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AU in days of therapy per 1,000 patient days and microbiologic data from 2015 and 2016 were collected from 26 hospitals. The prevalences of Pseudomonas aeruginosa, extended-spectrum β-lactamase (ESBL)–producing bacteria, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE) were calculated and compared to the average prevalence of all hospitals in the network. This proportion was used to calculate the adjusted AU (a-AU) for various categories of antimicrobials. For example, a-AU of antipseudomonal β-lactams (APBL) was the AU of APBL divided by (prevalence of P. aeruginosa at that hospital divided by the average prevalence of P. aeruginosa). Hospitals were categorized by bed size and ranked by AU and a-AU, and the rankings were compared.
Most hospitals in 2015 and 2016, respectively, moved ≥2 positions in the ranking using a-AU of APBL (15 of 24, 63%; 22 of 26, 85%), carbapenems (14 of 23, 61%; 22 of 25; 88%), anti-MRSA agents (13 of 23, 57%; 18 of 26, 69%), and anti-VRE agents (18 of 24, 75%; 15 of 26, 58%). Use of a-AU resulted in a shift in quartile of hospital ranking for 50% of APBL agents, 57% of carbapenems, 35% of anti-MRSA agents, and 75% of anti-VRE agents in 2015 and 50% of APBL agents, 28% of carbapenems, 50% of anti-MRSA agents, and 58% of anti-VRE agents in 2016.
The a-AU considerably changes how hospitals compare among each other within a network. Adjusting AU by microbiological burden allows for a more balanced comparison among hospitals with variable baseline rates of resistant bacteria.
The aim of this study is to report on the short-term and mid-term outcomes of preterm infants who underwent patent ductus arteriosus ligation through anterior mini-thoracotomy.
Data for 103 preterm infants who underwent patent ductus arteriosus clipping through an anterior mini-thoracotomy at the 2nd intercostal space between 2009 and 2019 were retrospectively reviewed. The patients were divided into two groups according to their weight at the time of surgery. The complications, morbidity, and mortality rates of each group were compared at postoperative day 30 and at the end of 1 year after surgery.
During the operation, the median weight of the patients was 900 g (IQR 800–1125 g), the median age was 21 days (IQR 14.5–29 days). The lowest body weight was 460 g. In three patients (3%), there was intraoperative bleeding from the patent ductus arteriosus that required transition to median sternotomy. In one patient (1%) a residual patent ductus arteriosus that required reoperation was observed. Twelve patients (12%) died in the first 30 days postoperatively. Six patients (6%) died between the postoperative day 30 and 1 year. There was no statistically significant difference in the rates of mortality, morbidity, and complication between the groups.
Based on our observations of over a hundred preterm infants with patent ductus arteriosus over a decade, ligation through anterior mini-thoracotomy is the main surgical procedure of choice for this patient group in our clinic. Our findings demonstrate the safety of this approach and we believe that it can be successfully replicated in other institutions.
Coronavirus disease 2019 (COVID-19) has rapidly spread globally, forcing countries to apply lockdowns and strict social distancing measures. The aim of this study was to assess eating habits and lifestyle behaviours among residents of the Middle East and North Africa (MENA) region during the lockdown. A cross-sectional study among adult residents of the MENA region was conducted using an online questionnaire designed on Google Forms during April 2020. A total of 2970 participants from eighteen countries participated in the present study. During the pandemic, over 30 % reported weight gain, 6·2 % consumed five or more meals per d compared with 2·2 % before the pandemic (P < 0·001) and 48·8 % did not consume fruits on a daily basis. Moreover, 39·1 % did not engage in physical activity, and over 35 % spent more than 5 h/d on screens. A significant association between the frequency of training during the pandemic and the reported change in weight was found (P < 0·001). A significantly higher percentage of participants reported physical and emotional exhaustion, irritability and tension either all the time or a large part of the time during the pandemic (P < 0·001). Although a high percentage of participants reported sleeping more hours per night during the pandemic, 63 % had sleep disturbances. The study highlights that the lockdown due to the COVID-19 pandemic caused a variety of lifestyle changes, physical inactivity and psychological problems among adults in the MENA region.
