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To evaluate the impact of a hard stop in the electronic health record (EHR) on inappropriate gastrointestinal pathogen panel testing (GIPP).
We used a quasi-experimental study to evaluate testing before and after the implementation of an EHR alert to stop inappropriate GIPP ordering.
Midwest academic medical center.
Hospitalized patients with diarrhea for which GIPP testing was ordered, between January 2016 through March 2017 (period 1) and April 2017 through June 2018 (period 2).
A hard stop in the EHR prevented clinicians from ordering a GIPP more than once per admission or in patients hospitalized for >72 hours.
During period 1, 1,587 GIPP tests were ordered over 212,212 patient days, at a rate of 7.48 per 1,000 patient days. In period 2, 1,165 GIPP tests were ordered over 222,343 patient days, at a rate of 5.24 per 1,000 patient days. The Poisson model estimated a 30% reduction in total GIPP ordering rates between the 2 periods (relative risk, 0.70; 95% confidence interval [CI], 0.63–0.78; P < .001). The rate of inappropriate tests ordered decreased from 21.5% to 4.9% between the 2 periods (P < .001). The total savings calculated factoring only GIPP orders that triggered the hard stop was ∼$67,000, with potential savings of $168,000 when factoring silent best-practice alert data.
A simple hard stop alert in the EHR resulted in significant reduction of inappropriate GIPP testing, which was associated with significant cost savings. Clinicians can practice diagnostic stewardship by avoiding ordering this test more than once per admission or in patients hospitalized >72 hours.
Engineering the surface structure, together with the incorporation of a second metal, is an effective strategy for boosting the catalytic activities of Pt-based catalysts toward various reactions. Here, we report a facile approach to the synthesis of Pt–Ag octahedral and tetrahedral nanocrystals covered by concave surfaces. The presence of the Ag(I) precursor not only facilitated the reduction of the Pt(IV) precursor but also led to the formation of concaved facets on the Pt–Ag nanocrystals. Besides, poly(vinylpyrrolidone) (PVP) was demonstrated to serve as a co-reductant, in addition to its role as a colloidal stabilizer. Using PVP with different molecular weights, we were able to tune the size of the Pt–Ag nanocrystals in the range of 9–25 and 14–32 nm for the octahedral and tetrahedral shapes, respectively. The Pt–Ag nanocrystals exhibited 4.6- and 2.0-fold enhancements in terms of specific and mass activities, respectively, toward methanol oxidation, when benchmarked against the commercial Pt/C catalyst. After 1000 cycles of the accelerated tests, the specific and mass activities of the Pt–Ag nanocrystals were still 3.6 and 1.6 times as high as those of the original commercial Pt/C.
The ‘Landscapes of Production and Punishment’ project aims to examine how convict labour from 1830–1877 affected the built and natural landscapes of the Tasman Peninsula, as well as the lives of the convicts themselves.
Semiconductor-based heterojunctions have been shown to be effective photocatalytic materials to overcome the drawbacks of low photocatalytic efficiency that results from a high rate of electron−hole recombination and narrow photo-response range. In this paper, we report on the study of heterojunctions made from visible light active, graphitic carbon nitride, g-C3N4), and UV light active, strontium pyroniobate, Sr2Nb2O7. Heterojunctions made from a combination of g-C3N4 and nitrogen-doped Sr2Nb2O7 obtained at different temperatures were also studied to determine the effect of N doping. The photocatalytic performance was evaluated by using photocatalytic hydrogen evolution reaction (HER)from water g under visible light irradiation. It was found that the photocatalytic activities of as prepared heterojunctions are significantly higher than that of individual components under similar conditions. Heterojunction formed from g-C3N4 and N-doped Sr2Nb2O7 at 700°C (CN/SNON-700) showed better performance than heterojunction made from g-C3N4 and Sr2Nb2O7 (CN/SNO). A plausible mechanism for the heterojunction enhanced photocatalytic activity is proposed based on, relative band positions, and photoluminescence data.
Jeffery et al. accurately identify the importance of developing an understanding of spatial reference frames in a three-dimensional world. We examine human spatial cognition via a unique paradigm that investigates the role of saliency and adjusting reference frames. This includes work with adults, typically developing children, and children who develop non-typically (e.g., those with autism).
We present direct terrestrial evidence of ice volume change of the Darwin and Hatherton glaciers which channel ice from the Transantarctic Mountains into the Ross Ice Shelf. Combining glacial geomorphology with cosmogenic exposure ages from 25 erratics indicates a pre-LGM ice volume at least 600 m thicker than current Hatherton ice elevation was established at least 2.2 million years ago. In particular, five erratics spread across a drift deposit at intermediate elevations located below a prominent moraine feature mapped previously as demarcating the LGM ice advance limits, give a well-constrained single population with mean 10Be age of 37.0 ± 5.5 ka (1σ). At lower elevations of 50–100 m above the surface of Lake Wellman, a further five samples from within a younger drift deposit range in exposure age from 1 to 19 ka. Our preferred age model interpretation, which is partly dependent on the selection of a minimum or maximum age-elevation model, suggests that LGM ice volume was not as large as previously estimated and constrains LGM ice elevation to be within ± 50 m of the modern Hatherton Glacier ice surface, effectively little different from what is observed today.
