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Due to concerns over increasing fluoroquinolone (FQ) resistance among gram-negative organisms, our stewardship program implemented a preauthorization use policy. The goal of this study was to assess the relationship between hospital FQ use and antibiotic resistance.
Large academic medical center.
We performed a retrospective analysis of FQ susceptibility of hospital isolates for 5 common gram-negative bacteria: Acinetobacter spp., Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Primary endpoint was the change of FQ susceptibility. A Poisson regression model was used to calculate the rate of change between the preintervention period (1998–2005) and the postimplementation period (2006–2016).
Large rates of decline of FQ susceptibility began in 1998, particularly among P. aeruginosa, Acinetobacter spp., and E. cloacae. Our FQ restriction policy improved FQ use from 173 days of therapy (DOT) per 1,000 patient days to <60 DOT per 1,000 patient days. Fluoroquinolone susceptibility increased for Acinetobacter spp. (rate ratio [RR], 1.038; 95% confidence interval [CI], 1.005–1.072), E. cloacae (RR, 1.028; 95% CI, 1.013–1.044), and P. aeruginosa (RR, 1.013; 95% CI, 1.006–1.020). No significant change in susceptibility was detected for K. pneumoniae (RR, 1.002; 95% CI, 0.996–1.008), and the susceptibility for E. coli continued to decline, although the decline was not as steep (RR, 0.981; 95% CI, 0.975–0.987).
A stewardship-driven FQ restriction program stopped overall declining FQ susceptibility rates for all species except E. coli. For 3 species (ie, Acinetobacter spp, E. cloacae, and P. aeruginosa), susceptibility rates improved after implementation, and this improvement has been sustained over a 10-year period.
The use of genetic markers to identify regions of the genome associated with variation in quantitative traits (QTL) is now widespread. Several studies have attempted to find QTLs for growth and fatness in pigs. Since the first published study (Andersson et al., 1994) many groups have found effects on chromosome 4, albeit with different breeds. In theory, joint analysis offers considerable potential to extract additional information from the data. This study aims to investigate the benefits and drawbacks of joint analysis.
Data on birth weight (BWT), growth rate to end of test or slaughter (GRE) and average backfat depth (BF) were supplied from seven different pig populations in six countries. The data from Scotland, France, USA, Netherlands and half of the data from Germany were Meishan (MS) x commercial F2 populations. Data from Sweden and the remaining German data were from wild boar (WB) x commercial F2 populations. A total of 31 different markers were used, all on chromosome 4.
A Lagrangian study was conducted in a eutrophic estuary (Guanabara Bay, Brazil) to investigate in situ plankton trophodynamics under the influence of the cold, nutrient-rich South Atlantic Coastal Water in a short-term temporal variability (scale of hours). We tested the hypothesis that the base of the plankton food web is composed of small cells and that microzooplankton is the main consumer of this assemblage. Samples of pico-, nano- and microplankton, as well as copepods, were collected during spring, when the entry of upwelling water in the Bay is commonly observed, and near the surface every 3 h during the 1-day sampling period. Potential predation of dinoflagellates, ciliates, copepod nauplii, copepodites and adult copepods was estimated based on predator-prey size relationships. The main trophic links in the Guanabara Bay food web for the period analysed were nanophytoplankton-copepods, nanophytoplankton-ciliates, and autotrophic dinoflagellates-heterotrophic dinoflagellates. According to microphytoplankton availability, adult copepods could not satisfy their food requirement, and nanophytoplankton represented an important supplementary food source. In fact, diel variations of nano- and microplankton biomass were opposite to that of copepods suggesting predation control by the latter on the former. The trophodynamics of Guanabara Bay, under the influence of upwelling water, resulted in marked differences from other eutrophic estuaries around the world.
Semantic memory may be impaired in clinically recognized states of cognitive impairment. We investigated the relationship between semantic memory and depressive symptoms (DS) in patients with cognitive impairment.
323 cognitively healthy controls and 848 patients with subjective cognitive decline (SCD), mild cognitive impairment (MCI), and Alzheimer's disease (AD) dementia were included. Semantic knowledge for famous faces, world capitals, and word vocabulary was investigated.
Compared to healthy controls, we found a statistically significant difference of semantic knowledge in the MCI groups and the AD group, respectively. Results of the SCD group were mixed. However, two of the three semantic memory measures (world capitals and word vocabulary) showed a significant association with DS.
We found a difference in semantic memory performance in MCI and AD as well as an association with DS. Results suggest that the difference in semantic memory is due to a storage loss rather than to a retrieval problem.