This chapter describes overland trade between Pakistan and China since 1969 until the present. Overland trade between the two countries takes place over the high-altitude Karakoram Highway, connecting Pakistan’s mountainous Gilgit-Baltistan region to the Xinjiang Uyghur Autonomous Region in western China. The Karakoram Highway is popularly described as a contemporary silk road; this idea has been reinforced by the 2013 announcement of the One Belt One Road initiative, which includes the China-Pakistan Economic Corridor. In this chapter, I explore the relationship between a documented, regulated silk route trade and its shadows; shadows take the form of traditional pathways between the two countries that are no longer used, as well as the undocumented movement of licit goods and smuggling of illicit substances.
The Khunjerab Pass (4693 metres), the Pakistan-China border crossing in the Karakoram mountains, is increasingly represented in Pakistani electronic media, such as online advertisements, blogs, and social media. The legibility of this place, until recently considered remote, is new. It dates back fifteen years and is primarily due to two landmark state initiatives: the 2006 opening of the Sost Dry Port along the border, and a long-overdue upgrade, between 2008 and 2013, of the Karakoram Highway that connects Pakistan and China's westernmost Xinjiang Uyghur Autonomous Region. Both initiatives were undertaken to streamline overland trade with China. More recently, the crossing at Khunjerab gained importance following the China-Pakistan Economic Corridor (CPEC), which was announced in May 2013 and became one of six economic corridors under President Xi Jinping's signature One Belt One Road (OBOR) initiative. Pakistan now sees itself as pivotal to Chinese plans for global connectivity; Pakistani leaders have described relations between the two countries as ‘higher than the Himalaya, deeper than the ocean, sweeter than honey, stronger than steel, dearer than eyesight’ (The Nation, 2010).
The Karakoram mountain range, on the western terminus of the Himalayan mountains spanning South Asia, is the most glaciated region outside extreme latitudes (Hewitt, 2006). The Karakoram is located in Pakistan’s northernmost administrative region, Gilgit-Baltistan. The region is sparsely populated, with its approximately two million residents clustered along the Karakoram Highway.
Located along Pakistan's central Asian margins, the high mountain region of Gilgit-Baltistan borders Afghanistan and India, and since 1969 has connected Pakistan to China. In this article, I argue that over the last 50 years, expanding forms of connectivity between Pakistan and China were localized in Gilgit-Baltistan through three processes: (1) from 1969, overland connectivity between Gilgit-Baltistan and western China has enabled Pakistan to imagine and project expansive ties—and geopolitical aspirations—that transcend the border areas where the cross-border trade was initially localized; (2) unfolding ties between the two countries were accompanied by new material exchanges: initially barter trade and regulated caravans, followed by private commerce in the mid-1980s and, finally, economic corridor development under the Belt and Road Initiative; and (3) Chinese investments in Pakistan were part of a new cycle of global accumulation. Concurrently, in the wake of transnational investments, local governance in Gilgit-Baltistan adopted neoliberal administrative measures: the prioritizing of investment capitalism, the privatization of public goods and services, and securitization.
The aim of this study is to investigate the “Hospital Service providers” perception, attitude and actual practice in managing schizophrenia in Malaysia.
In this study, it was designed as a mixed -methods study. in the first phase, quantitative surveys have been implemented among 42 service providers. in the second phase, the descriptive qualitative study method was also used.
