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We performed a mixed-methods study to evaluate antimicrobial stewardship program (ASP) uptake and to assess variability of program implementation in Missouri hospitals. Despite increasing uptake of ASPs in Missouri, there is wide variability in both the scope and sophistication of these programs.
Akathisia, dystonia, dyskinesia and parkinsonism, the four main categories of neuroleptic-induced extrapyramidal syndromes (EPS), represent major disadvantages in antipsychotic therapy. In vulnerable patients, acute EPS may progress into potentially irreversible forms such as tardive dystonia and tardive dyskinesia. In the psychiatric clinic, these EPS are often insufficiently recognised or permitted to exist without treatment. In order to ensure a better EPS diagnosis, a simple examination procedure is described. EPS rating scales may serve as an aid in this process. Guidelines are given to prevent and treat EPS. Thus, EPS are best prevented by a course of neuroleptic medication involving as little antidopaminergic D2 effect as possible, including the use of the lowest effective dose (sometimes obtained by addition of a benzodiazepine or carbamazepine) and with antipsychotic drugs which produce low D2 receptor blockade. Treating EPS also consists of using the lowest effective dose and antipsychotics with a low D2 dopamine receptor occupancy. At present, clozapine is the only drug that produces antipsychotic benefits at doses that cause far less D2 receptor antagonism in the basal ganglia of the brain than that seen with standard neuroleptics; however, newer drugs, such as olanzepine, seroquel and sertindole, are on the way.
Parasitism can affect every aspect of wildlife ecology, from predator avoidance and competition for food to migrations and reproduction. In the wild, these ecological effects can have implications for host fitness and parasite dynamics. In contrast, domestic environments are typically characterised by high host densities, low host diversity, and veterinary interventions, and are not subject to processes like predation, competition, and migration. When wild and domesticated hosts interact via shared parasite populations, understanding and predicting the outcomes of parasite ecology and evolution for wildlife conservation and sustainable farming can be a challenge. We describe the ecology and evolution of ectoparasitic sea lice that are shared by farmed and wild salmon and the insights that experiments, fieldwork, and mathematical modelling have generated for theory and applied problems of host–parasite interactions over the course of a long-term study in Pacific Canada. The salmon–sea lice host–parasite system provides a rich case study to examine the ecological context of host–parasite interactions and to shed light on the principal challenges of parasite management for wildlife health and conservation.
Despite children’s unique vulnerability, clinical guidance and resources are lacking around the use of radiation medical countermeasures (MCMs) available commercially and in the Strategic National Stockpile to support immediate dispensing to pediatric populations. To better understand the current capabilities and shortfalls, a literature review and gap analysis were performed.
A comprehensive review of the medical literature, Food and Drug Administration (FDA)-approved labeling, FDA summary reviews, medical references, and educational resources related to pediatric radiation MCMs was performed from May 2016 to February 2017.
Fifteen gaps related to the use of radiation MCMs in children were identified. The need to address these gaps was prioritized based upon the potential to decrease morbidity and mortality, improve clinical management, strengthen caregiver education, and increase the relevant evidence base.
Key gaps exist in information to support the safe and successful use of MCMs in children during radiation emergencies; failure to address these gaps could have negative consequences for families and communities. There is a clear need for pediatric-specific guidance to ensure clinicians can appropriately identify, triage, and treat children who have been exposed to radiation, and for resources to ensure accurate communication about the safety and utility of radiation MCMs for children. (Disaster Med Public Health Preparedness. 2019;13:639-646)
Westgate Oxford is a commercial redevelopment of a large shopping complex in the center of Oxford, with clients Westgate Oxford Alliance and principal contractor Laing O'Rourke. The excavations, carried out by Oxford Archaeology, between 2014 and 2016, were required as part of UK Planning Guidelines and were the largest ever undertaken in the city and principally focused on a large medieval suburban friary. The project won Best Archaeological Project 2016 at the prestigious national British Archaeological Awards, and the outreach program, which included an evolving pop-up museum, was a significant contributing factor. This essay will demonstrate how to set up a pop-up museum in eight steps. The essay will look at how to work with different partners of a project. It will discuss choosing a story to tell and how to deal with a changing narrative on an archaeological site in “real time.” It will show how the Pop Up museum became the principal location for dissemination for the Westgate Oxford project. The essay will conclude with how to keep the story alive and plans for the future of the Westgate Oxford Pop Up Museum.
Preparing and responding to the needs of children during public health emergencies continues to be challenging. The purpose of this study was to assess the usefulness of a tabletop exercise in initiating pediatric preparedness strategies and assessing the impact of the exercise on participants’ understanding of and confidence in their roles during pediatric public health emergencies.
A tabletop exercise was developed to simulate a public health emergency scenario involving smallpox in a child, with subsequent spread to multiple states. During the exercise, participants discussed and developed communication, collaboration, and medical countermeasure strategies to enhance pediatric public health preparedness. Exercise evaluation was designed to assess participants’ knowledge gained and level of confidence surrounding pediatric public health emergencies.
