of MnSOD mRNA level, MnSOD protein level and MnSOD activity in the heart, respectively. Our findings indicate that heart MnSOD mRNA expression level is a more reliable indicator than heart MnSOD protein expression level and its activity for the evaluation of Mn requirement of broilers, and about 100 mg Mn/kg of diet is required for the full expression of heart MnSOD in broilers fed the conventional basal maize–soyabean meal diet from 22 to 42 d of age.
Decreased hemoglobin levels increase the risk of developing dementia among the elderly. However, the underlying mechanisms that link decreased hemoglobin levels to incident dementia still remain unclear, possibly due to the fact that few studies have reported on the relationship between low hemoglobin levels and neuroimaging markers. We, therefore, investigated the relationships between decreased hemoglobin levels, cerebral small-vessel disease (CSVD), and cortical atrophy in cognitively healthy women and men.
Cognitively normal women (n = 1,022) and men (n = 1,018) who underwent medical check-ups and magnetic resonance imaging (MRI) were enrolled at a health promotion center. We measured hemoglobin levels, white matter hyperintensities (WMH) scales, lacunes, and microbleeds. Cortical thickness was automatically measured using surface based methods. Multivariate regression analyses were performed after controlling for possible confounders.
Decreased hemoglobin levels were not associated with the presence of WMH, lacunes, or microbleeds in women and men. Among women, decreased hemoglobin levels were associated with decreased cortical thickness in the frontal (Estimates, 95% confidence interval, −0.007, (−0.013, −0.001)), temporal (−0.010, (−0.018, −0.002)), parietal (−0.009, (−0.015, −0.003)), and occipital regions (−0.011, (−0.019, −0.003)). Among men, however, no associations were observed between hemoglobin levels and cortical thickness.
Our findings suggested that decreased hemoglobin levels affected cortical atrophy, but not increased CSVD, among women, although the association is modest. Given the paucity of modifiable risk factors for age-related cognitive decline, our results have important public health implications.
The target article provides an intermediate account of culture and freedom that is conceived to be curvilinear by treating economic development not as an adaptive outcome in response to climate but as a cause of culture parallel to climate. We argue that the extent of environmental variability, including climatic variability, affects cultural adaptation.
Hypertension is a risk factor in many cardiovascular or cerebrovascular diseases. Adolescent hypertension may develop into adult hypertension. Examining the aetiologic factors of adolescent hypertension is crucial in its prevention and in managing its possible complications. The predominant view of aetiologic factors includes heredity, overweight/obesity, insulin resistance, gestational hypertension, diet, and intrauterine growth retardation. This article reported that children's academic grades in schools were positively correlated with adolescent blood pressure.
Numerous calc-alkaline granitoid intrusions in the eastern Kunlun Orogen provide a valuable opportunity to constrain the evolution of the orogen. The age and genesis of these intrusions, however, remain poorly understood. The granitoid intrusions near the Balong region, eastern Kunlun Orogen, consist of granodiorite, diorite and syenogranite. The granodiorite contains crystallized segregations, abundant mafic microgranular enclaves (MMEs) and small quartz diorite stocks. In situ zircon U–Pb dating reveals that the granodiorites and quartz diorites were emplaced between 263 and 241 Ma, whereas the syenogranite was produced at c. 231 Ma. The granodiorite and quartz diorite have a calc-alkaline affinity and are metaluminous and Na-rich, with slightly enriched Sr–Nd isotope compositions. The granodiorite is characterized by fractionated REE patterns, whereas the quartz diorite displays a relatively flat REE pattern. The MMEs are consistent with the granodiorite in terms of incompatible elements and Sr–Nd isotope composition. Compared to the granodiorite and diorite, the syenogranite has higher SiO2, K, Rb, Th and Sr contents and a lower Rb/Sr ratio. The results presented here, when combined with regional geological data, indicate that the granodiorite and quartz diorite were derived from dehydration melting of mafic lower crustal rocks during the N-directed subduction of the Anyemaqen ocean lithosphere in Late Permian–Middle Triassic times, whereas the syenogranite was produced at a higher crustal level in a syn-collisional setting compared to the granodiorite.