The questionnaires designed to gather the data relating to the respondent satisfied in managing Schizophrenia in Malaysia. Thirty five (or 83.3%) of the respondents are satisfied with the current Schizophrenic overall management, but twenty one (or 50.1%) of the respondents does not satisfy with current psychosocial interventions available in Malaysia. The qualitative found that, the psychiatrists responded that they are satisfied with current use of atypical antipsychotic in the hospitals but they are concerned with the lack of community services particularly in the university hospitals. The medical officers and general practitioners responded that they received many patients who were brought by their families to see them in outpatient clinic. However, many doctors failed to diagnose the disorder as they have a lack of training in diagnosing mental illness diseases. This is mainly due to misperception about mental illness particularly in rural areas among the Malay population.
The study concluded that more community awareness program needs to be done which emphasis on mental illness to reduce the duration of untreated illness and ensure active roles of family members in supervision of treatment.
The nasal septal swell body is a normal anatomical structure located in the superior nasal septum anterior to the middle turbinate. However, the impact of the septal swell body in nasal breathing during normal function and disease remains unclear. This study aimed to establish that the septal swell body varies in size over time and correlates this with the natural variation of the inferior turbinates.
Consecutive patients who underwent at least two computed tomography scans were identified. The width and height of the septal swell body and the inferior turbinates was recorded. A correlation between the difference in septal swell body and turbinates between the two scans was performed using a Pearson's coefficient.
A total of 34 patients (53 per cent female with a mean age of 58.3 ± 20.2 years) were included. The mean and mean difference in septal swell body width between scans for the same patient was 1.57 ± 1.00 mm. The mean difference in turbinate width between scans was 2.23 ± 2.52 mm. A statistically significant correlation was identified between the difference in septal swell body and total turbinate width (r = 0.35, p = 0.04).
The septal swell body is a dynamic structure that varies in width over time in close correlation to the inferior turbinates. Further research is required to quantify its relevance as a surgical area of interest.
Tropical forests in Asia have undergone massive declines over the last five decades due to deforestation and subsequent conversion to forest monocultures, agricultural land or other forms of land use (FAO, 2016; Giam, 2017; Hughes, 2017; Meijide et al., 2018; Vijay et al., 2016). The remnant patches of forest are typically degraded, with relatively low tree species diversity compared to the original primary forests (FAO, 2016; Giam, 2017; Vijay et al., 2016). Forests appear to be the most degraded in the Indian subcontinent, with over one billion people occupying the extra-forest matrix, allowing limited or no gene flow between forest patches for some groups of biota (Reddy et al., 2016). This has also created a mosaic of agroforestry–forest patch landscapes where a surprisingly wide range of animals persist, sometimes in large numbers (e.g. Estrada et al., 2017; Flesher, 2015; Nakashima et al., 2013; Nekaris et al., 2017; Pliosungnoen et al., 2010). Canopies are often occupied by a variety of medium to large squirrel species (Squiridae), palm civets (Viverridae) and diurnal and nocturnal primates (Khan, 2015). Collectively, these arboreal species help in pollination of flowers, seed dispersal and sometimes even pest control, suggesting that these assemblages perform important ecosystem functions (Estrada et al., 2012; Estrada et al., 2017; McConkey and O’Farrill, 2016). Unfortunately, current trends in forest destruction and modification forebode rapid and irreversible decline of many species, especially primates, that could lead to loss of forest functions and regeneration potential (Estrada et al., 2017; Johns and Skorupa, 1987; McConkey and O’Farrill, 2016).
This study evaluated cardiac function using tissue Doppler echocardiography and assessed electrocardiographic findings in children diagnosed with Wilson’s disease.
Asymptomatic patients with a diagnosis of Wilson’s disease (n = 43) were compared to healthy controls (n = 37) that were age and gender matched.