In total, 22 participants identified over 100 communication and collaboration strategies to promote pediatric public health preparedness during the exercise and found that the most beneficial aspect during the exercise was the partnership between pediatricians and public health officials. Participants’ knowledge and level of confidence surrounding a pediatric public health emergency increased after the exercise.
The tabletop exercise was effective in identifying strategies to improve pediatric public health preparedness as well as enhancing participants’ knowledge and confidence surrounding a potential pediatric public health emergency. (Disaster Med Public Health Preparedness. 2018;12:582–586)
The generation of internal gravity waves by a vertically oscillating cylinder that is tilted to the horizontal in a stratified Boussinesq fluid of constant buoyancy frequency,
, is investigated. This variant of the widely studied horizontal configuration – where a cylinder aligned with a plane of constant gravitational potential induces four wave beams that emanate from the cylinder, forming a cross pattern known as the ‘St. Andrew’s Cross’ – brings out certain unique features of radiated internal waves from a line source tilted to the horizontal. Specifically, simple kinematic considerations reveal that for a cylinder inclined by a given angle
to the horizontal, there is a cutoff frequency,
, below which there is no longer a radiated wave field. Furthermore, three-dimensional effects due to the finite length of the cylinder, which are minor in the horizontal configuration, become a significant factor and eventually dominate the wave field as the cutoff frequency is approached; these results are confirmed by supporting laboratory experiments. The kinematic analysis, moreover, suggests a resonance phenomenon near the cutoff frequency as the group-velocity component perpendicular to the cylinder direction vanishes at cutoff; as a result, energy cannot be easily radiated away from the source, and nonlinear and viscous effects are likely to come into play. This scenario is examined by adapting the model for three-dimensional wave beams developed in Kataoka & Akylas (J. Fluid Mech., vol. 769, 2015, pp. 621–634) to the near-resonant wave field due to a tilted line source of large but finite length. According to this model, the combination of three-dimensional, nonlinear and viscous effects near cutoff triggers transfer of energy, through the action of Reynolds stresses, to a circulating horizontal mean flow. Experimental evidence of such an induced mean flow near cutoff is also presented.
Objectives: The Priorities and Evaluation Committee (PEC) funding recommendations for new cancer drugs in British Columbia, Canada have been based on both clinical and economic evidence. The British Columbia Ministry of Health makes funding decisions. We assessed the association between cost-effectiveness of cancer drugs considered from 1998 to 2008 and the subsequent funding decisions.
Methods: All proposals submitted to the PEC between 1998 and 2008 were reviewed, and the association between cost-effectiveness and funding decisions was examined by (i) using logistic regression to test the hypothesis that interventions with higher incremental cost-effectiveness ratios (ICERs) have a lower probability of receiving a positive funding decision and (ii) using parametric and nonparametric tests to determine if a statistically significant difference exists between the mean cost-effectiveness of funded versus not funded proposals. A sub-analysis was conducted to determine if the findings varied across different outcome measures.
Results: Of the 149 proposals reviewed, 78 reported cost-effectiveness using various outcome measures. In the proposals that used life-years gained as the outcome (n = 22), a statistically significant difference of nearly $115,000 was observed between the mean ICERs for funded proposals ($42,006) and for unfunded proposals ($156,967). An odds ratio indicating higher ICERs have a lower probability of being funded was also found to be statistically significant (p < .05).
Conclusions: Economic evidence appears to play a role in British Columbia cancer funding decisions from 1998 to 2008; other decision-making criteria may also have an important role in recommendations and subsequent funding decisions.
Given the ubiquity of layering in environmental stratifications, an interesting example being double-diffusive staircase structures in the Arctic Ocean, we present the results of a joint theoretical and laboratory experimental study investigating the impact of multiple layering on internal wave propagation. We first present results for a simplified model that demonstrates the non-trivial impact of multiple layering. Thereafter, utilizing a weakly viscous linear model that can handle arbitrary vertical stratifications, we perform a comparison of theory with experiments. We conclude by applying this model to a case study of a staircase stratification profile obtained from the Arctic Ocean, finding a rich landscape of transmission behaviour.
Our view of the low-redshift Cosmic Web has been revolutionized by galaxy redshift surveys such as 6dFGS, SDSS and 2MRS. However, the trade-off between depth and angular coverage limits a systematic three-dimensional account of the entire sky beyond the Local Volume (z < 0.05). In order to reliably map the Universe to cosmologically significant depths over the full celestial sphere, one must draw on multiwavelength datasets and state-of-the-art photometric redshift techniques. We have undertaken a dedicated program of cross-matching the largest photometric all-sky surveys – 2MASS, WISE and SuperCOSMOS – to obtain accurate redshift estimates of millions of galaxies. The first outcome of these efforts – the 2MASS Photometric Redshift catalog (2MPZ, Bilicki et al. 2014a) – has been publicly released and includes almost 1 million galaxies with a mean redshift of z=0.08. Here we summarize how this catalog was constructed and how using the WISE mid-infrared sample together with SuperCOSMOS optical data allows us to push to redshift shells of z∼ 0.2 –0.3 on unprecedented angular scales. Our catalogs, with ∼ 20 million sources in total, provide access to cosmological volumes crucial for studies of local galaxy flows (clustering dipole, bulk flow) and cross-correlations with the cosmic microwave background such as the integrated Sachs-Wolfe effect or lensing studies.