Eighty-two chickens purchased at 11 retailers (supplied by 12 wholesalers) in the south of England were cultured for Campylobacter jejuni by a method involving total immersion. The organism was isolated from 22 (48%) of 46 fresh birds, 12 of 12 uneviscerated (New York dressed) birds, but only 1 of 24 frozen birds. Viable counts of up to 1·5 × 106/chicken were obtained from fresh birds and 2·4 × 107/chicken from uneviscerated birds. Surface swabbing of breasts, thighs, wings and vents of fresh chickens showed that contamination was generally distributed over the carcasses. Salmonellas were found in only 2 of 69 of the fresh chickens.
The prevalence of several Lior and Penner C. jejuni serogroups was similar in chickens and sporadic human cases of enteritis. Penner serogroup 4 (mostly of Lior serogroup 1) was found in 26% of human isolates and 14% of chicken isolates.
The rising incidence of campylobacter enteritis during the last 6 years could well be a reflection of the increasing proportion of fresh chickens consumed over that period (32% higher in 1986 than in 1981).
Early worsening of anxiety, agitation and irritability are thought to be
common among people commencing antidepressants, especially for anxiety
disorders. This phenomenon, which may be termed jitteriness/anxiety
syndrome, is cited as an explanation for early treatment failure and
caution in using selective serotonin reuptake inhibitors (SSRIs).
However, we believe that it is inconsistently defined and that robust
evidence to support the phenomenon is lacking.
To review systematically all evidence relating to jitteriness/ anxiety
syndrome to identify: constituent symptoms; medications implicated;
disorders in which it was reported; incidence; time course; management
strategies; relationship of this syndrome to therapeutic response;
distinction between syndrome and akathisia; relationship between syndrome
and suicide; and genetic predispositions.
A systematic search identified articles and these were included in the
review if they addressed one of the above aspects of jitteriness/anxiety
Of 245 articles identified, 107 articles were included for review. No
validated rating scales for jitteriness/anxiety syndrome were identified.
There was no robust evidence that the incidence differed between SSRIs
and tricyclic antidepressants, or that there was a higher incidence in
anxiety disorders. Published incidence rates varied widely from 4 to 65%
of people commencing antidepressant treatment. Common treatment
strategies for this syndrome included a slower titration of
antidepressant and the addition of benzodiazepines. Conclusive evidence
for the efficacy of these strategies is lacking. There was conflicting
and inconclusive evidence as to whether the emergence of this syndrome
had a predictive value on the response to treatment. It appears to be a
separate syndrome from akathisia, but evidence for this assertion was
limited. The effect of jitteriness/anxiety syndrome on suicide rates has
not been evaluated. Three studies examined genetic variations and
side-effects from treatment, but none was specifically designed to assess
Jitteriness/anxiety syndrome remains poorly characterised. Despite this,
clinicians' perception of this syndrome influences prescribing and it is
cited to support postulated mechanisms of drug action. We recommend
systematised evaluation of side-effects at earlier time points in
antidepressant trials to further elucidate this clinically important
The concentration of viable cells in an aerosol of micro-organisms is reduced by physical loss and biological decay. To study biological decay it is necessary to distinguish between the two processes. The preferred way of doing this is to mix the test aerosol with a tracer which is subject only to physical loss: the tracer and test cells should be mixed before dissemination.
The recommended tracers for bacterial clouds are bacteria made radioactive by growing on a medium containing 32P, then killed with formaldehyde and washed. To ensure closest identity of physical behaviour it is necessary that the tracer should be of the same species as the cells under test.
We are grateful to Mr E. O. Powell for helpful comment during the preparation of this paper.
The importance of the neurotransmitter serotonin (5-HT) in the pathophysiology of anxiety is well known. A key role for postsynaptic 5-HT1A receptors has recently been suggested in studies of genetic knockout mice.
To measure 5-HT1A receptor binding in patients with panic disorder in the untreated state and after recovery on treatment with selective serotonin reuptake inhibitors (SSRIs).
Nine symptomatic untreated patients with panic disorder, seven patients recovered on SSRI medication and nineteen healthy volunteers underwent a single positron emission tomography (PET) scan using the 5-HT1A tracer [11C]WAY-100635.
In comparison with controls, both presynaptic and postsynaptic 5-HT1A receptor binding was reduced in untreated patients, with the most significant reductions being in the raphe, orbitofrontal cortex, temporal cortex and amygdala. In recovered patients presynaptic binding was reduced, but there was no significant reduction in postsynaptic binding.