The standard electrocardiographic and conventional echocardiographic examinations were similar in both groups. The left ventricular ejection fraction, shortening fraction, and diastolic function were not significantly different between the two groups. The Tei index for mitral lateral, mitral septal, tricuspid lateral, tricuspid septal, and inter-ventricular septum on tissue Doppler echocardiography was higher in the patient group, yet it did not reach statistical significance. Mitral lateral and septal systolic annular velocity values were significantly lower in the patient group when compared to the control group (p = 0.02 and 0.04, respectively). Also, mitral lateral and septal isovolumetric contraction time values were higher in the patient group (p = 0.04). Although the left ventricular values were not significantly different, relative left ventricular wall thickness was higher in the patient group when compared to the control group, and concentric remodelling in the left ventricle was found in 7 (16%) of 42 patients. QT interval (p = 0.02) and P-wave dispersion values (p = 0.04) were significantly higher in the patient group compared to the control group, and these tend to predict arrhythmias.
Our study based on the tissue Doppler echocardiography assessment indicated a subclinical systolic, rather than diastolic, dysfunction in the myocardium with increased QT interval and P-wave dispersion, despite the young age of the patients and short disease duration.
In this paper the space variable-order fractional Schrödinger equation (VOFSE) is studied numerically, where the variable-order fractional derivative is described here in the sense of the quantum Riesz-Feller definition. The proposed numerical method is the weighted average non-standard finite difference method (WANSFDM). Special attention is given to study the stability analysis and the convergence of the proposed method. Finally, two numerical examples are provided to show that this method is reliable and computationally efficient.
Shoe soles have been shown to transfer infectious microorganisms to floor and ground surfaces. However, the possible modes of transmission of infectious agents from floors or ground surfaces to human contact for infection have not been systematically reviewed. A systematic review was performed on articles indexed in medical databases (Medline, EMBASE, PubMed) using a pre-defined search strategy and MeSH terms (date of last search: 15 March 2016). Only primary research studies in English that investigated the transmission dynamics of infectious microorganisms from floor or ground surfaces to human infection were included. Extraction of articles was performed two independent reviewers using pre-defined data fields in an Excel sheet. Disagreements were resolved by consensus. Thirty studies met the inclusion criteria. Almost all hospital-associated microorganisms including methicillin-resistant Staphylococcus aureus, Clostridium difficile, and multidrug-resistant Gram-negative species were identified on floor or ground surfaces. Several modes of transmission dynamics, most commonly direct contact or aerosolization, were identified. In conclusion, interventions such as efficient cleaning of floor surfaces and vectors that transfer infectious organisms to floors such as shoe soles could be an effective infection control strategy to prevent human disease.
Patients with psychosis display the so-called ‘Jumping to Conclusions’ bias (JTC) – a tendency for hasty decision-making in probabilistic reasoning tasks. So far, only a few studies have evaluated the JTC bias in ‘at-risk mental state’ (ARMS) patients, specifically in ARMS samples fulfilling ‘ultra-high risk’ (UHR) criteria, thus not allowing for comparisons between different ARMS subgroups.
In the framework of the PREVENT (secondary prevention of schizophrenia) study, a JTC task was applied to 188 patients either fulfilling UHR criteria or presenting with cognitive basic symptoms (BS). Similar data were available for 30 healthy control participants matched for age, gender, education and premorbid verbal intelligence. ARMS patients were identified by the Structured Interview for Prodromal Symptoms (SIPS) and the Schizophrenia Proneness Instrument – Adult Version (SPI-A).
The mean number of draws to decision (DTD) significantly differed between ARM -subgroups: UHR patients made significantly less draws to make a decision than ARMS patients with only cognitive BS. Furthermore, UHR patients tended to fulfil behavioural criteria for JTC more often than BS patients. In a secondary analysis, ARMS patients were much hastier in their decision-making than controls. In patients, DTD was moderately associated with positive and negative symptoms as well as disorganization and excitement.
Our data indicate an enhanced JTC bias in the UHR group compared to ARMS patients with only cognitive BS. This underscores the importance of reasoning deficits within cognitive theories of the developing psychosis. Interactions with the liability to psychotic transitions and therapeutic interventions should be unravelled in longitudinal studies.