Health-related quality of life (HRQOL) is an important issue in the context of dementia care. The purpose of this study was to investigate the association between HRQOL and depressive symptoms in patients with subjective cognitive decline (SCD) and subtypes of mild cognitive impairment (MCI) and Alzheimer´s disease (AD).
In this cross-sectional, observational study, a control group and four experimental groups (SCD, non-amnestic MCI, amnesticMCI, AD) were compared. Neuropsychological measurers (NTBV) and psychological questionnaires were used for data collection.
The control group scored higher than patients with SCD, naMCI, aMCI, or AD for the Mental Health Component Score (MHCS) of the Short Form of the Health Survey (SF-36). The Physical Health Component Score (PHCS) of the SF-36 differed only between some groups. Furthermore, cognitive variables were more strongly associated with the physical aspects of HRQOL, whereas depressive symptoms were more strongly related with the mental aspects of HRQOL.
HRQOL and depressive symptoms are closely related in patients with cognitive impairments. Therefore, it is of great importance to assess patients with subjective impairment carefully in terms of depressive symptoms.
Impairments in facial emotion recognition (FER) have been detected in patients with Parkinson disease (PD). Presently, we aim at assessing differences in emotion recognition performance in PD patient groups with and without mild forms of cognitive impairment (MCI) compared to healthy controls.
Performance on a concise emotion recognition test battery (VERT-K) of three groups of 97 PD patients was compared with an age-equivalent sample of 168 healthy controls. Patients were categorized into groups according to two well-established classifications of MCI according to Petersen's (cognitively intact vs. amnestic MCI, aMCI, vs. non-amnestic MCI, non-aMCI) and Litvan's (cognitively intact vs. single-domain MCI, sMCI, vs. multi-domain MCI, mMCI) criteria. Patients and controls underwent individual assessments using a comprehensive neuropsychological test battery examining attention, executive functioning, language, and memory (Neuropsychological Test Battery Vienna, NTBV), the Beck Depression Inventory, and a measure of premorbid IQ (WST).
Cognitively intact PD patients and patients with MCI in PD (PD-MCI) showed significantly worse emotion recognition performance when compared to healthy controls. Between-groups effect sizes were substantial, showing non-trivial effects in all comparisons (Cohen's ds from 0.31 to 1.22). Moreover, emotion recognition performance was higher in women, positively associated with premorbid IQ and negatively associated with age. Depressive symptoms were not related to FER.
The present investigation yields further evidence for impaired FER in PD. Interestingly, our data suggest FER deficits even in cognitively intact PD patients indicating FER dysfunction prior to the development of overt cognitive dysfunction. Age showed a negative association whereas IQ showed a positive association with FER.
Vancomycin-resistant enterococci (VRE) infections are a public health threat associated with increased patient mortality and healthcare costs. Antibiotic usage, particularly cephalosporins, has been associated with VRE colonization and VRE bloodstream infections (VRE BSI). We examined the relationship between antimicrobial usage and incident VRE colonization at the individual patient level. Prospective, weekly surveillance was undertaken for incident VRE colonization defined by negative admission but positive surveillance swab in a medical intensive care unit over a 17-month period. Antimicrobial exposure was quantified as days of therapy (DOT)/1000 patient-days. Multiple logistic regression was used to analyse incident VRE colonization and antibiotic DOT, controlling for demographic and clinical covariates. Ninety-six percent (1398/1454) of admissions were swabbed within 24 h of intensive care unit (ICU) arrival and of the 380 patients in the ICU long enough for weekly surveillance, 83 (22%) developed incident VRE colonization. Incident colonization was associated in bivariate analysis with male gender, more previous hospital admissions, longer previous hospital stay, and use of cefepime/ceftazidime, fluconazole, azithromycin, and metronidazole (P < 0·05). After controlling for demographic and clinical covariates, metronidazole was the only antibiotic independently associated with incident VRE colonization (odds ratio 2·0, 95% confidence interval 1·2–3·3, P < 0·009). Our findings suggest that risk of incident VRE colonization differs between individual antibiotic agents and support the possibility that antimicrobial stewardship may impact VRE colonization and infection.
Deficits in facial emotion recognition (FER) have been shown to substantially impair several aspects in everyday life of affected individuals (e.g. social functioning). Presently, we aim at assessing differences in emotion recognition performance in three patient groups suffering from mild forms of cognitive impairment compared to healthy controls.
Performance on a concise emotion recognition test battery (VERT-K) of 68 patients with subjective cognitive decline (SCD), 44 non-amnestic (non-aMCI), and 25 amnestic patients (aMCI) with mild cognitive impairment (MCI) was compared with an age-equivalent sample of 138 healthy controls all of which were recruited within the framework of the Vienna Conversion to Dementia Study. Additionally, patients and controls underwent individual assessment using a comprehensive neuropsychological test battery examining attention, executive functioning, language, and memory (NTBV), the Beck Depression Inventory (BDI), and a measure of premorbid IQ (WST).