The ontolex interface is anchored on two essential elements of human knowledge: conceptual structure and lexical access. A well-structured ontolex interface facilitates bilingual representation of both the conceptual structure and the lexical information which will be crucial in overcoming linguistic barriers. In this chapter we propose a robust and versatile approach for constructing the ontolex interface infrastructure: Bilingual Ontological WordNet (BOW). The Academia Sinica Bilingual Ontological WordNet (Sinica BOW) was constructed in 2003 using this approach. We argue that this novel combination of ontology and WordNet will (1) give each linguistic form a precise location in the taxonomy, (2) clarify the relation between the conceptual classification and its linguistic instantiation, and (3) facilitate a genuine crosslingual access of knowledge.
In terms of the ongoing research regarding ontologies and lexical resources, the issue of multilingual application remains an area of opportunity and challenge. On the one hand, an ontology provides a platform whereby knowledge can be represented uniformly across different languages. On the other hand, the complex mapping between linguistic forms and meanings needs to be explicitly represented in a lexical knowledge-base. The mappings are compounded when crosslingual correspondences are considered. For the successful application of ontology and lexical resources to multilingual language processing, it will be essential that these two components are integrated. In this chapter, we propose a framework for integrating bilingual WordNet with an upper ontology.
Single-nucleotide polymorphisms (SNPs) of exon 8 of the GHR gene were detected in Chinese Holstein cows by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP). The results showed that exon 8 of the GHR gene digested by TasI could be divided into two kinds of alleles and three kinds of genotypes. The frequencies of allele A and T were 0.6339 and 0.3661, respectively. The frequencies of genotypes AA, AT and TT were 0.459, 0.350 and 0.191, respectively. Sequencing showed one single nucleotide mutation T→A at 4962 bp of the gene in genotype TT when compared with genotype AA, and this mutation resulted in an amino acid change of phenylalanine (TTT)→tyrosine (TAT). The result of χ2 testing indicated that the genotypic frequency of the GHR gene digested by TasI did not fit with Hardy–Weinberg equilibrium in this population (P<0.05). The least-square mean of the fat percentage of this population was higher for genotype TT than for genotype AA (P<0.05).
In this study, the mechanical properties of human dental structures have been investigated by using instrumented nanoindentation. Immersion in solutions containing Streptococcus mutans, which is the principal cause of dental caries, was applied to tooth specimens to clarify its effect on the microstructure and mechanical properties of the dental structures. With an extended time of up to 16 h, the pH value of the S. mutans solutions dropped from 7.3 to 5.8. Therefore, after immersion in the S. mutans solutions for 16 h, slight erosions of the dental structures began; after 64 h, severe tooth decay occurred with obviously etched dental features. After 128 h, the elastic modulus of enamel and dentine dropped to 85 and 67%, respectively, of the original values of untreated specimens, and the hardness dropped to 88 and 55%, respectively.
Cryopreservation can cause cumulus cell damage around the immature oocytes, which may result in poor subsequent development. To evaluate the effect of the meiosis stage on the cumulus cell cryoinjury and determine the suitable stage for cryopreservation in immature oocytes, mouse oocytes at germinal vesicle (GV) and germinal vesicle breakdown (GVBD) stages were vitrified using open pulled straw (OPS) method. Cumulus cells damage was scored immediately after thawing by double-fluorescent staining. The survival rate of the oocytes was evaluated and the subsequent development of oocytes was assessed through in vitro culture (IVC) and in vitro fertilization (IVF) separately. After vitrification, a higher proportion of cumulus cells of GV oocytes were damaged than those of GVBD and untreated control groups. The survival rate of vitrified GVBD oocytes (94.1%) was significantly higher (p < 0.05) than that of GV oocytes (85.4%). Oocytes vitrified at GVBD stage (55.7%) showed similar cleavage rate compared to those at GV stage (49.2%), but significantly higher (p < 0.05) blastocyst rate (40.9% vs. 27.4%). These results demonstrate that oocytes at GVBD stage remain better cumulus membrane integrity and developmental ability during vitrification than those at GV stage, indicating they are more suitable for immature oocytes cryopreservation in mice.