Panic disorder is associated with reduced 5-HT1A receptor availability, which is also known to have a key role in depression.
We discuss the nitridation of ALD-deposited hafnium silicate films by exposure to atomic nitrogen generated in a remote nitrogen plasma. Nitrogen concentration [N] as measured by X-ray photoelectron spectroscopy (XPS) is determined as a function of the nitridation temperature and other process conditions. Nitrogen concentrations up to 13.7 atomic % were achieved.
In this paper the methods of Parts 1 and 2 are extended to the case when the elliptic
cylinder is executing angular oscillations about its centreline. At large distances from
the cylinder the solution for a beam of waves tends to a similarity solution that
decays more rapidly with distance than does the similarity solution for rectilinear
oscillations described in Thomas & Stevenson (1972). Figure 4 shows in a remarkable
way how the predicted wave profiles change with distance from the inviscid solution
to the similarity one.
In the latter part of the paper the predictions of Parts 1 and 2 and other theories
are compared with recent experimental observations. The results of the experiments
are in good agreement with the predictions of Parts 1 and 2.
To allow an objective study of transition region blinkers an automated identification program has been developed to analyse the CDS/SoHO data. The general properties of blinkers identified by this method confirmed the properties of those identified by eye in previous studies. Blinkers have typical lifetimes of about 20 minutes, areas of about 2.8 × 107 km2 and intensity enhancement factors of about 2. For the first time, blinkers have been identified in active regions. These blinkers have the same general properties as quiet-region blinkers. The automated approach found many more blinkers than previously had been found giving a global birth rates of about 9 s−1 for quiet-region blinkers and 16 s−1 for active-region blinkers. Most blinkers, active or quiet region, are red shifted with typical velocities of about 13 km s−1. Finally, we can confirm that blinkers are not enhancements in temperature, but either enhancements in density or increases in the filling factor.
The availability of complete genome sequences is a revolution in the study of microorganisms. A fully annotated genome
sequence provides an interactive tool for scientists and influences the approach and focus of research. In this article I
discuss the impact of genome sequencing projects of bacteria. Much useful data have been obtained but the experimental
methods needed to fully exploit the information continue to develop. Some of the approaches and particular applications
relevant to bacteria of clinical importance are discussed.
Geometry optimizations and electronic structure calculations using Density Functional Theory (DFT) are reported for tetra-acetylene porphyrins (TAP), their dimers, and octabromotetraphenyl porphyrins (OBP). The acetylene group contributes to the π-electron conjugation along the porphyrin ring for the HOMO and LUMO, and reduces significantly the HOMO-LUMO gap. The gap is further reduced in dimers. The planar geometry of the TAP dimer has a lower energy than the non-planar one. The geometry of H2OBP is found to be non-planar, and the distortion of porphyrin ring is shown to be closely related to the HOMO-LUMO gap.
Pd and Zn - tetraphenyltetrabenzoporphyrins (PdTPTBP and ZnTPTBP), hexacyanin 3 (HITCI), and substituted phthalocyanines were incorporated in solid-state matrices (xerogels) using a sol-gel process. Nonlinear reverse saturable absorption was observed with those materials when they were illuminated with nanosecond laser pulses at 532 nm, or other wavelengths in the visible spectrum (between 450 nm and 630 nm). PdTPTBP doped xerogels exhibit a nonlinear activation threshold of about 10 mJ/cm , which is much lower than the value of 80 mJ/cm2 obtained under similar conditions with classical Al phthalocyanine chloride, or HITCI molecules. Solid state “red active” reverse saturable absorbers can be obtained with substituted phthalocyanines doped xerogels. The different experimental results are discussed using classical 4- energy level diagrams.
During the past decade, there has been considerable effort in the design of new materials with greatly enhanced nonlinear absorption characteristics. In recent years, it has been shown that incorporation of bipolaronic charges in the pi-electron sequence in conjugated polymers or copolymers leads to enhanced third-order nonlinear optical properties. In this current study a design strategy for the synthesis of optical power limiting copolymers is presented whose properties are based on the photogeneration of stable bipolaron-like dications.
We present two-wave mixing results obtained with CdSSe:V crystals. A large photorefractive gain of 0.24 cm-1 was observed at 633 nm with an optical intensity of 60 mW/cm2 and a grating period of 1.6 μrm. At this wavelength, we measured the photorefractive gain as a function of the grating period and incident optical intensity. To our knowledge, this is the first observation of the photorefractive effect in vanadium doped CdSSe crystals. The CdSSe crystals were grown by physical vapor transport (PVT) and doped with 150 ppm (nominal) vanadium for creating trap centers. The grown crystal has a large crystal size, good optical quality and a medium resistivity of 10-5 - 108 Ω-cm. Room temperature absorption and low temperature photoluminescence spectroscopy measurements are also discussed. With a significant photorefractive effect, the CdSSe:V crystals are promising for many device applications based on photorefractive effect, including optical limiting devices in the visible region.