Type of diagnosis showed a significant effect on emotion recognition performance, indicating progressively deteriorating results as severity of diagnosis increased. Between-groups effect sizes were substantial, showing non-trivial effects in all comparisons (Cohen's ds from −0.30 to −0.83) except for SCD versus controls. Moreover, emotion recognition performance was higher in women and positively associated with premorbid IQ.
Our findings indicate substantial effects of progressive neurological damage on emotion recognition in patients. Importantly, emotion recognition deficits were observable in non-amnestic patients as well, thus conceivably suggesting associations between decreased recognition performance and global cognitive decline. Premorbid IQ appears to act as protective factor yielding lesser deficits in patients showing higher IQs.
Germany has been an officially bovine tuberculosis (bTB)-free (OTF) country since 1996. Gradually rising numbers of bTB herd incidents due to Mycobacterium bovis and M. caprae in North-Western and Southern Germany during the last few years prompted the competent authorities to conduct a nationwide bTB survey in 2013/2014. This led to the detection of a dairy herd in which as many as 55 cattle reacted positively to consecutive intra vitam testing. Test-positive animals lacked visible lesions indicative of bTB at necropsy. Extensive mycobacterial culturing as well as molecular testing of samples from 11 tissues for members of the M. tuberculosis complex (MTC) yielded negative results throughout. However, caseous lymphadenitis of Ln. mandibularis accessorius was observed during meat inspection of a fattening pig from the same farm at regular slaughter at that time. Respective tissue samples tested MTC positive by polymerase chain reaction, and M. tuberculosis T1 family were identified by spoligotyping. Four human reactors within the farmer's family were also found to be immunoreactive. As exposure of livestock to M. tuberculosis is not generally considered, its impact may result in regulatory and practical difficulties when using protocols designed to detect classical bTB, particularly in OTF countries.
We describe a laboratory plasma physics experiment at Los Alamos National Laboratory that uses two merging supersonic plasma jets formed and launched by pulsed-power-driven railguns. The jets can be formed using any atomic species or mixture available in a compressed-gas bottle and have the following nominal initial parameters at the railgun nozzle exit: ne ≈ ni ~ 1016 cm−3, Te ≈ Ti ≈ 1.4 eV, Vjet ≈ 30–100 km/s, mean charge
≈ 1, sonic Mach number Ms ≡ Vjet/Cs > 10, jet diameter = 5 cm, and jet length ≈20 cm. Experiments to date have focused on the study of merging-jet dynamics and the shocks that form as a result of the interaction, in both collisional and collisionless regimes with respect to the inter-jet classical ion mean free path, and with and without an applied magnetic field. However, many other studies are also possible, as discussed in this paper.
The goals of this study were to establish prevalence of subjective memory complaints (SMC) and depressive symptoms (DS) and their relation to cognitive functioning and cognitive status in an outpatient memory clinic cohort.
Two hundred forty-eight cognitively healthy controls and 581 consecutive patients with cognitive complaints who fulfilled the inclusion criteria were included in the study.
A statistically significant difference (p < 0.001) between control group and patient group regarding mean SMC was detected. 7.7% of controls reported a considerable degree of SMC, whereas 35.8% of patients reported considerable SMC. Additionally, a statistically significant difference (p < 0.001) between controls and patient group regarding Beck depression score was detected. 16.6% of controls showed a clinical relevant degree of DS, whereas 48.5% of patients showed DS. An analysis of variance revealed a statistically significant difference across all four groups (control group, SCI group, naMCI group, aMCI group) (p < 0.001). Whereas 8% of controls reported a considerable degree of SMC, 34% of the SCI group, 31% of the naMCI group, and 54% of the aMCI group reported considerable SMC. A two-factor analysis of variance with the factors cognitive status (controls, SCI group, naMCI group, aMCI group) and depressive status (depressed vs. not depressed) and SMC as dependent variable revealed that both factors were significant (p < 0.001), whereas the interaction was not (p = 0.820).
A large proportion of patients seeking help in a memory outpatient clinic report considerable SMC, with an increasing degree from cognitively healthy elderly to aMCI. Depressive status increases SMC consistently across groups with different cognitive status.