Poly(amic acid) (PAA)–clay nacrelike composite films have been prepared by electrophoretic deposition of an emulsion of PAA, which was synthesized from pyromellitic dianhydride and 4,4′-dianminodiphenyl ether (ODA), containing various loadings of ODA-modified montmorillonite (MMT). The layered silicate was intercalated through reacting with PAA, and the ordered layered assembly of the PAA–MMT composite films was successfully accomplished, as conformed by Fourier transform infrared analysis and x-ray diffraction. The structural characterization of the films was supported by scanning electron microscopy, which displayed an ordered layered structure. The thermogravimetric analysis showed the content of the ODA-modified clay in PAA–MMT composite films that changed from 14.3 to 32.1 wt% and the improved thermal properties of the composite films. The mechanical properties of the composites were measured by tensile test. It was found that the modulus and strength of the composite films were greatly improved compared to those of the pure polymer film. An increment of about 155% in the modulus and 40% in the tensile strength were obtained from the composite films.
Nano-grained phosphors of Eu3+-doped MgGa2O4 crystallites were prepared by sol-gel technique. The characterization and optical properties of luminescent MgGa2O4:Eu3+ powders have been investigated. The dried sol-gel powders were calcined in air at different temperature from 600 to 1000 °C for 5 h. The x-ray diffraction profiles showed that the MgGa2O4:Eu3+ powders began to crystallize around 600 °C and formed stable MgGa2O4 phase in the temperature range of 600–900 °C. The transmission electron microscopy morphology observations revealed that the fired powders exhibit small grain size less than 20 nm. In the PL studies, under ultraviolet (394 nm) excitation, the calcined powders emitted bright red luminescence (615 nm, 5D0→7F2), and the powders fired at 900 °C were found to have the maximum photoluminescence intensity. The quenching concentration of Eu3+ in MgGa2O4 crystallites was also indicated to be about 5∼6 mol%.
Red light emitting of Mn2+ doped Ba2ZnS3 phosphor powders have been synthesized by double-crucible method at different thermal treatments. XRD results indicate that the raw materials are completely sulfurized above 950°C, and the Ba2ZnS3: Mn2+ powders don't change its orthorhombic crystal structure with increasing doping concentration from 0 to 0.8 mol%. The photoluminescence of Ba2ZnS3: Mn2+ powders fulfilled the most efficient emission at the excitation wavelength λex=358 nm and showed the red emission light with peak wavelength λem=627nm at the doping concentration of Mn2+ ion between 0.2 and 0.8 mol%. The high-luminance red emission results from the 4T1 (4G)—6A1 (6S) transition in the Mn2+ ion. Ba2ZnS3: Mn2+ phosphors synthesized by double-crucible method have broad emission spectra (550nm∼750nm) with FWHM (full width at half maximum broadband) about 66nm. In our research, the Ba2ZnS3 doped with 0.4 mol% Mn2+ has the highest luminescent intensity as thermal treatment at 950°C for 16 hours and the CIE coordinate is x=0.66, y=0.33.
The distribution of the interpoint distance process of a sequence of pairwise interaction point processes is considered. It is shown that, if the interaction function is piecewise-continuous, then the sequence of interpoint distance processes converges weakly to an inhomogeneous Poisson process under certain sparseness conditions. Convergence of the expectation of the interpoint distance process to the mean of the limiting Poisson process is also established. This suggests a new nonparametric estimator for the interaction function if independent identically distributed samples of the point process are available.
Prospective studies were conducted for nosocomial Pseudomonas aeruginosa infections from February 1, 1994, to October 30,1995. Of 97 P aeruginosa isolates from 97 patients, 35 were resistant to ceftazidime. Logistic regression revealed previous cephalosporin or piperacillin use as independent risk factors for nosocomial ceftazidime-resistant P aeruginosa infection. Pulsed-field gel electrophoresis revealed that four nosocomial ceftazidime-resistant P aeruginosa infections were caused by cross-infection, probably through medical personnel.