Al6061 and AZ31 plates were processed using accumulative roll bonding (ARB) method up to two passes to produce laminated composites. The sandwich stacks of Al6061/AZ31/Al6061 were held at 450 °C for 10 min in a cubical furnace and rolled together with reduction of 50% in one pass. The microstructural investigations were done using optical and scanning electron microscopes. The structures of the interface, mechanical and drop impact properties of the laminated composites after the first and second passes were investigated and compared with Al6061 and AZ31 alloy plates. It was found that Al6061 improved the elongation to failure property of AZ31 after the first pass of ARB process and the drop impact properties of AZ31 after the first and second passes. However, elongation to failure magnitude with the uniaxial tensile loading decreased with increase in the number of passes due to the formation of brittle intermetallic between the Al6061/AZ31 nonuniform interfaces.
The Business Meeting of Commission 10 was held as part of the Business Meeting of Division II (Sun and Heliosphere), chaired by Valentin Martínez-Pillet, the President of the Division. The President of Commission 10 (C10; Solar activity), Lidia van Driel-Gesztelyi, took the chair for the business meeting of C10. She summarised the activities of C10 over the triennium and the election of the incoming OC.
Mg doped ZnO thin films were prepared by DC/RF magnetron co-sputtering in (Ar+O2) ambient conditions using metallic Mg and Zn targets. We present a comprehensive study of the effects of film thickness on the structural, optical and magnetic properties. Room temperature ferromagnetism was observed in the films and the saturation magnetization (MS) increases at first as the film’s thickness increases and then decreases. The MS value as high as ∼15.76 emu/cm3 was achieved for the Mg-doped ZnO film of thickness 120 nm. The optical band gap of the films determined to be in the range 3.42 to 3.52 eV.
Commission 10 of the International Astronomical Union has more than 650 members who study a wide range of activity phenomena produced by our nearest star, the Sun. Solar activity is intrinsically related to solar magnetic fields and encompasses events from the smallest energy releases (nano- or even picoflares) to the largest eruptions in the Solar System, coronal mass ejections (CMEs), which propagate into the Heliosphere reaching the Earth and beyond. Solar activity is manifested in the appearance of sunspot groups or active regions, which are the principal sources of activity phenomena from the emergence of their magnetic flux through their dispersion and decay. The period 2008–2009 saw an unanticipated extended solar cycle minimum and unprecedentedly weak polar-cap and heliospheric field. Associated with that was the 2009 historical maximum in galactic cosmic rays flux since measurements begun in the middle of the 20th Century. Since then Cycle 24 has re-started solar activity producing some spectacular eruptions observed with a fleet of spacecraft and ground-based facilities. In the last triennium major advances in our knowledge and understanding of solar activity were due to continuing success of space missions as SOHO, Hinode, RHESSI and the twin STEREO spacecraft, further enriched by the breathtaking images of the solar atmosphere produced by the Solar Dynamic Observatory (SDO) launched on 11 February 2010 in the framework of NASA's Living with a Star program. In August 2012, at the time of the IAU General Assembly in Beijing when the mandate of this Commission ends, we will be in the unique position to have for the first time a full 3-D view of the Sun and solar activity phenomena provided by the twin STEREO missions about 120 degrees behind and ahead of Earth and other spacecraft around the Earth and ground-based observatories. These new observational insights are continuously posing new questions, inspiring and advancing theoretical analysis and modelling, improving our understanding of the physics underlying magnetic activity phenomena. Commission 10 reports on a vigorously evolving field of research produced by a large community. The number of refereed publications containing ‘Sun’, ‘heliosphere’, or a synonym in their abstracts continued the steady growth seen over the preceding decades, reaching about 2000 in the years 2008–2010, with a total of close to 4000 unique authors. This report, however, has its limitations and it is inherently incomplete, as it was prepared jointly by the members of the Organising Committee of Commission 10 (see the names of the primary contributors to the sections indicated in parentheses) reflecting their fields of expertise and interest. Nevertheless, we believe that it is a representative sample of significant new results obtained during the last triennium in the field of solar activity.