A fast moving infrared excess source (G2) which is widely interpreted as a core-less gas and dust cloud approaches Sagittarius A* (Sgr A*) on a presumably elliptical orbit. VLT Ks-band and Keck K′-band data result in clear continuum identifications and proper motions of this ∼19m Dusty S-cluster Object (DSO). In 2002-2007 it is confused with the star S63, but free of confusion again since 2007. Its near-infrared (NIR) colors and a comparison to other sources in the field speak in favor of the DSO being an IR excess star with photospheric continuum emission at 2 microns than a core-less gas and dust cloud. We also find very compact L′-band emission (<0.1″) contrasted by the reported extended (0.03″ up to ∼0.2″ for the tail) Brγ emission. The presence of a star will change the expected accretion phenomena, since a stellar Roche lobe may retain a fraction of the material during and after the peri-bothron passage.
Political scientists have contributed to the world of electoral systems as scientists and as engineers. Taking stock of recent scientific research, we show that context modifies the effects of electoral rules on political outcomes in specific and systematic ways. We explore how electoral rules shape the inclusion of women and minorities, the depth and nature of political competition, and patterns of redistribution and regulation, and we consider institutional innovations that could promote political equality. Finally, we describe the diverse ways that political scientists produce an impact on the world by sharing and applying their knowledge of the consequences of electoral rules and global trends in reform.
In Chapter 4, we began to consider the conditionality of electoral system effects through an analysis of the number of parties in mixed-member systems. We saw that FPTP rules produce their expected effects in established democracies, most notably by constraining the number of parties. At the same time, we saw a very different result under FPTP rules in new democracies, which tended to produce many more parties. We argued that these different outcomes were due to far greater strategic defection in established democracies by candidates and their supporters who faced little chance of success in SMDs, but this argument was merely conjecture; we did not demonstrate the behavior that underlay the different results. To get at these mechanisms, we need to delve more deeply into whether voters and elites in different contexts do, in fact, behave in this way. We need to address the question: Is there, in fact, more strategic defection in established democracies than in new ones? In Chapters 5 and 6, we address this issue of strategic defection under different contexts.
In this chapter, we study votes cast under mixed-member systems to learn more about the factors that shape voting behavior. Our principal aim is to explore the conditions under which voters will be likely to cast strategic ballots, whereby they withdraw support from their preferred candidate in order to affect the race, but our strongest findings in this chapter relate to the personal vote. In the study of mixed-member electoral systems, work on strategic voting is particularly well established. Ticket splitting in which a greater number of votes are cast for large parties in the SMD tier than in the PR tier (and a smaller number of votes are cast for minor parties in SMDs) has been put forward as evidence that voters react strategically to restrictive electoral rules – such as FPTP – that tend to deny representation to minor parties. On this topic, the literature gives substantial attention to strategic voting, but does not account sufficiently for another factor that can drive ticket splitting: the personal vote – additional SMD votes cast for a candidate due to the candidate's personal appeal to voters.
Electoral Systems and Political Context illustrates how political and social context conditions the effects of electoral rules. The book examines electoral behavior and outcomes in countries that use 'mixed-member' electoral systems – where voters cast one ballot for a party list under proportional representation (PR) and one for a candidate in a single member district (SMD). Based on comparisons of outcomes under the two different rules used in mixed-member systems, the book highlights how electoral systems' effects – especially strategic voting, the number of parties and women's representation – tend to be different in new democracies from what one usually sees in established democracies. Moreover, electoral systems such as SMDs are usually presumed to constrain the number of parties irrespective of the level of social diversity, but this book demonstrates that social diversity frequently shapes party fragmentation even under such restrictive rules.
In the early 1990s, Japan and Russia each adopted a very similar version of a “mixed-member” electoral system. In the form used in Japan and Russia, in elections to a single house of the legislature each voter cast two ballots: one for a candidate in a single-member district (SMD) and one for a party under proportional representation (PR). In the SMD races, both countries used first-past-the-post (FPTP) rules, meaning that the candidate winning the largest number of votes in the district wins the race, even if tallying under a majority of all the SMD ballots cast. In PR, parties win shares of seats roughly in proportion to their share of the party vote. In both Japan and Russia, the PR systems used closed-list rules, meaning that prior to each election central party leaders put together a rank-ordered list of candidates to determine which individuals would win seats if the party won representation in PR. In PR in both countries, voters were only given the chance to choose a single pre-set party list. Both countries used mixed-member-majoritarian (MMM) electoral systems, meaning that the SMD and PR components of the system were “unlinked” – seats won by a party in one tier (e.g., SMDs) did not affect the number of seats allocated to the party in the other tier (e.g., PR). In short, both Russia and Japan adopted very similar forms of mixed-member electoral systems.
In both countries, it was widely expected that the different rules would promote particular outcomes: The SMD tier was expected to lead to a small number of large, catchall parties, especially at the district level. The PR tier was supposed to promote the proliferation of political parties, greater proportionality, and more female representation – especially when compared with results in the SMD tier.