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Antimicrobial stewardship improves patient care and reduces antimicrobial resistance, inappropriate use, and adverse outcomes. Despite high-profile mandates for antimicrobial stewardship programs across the healthcare continuum, descriptive data, and recommendations for dedicated resources, including appropriate physician, pharmacist, data analytics, and administrative staffing support, are not robust. This review summarizes the current literature on antimicrobial stewardship staffing and calls for the development of minimum staffing recommendations.
Understanding provider perceptions of antimicrobial use (AU) feedback is important for optimal implementation. A survey addressing AU attribution scenarios, feedback methods, and implementation barriers was distributed to inpatient providers. As AU scenarios became more complex, disagreement regarding AU attribution arose. All providers were highly concerned about barriers to AU reporting.
Maize (Zea mays L.) is the major staple crop in Timor-Leste, but yields are low, averaging 1·0–1·7 t/ha, and losses during storage are high from maize weevil (Sitophilus zeamais Motschulsky) damage. The current research, assessing both weevil damage and management options, studied household storage of traditional and introduced maize varieties in 18 farmer groups for 33 weeks, and then evaluated the weevil damage in cobs stored for 9 months of 19 populations from different multi-location yield trials in 2007 and 2010. Storage of shelled grain in airtight containers for 33 weeks had no weevil damage on-farm. In contrast, storing shelled maize in a woven sack was the worst storage method with an average of 0·96 of grain attacked by weevils by Week 33, with local and introduced varieties damaged similarly. Shelled grain stored in a woven sack were infested significantly more than in traditional storage methods husked on the cob – above a fireplace, in a tree or an elevated house. Importantly, modern varieties were damaged more extensively by weevils than local maize types when the husked maize was stored using traditional methods. In the yield trials, grain weevil damage averaged 0·39 in both years after storage in the husk for 9 months. Varietal and location effects were significant for proportion of weevil damage, but the interaction effect was not significant in either year. The broadsense heritabilities were intermediate/high for proportion of weevil-damaged grain (H2=0·81 in 2007 and 0·59 in 2010), and there is potential that populations can be found combining a substantial yield increase with no increase in weevil susceptibility for households using traditional storage methods. For those households with access to airtight storage systems, the results emphasize the need to exploit the interaction of variety with storage method to benefit from the yield advantage of introduced varieties through the concurrent dissemination of improved seed with subsidized, airtight storage drums.
Changes in corpus callosum area and thickness have been reported in
bipolar disorder. Imaging and limited neuropathological data suggest
possible abnormalities in myelination and/or glial function.
To compare corpus callosum area, thickness and magnetic resonance imaging
(MRI) T1 signal intensity in patients with bipolar disorder and
A total of 48 patients with euthymic bipolar disorder and 46 healthy
controls underwent MRI analysis of callosal midsagittal area, callosal
thickness and T1 signal intensity.
The bipolar group had smaller overall and subregional callosal areas and
correspondingly reduced callosal width than the control group. Age
correlated negatively with callosal area in the control group but not in
the bipolar group. Signal intensity was higher in women than in men in
both groups. Signal intensity was reduced in women, but not in men, in
the bipolar group.
Observed differences probably relate to diagnosis rather than mood state
and bipolar disorder appears to result in morphometric change that
overrides changes seen in normal ageing. Intensity changes are consistent
with possible altered myelination or glial function. A gender-dependent
factor appears to operate and to interact with diagnosis.
Ossified skeletal elements within the orbit, such as scleral ossicles, palpebrals, supraorbitals and sesamoids, are widespread across Reptilia, including extant members of Crocodylia, Aves, Squamata and Chelonia. Extant crocodylians lack scleral ossicles, but have a unique palpebral that has recently been shown, through developmental studies, to be an osteoderm in the upper eyelid. Here, we examine the diversity and disparity of the crocodylian palpebral in extant members of Crocodylia and, through the fossil record, trace the origin and evolutionary history of the element throughout Pseudosuchia (all archosaurs more closely related to crocodylians than avians). We show that the crocodylian palpebral originated outside of Crocodylomorpha in early pseudosuchian groups (e.g. Aetosauria, Loricata) and that scleral ossicles are lost in nearly all groups of pseudosuchians, but appear in poposauroids, at least one early crocodylomorph, and some partially or fully marine Crocodyliformes (e.g. thalattosuchians). The morphology and number of palpebrals differs across Crocodyliformes; the presence of two palpebrals is plesiomorphic, but this is reduced to one by Crocodylia. We further recommend the restriction of the term palpebral to the structure in crocodylians and their homologues, but not to the structure in ornithischian dinosaurs.