In the Century since Slipher's first observations, roughly three million galaxy redshifts have been measured. The resulting maps of large-scale structure have taught us much of central importance in cosmology, ranging from the matter content of the universe to the study of the primordial density fluctuations. This talk aims to review some of the key observational and theoretical milestones on this journey, and to speculate about what the future may bring.
We investigate the accuracy achievable on measurements of the the growth rate of structure f(z) using redshift-space distortions (RSD), when (a) these are measured on the group-galaxy cross correlation function; (b) the latter is expanded over a modified version of the conventional spherical armonics, “truncated multipole moments”. Simulation results give first indications that this combination can push systematic errors on f(z) below 3%, using scales r ⩾ 10h−1 Mpc.
A heuristic greedy algorithm is developed for efficiently tiling spatially dense redshift surveys. In its first application to the Galaxy and MassAssembly (GAMA) redshift survey we find it rapidly improves the spatial uniformity of our data, and naturally corrects for any spatial bias introduced by the 2dF multi-object spectrograph. We make conservative predictions for the final state of the GAMA redshift survey after our final allocation of time, and can be confident that even if worse than typical weather affects our observations, all of our main survey requirements will be met.
InxGa1-xN-based LED structures were grown on digital AlxGa1-xN/GaN DBR substrate to enhance emission extraction. Same LED structure was grown on sapphire substrate as a comparison. LEDs grown on DBR substrate exhibited similar IV characteristics to that grown on sapphire substrate but emission-angle-dependent EL spectra were observed. Also, the resonant vertical cavity modes were observed in EL spectra of LEDs with DBR structure and compared to simulated results. Image processing analysis results show that light extraction of LEDs is enhanced with use of DBR substrate.
Distributed Bragg Reflectors (DBRs) are an important component of various optoelectronic devices for ultra violet and visible wavelengths. In the III-Nitride material system, Aluminum Nitride (AlN) and Gallium Nitride (GaN) offer a large contrast in refractive index and are therefore well suited for fabricating DBRs with high reflectivity and wide bandwidths using relatively few periods. However, the large lattice and thermal mismatch leads to cracking in these heterostructures. In this work short period superlattice layers have been used to fabricate high reflectivity (> 94%) nitride based DBRs via Metal Organic Vapor Phase Epitaxy. Short period AlN/GaN superlattices containing three to four monolayers of GaN have been employed as the low refractive index layer in DBRs to minimize cracking. Using this technique, crack-free DBRs reflecting from 440-475 nm with up to 25 periods have been fabricated. The technique has been proven to be versatile and resulted in large area yield DBRs grown on a variety of different sapphire substrates.
A study is presented of the generation of internal tides by barotropic tidal flow over topography in the shape of a double ridge. An iterative map is constructed to expedite the search for the closed ray paths that form wave attractors in this geometry. The map connects the positions along a ray path of consecutive reflections from the surface, which is double-valued owing to the presence of both left- and right-going waves, but which can be made into a genuine one-dimensional map using a checkerboarding algorithm. Calculations are then presented for the steady-state scattering of internal tides from the barotropic tide above the double ridges. The calculations exploit a Green function technique that distributes sources along the topography to generate the scattering, and discretizes in space to calculate the source density via a standard matrix inversion. When attractors are present, the numerical procedure appears to fail, displaying no convergence with the number of grid points used in the spatial discretizations, indicating a failure of the Green function solution. With the addition of dissipation into the problem, these difficulties are avoided, leading to convergent numerical solutions. The paper concludes with a comparison between theory and a laboratory experiment.
We present the results of a combined experimental and numerical study of the generation of internal waves using the novel internal wave generator design of Gostiaux et al. (Exp. Fluids, vol. 42, 2007, pp. 123–130). This mechanism, which involves a tunable source composed of oscillating plates, has so far been used for a few fundamental studies of internal waves, but its full potential is yet to be realized. Our study reveals that this approach is capable of producing a wide variety of two-dimensional wave fields, including plane waves, wave beams and discrete vertical modes in finite-depth stratifications. The effects of discretization by a finite number of plates, forcing amplitude and angle of propagation are investigated, and it is found that the method is remarkably efficient at generating a complete wave field despite forcing only one velocity component in a controllable manner. We furthermore find that the nature of the radiated wave field is well predicted using Fourier transforms of the spatial structure of the wave generator.
This report summarises a workshop convened by the UK Food Standards Agency (FSA) on 14 October 2008 to discuss current FSA-funded research on carbohydrates and cardiovascular health. The objective of this workshop was to discuss the results of recent research and to identify any areas which could inform future FSA research calls. This workshop highlighted that the FSA is currently funding some of the largest, well-powered intervention trials investigating the type of fat and carbohydrate, whole grains and fruit and vegetables, on various CVD risk factors. Results of these trials will make a substantive contribution to the evidence on diet and cardiovascular risk.