This study provides a comprehensive epidemio-clinical picture of sporadic, domestically acquired cases of amoebiasis, cryptosporidiosis and giardiasis in one Canadian community based on patient symptom, outcome and exposure data from an enhanced surveillance system. It yields valuable data for estimating the burden of those diseases including the proportion of bloody diarrhoea, hospitalization, and disease duration. Age differences were observed by incidence rate and for some clinical information and exposures to risk factors. For each of the three diseases, the animal/environment-to-person route was the most common possible main transmission route according to the exposure reported, whereas the person-to-person route was the least common. Exposure was higher for the 10–24 years age group of giardiasis cases for swimming in recreational waters (79%) and attending a barbeque (50%). Therefore, comparisons between groups of cases or extrapolation of results when estimating the burden of illness should be adjusted for age.
Conflict is the most common cause of food insecurity. Foreign aid to countries emerging from conflict often allows a funded but brief window for the confirmation-testing and diffusion of agricultural innovation in affected areas. This paper asks the question: what lessons has agricultural research learned through its involvement in this process in countries emerging from conflict? Drawing on experience from Afghanistan and other countries, this paper documents some cases in which it has been possible to inject an element of simple hypothesis testing, often in farmer-managed trials, into post-conflict plans leading to useful lessons. Agricultural researchers need to be cognizant of this approach so that the practice becomes more widely used and lessons recorded for future use.
We determined the distribution and sophistication of obstetric technologies in all 80 maternity hospitals in the state of Washington and examined the effect of rural or urban location, birth volume, and physician staffing on technological intensity. Although smaller and more rural hospitals refer most premature and low-birth-weight infants to regional referral centers, sophisticated prenatal and intrapartum technologies are available in the majority of even the smallest and most remote rural units. Rural hospitals have slightly lower obstetrical intervention rates than do their urban counterparts, but the differences are not great.
The purpose of this study was to examine differences in the way Britain and the United States invest in and deploy a new medical technology. We used structured interviews to obtain information on the technical sophistication and approximate replacement value of all hospital-based obstetrical ultrasound machines in every maternity hospital in Washington state and Wales. The supply of hospital-based ultrasound machines—approximately two machines per 1,000 births—was similar in both countries. Wales had fewer advanced ultrasound machines than Washington state, and they were based exclusively in high-volume district general hospitals; there were no obstetric ultrasound machines in the private sector. In Washington state, the majority of advanced machines were in small and medium-sized hospitals, and many private offices had ultrasound machines. The approximate replacement value of hospital-based machines was three times as high per birth in Washington state as in Wales. In the case of obstetrical ultrasound, centralization of facilities, a relatively small private sector, and global budgeting lead to lower expenditures per patient within the National Health Service without compromising access to care.
Six weed control programs with and without irrigation were investigated in a newly established pecan orchard. Irrigation increased crown diameter growth in only one of seven growing seasons but increased nut yield an average of 35% in the first two bearing years. Weed control program significantly influenced crown diameter beginning in the fourth growing season and continued through season six while also impacting final crown diameter. The use of postemergence (POST) herbicides increased crown diameter a minimum 4 mm vs. preemergence (PRE) herbicides. Mowing neither increased nor decreased crown diameter when used with herbicides; however, when used solely, crown diameter was 29% less. Highest growth rates were obtained with a combination PRE plus POST weed management system. Nut yields were closely linked to growth data. No differences in nut yield were observed between PRE- or POST-herbicide programs alone or in combination with mowing. Mowing alone decreased nut yield 57% vs. herbicide-based approaches. A combination PRE- plus POST-weed control program increased yield 38% vs. all other treatments.
There is uncertainty around the types of interventions that are provided by emergency medical services (EMS) to children during prehospital transport. We describe the patient characteristics, events, interventions provided and outcomes of a cohort of children transported by EMS.
This prospective cohort study was conducted in a city of 750 000 people with a 2-tiered EMS system. All children <16 years of age who were attended by EMS during a 6-month period were enrolled. Data were extracted from ambulance call reports and hospital charts, and analyzed using descriptive statistics.
During the study period there were 1377 pediatric EMS calls. Mean age was 8.2 years (standard deviation 5.4), and the most common diagnoses were trauma (44.9%), seizure (11.8%) and respiratory distress (8.8%). The ambulance return code was Urgent in 7%, Prompt in 57%, Deferrable in 8% and Not Transported in 28%. Fifty-six percent received either an Advanced Life Support or Basic Life Support prehospital intervention. Common procedures included cardiac monitoring (20.0%), oxygen administration (19.8%), blood glucose monitoring (16.3%), spine board (12.2%), limb immobilization (11.1%) and cervical collar (10.0%). Uncommon procedures included administering medications intravenously (IV) (1.4%), bag-valve-mask ventilation (0.3%) and endotracheal intubation (0.1%). Seventy-eight percent of attempted IV lines were successful. Only 9.0% of EMS-transported children were admitted to hospital, and 2.2% were admitted to the intensive care unit.
This first study of Canadian pediatric prehospital interventions shows a high rate of non-transport, and a low rate of Urgent transports and hospital admissions for children. Very few children receive prehospital airway management, ventilation or IV medications; consequently EMS personnel have little opportunity to maintain these pediatric skills in the field.
The probability of a Glossina pallidipes picking up an infection from a single blood meal in Lambwe Valley was estimated to be 0.0092 for Trypanosoma vivax, 0.0028 for T. congolense, 0.00097 for T. brucei and 0.00024 for the human infective T. brucei. In cattle, the prevalence of blood protozoa was Trypanosoma spp. 5.55%, Babesia spp. 2% and Theileria spp. 33.06%. Thirty-eight point three per cent of the cattle with trypanosomes also had Theileria spp., 2.12% of the cattle with trypanosomes also had Babesia spp. and 88.28% of the cattle with babesia had also Theileria spp.
The female sex pheromones of Chilo suppressalis (Wlk.) were previously identified as (Z)-11-hexadecenal and (Z)-13-octadecenal. This paper describes field trials of the synthetic pheromones carried out in the Philippines, Korea and Iran during 1975 and 1976. These trials established that the two pheromones in their naturally occurring ratio are attractive to male C. suppressalis in the field. Both pheromones are necessary for efficient attraction, and ratios of the two pheromones close to the naturally occurring ratio are the most attractive. The rate of release of the pheromones was found to be critical in order to obtain an attractant source comparable with the virgin female moth. The bisulphite adducts of the pheromones showed some promise as a slow-release source of attractant material with a long field life.
Preliminary experiments were carried out to assess the potential use of the two natural pheromones and of two pheromone “mimics”. (Z)-9-tetradecenyl formate and (Z)-11-hexadecenyl formate, as mating disruptants. All four compounds were shown to interfere with pheromonal communication between the sexes
When in 1948 I first made the acquaintance of the mite about to be described I was intrigued with the idea that a form morphologically so similar to those described by Oudemans, 1915 and Hirst 1928 should come from such a different habitat. Whilst recognizing the totally different geographical areas, sphagnum bogs of boreal Canada as opposed to humid forests of tropical Ceylon and Malaya, the question arises as to whether the micro-habitat in which these three species live is so totally different. From the published material available (vide Thienemann 1928-29), which I admit is not very extensive, there does not seem to be much chemical difference between the waters of Nepenthes and those of Sarracenia. The similarity of these two micro-habitats is further substantiated by the fact that copepods of the genus Parastenocaris have been found in the pitchers of Sarracenia which closely resemble those described by Menzel 1921, Chappius 1931 and Thienemann 1928-29 (quoting from Ghosh, no reference given) from the water of Nepenthes. The question of distribution over such great distances and over what must be long ages poses certain difficulties which can only be answered when we know more about the past history and distribution of pitcher plants and mites. The possession of an hypopial stage by all three species does offer some help in the problem but the further question of how the Canadian mites have adapted themselves to the rigours of a northern winter is difficult to understand.
In the winter of 1939 a sample of mites from salted steer hides was sent to me from Buenos Aires for identification with the note that they were present in great numbers in this habitat. As upon examination these appeared to constitute a new species sufficiently unlike the existing representatives of the genus Pontoppidania to preclude its inclusion in that group, the erection of a new, but closely allied genus, seemed to be warranted. Because of the peculiar nature of its habitat and because of its association with hides the name Diphtheroglyphus has been given to this group.
The subfamily Rhizoglyphinae is a group which was reclassified by the Russian Zoologist, A. A. Zakhvatkine, in 1937. As a result of his studies he became convinced that Oudemans' 1923-1932 classification of the Diacotricha was unstable and very artificial.