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To integrate electronic clinical decision support tools into clinical practice and to evaluate the impact on indwelling urinary catheter (IUC) use and catheter-associated urinary tract infections (CAUTIs).
Design, Setting, and Participants
This 4-phase observational study included all inpatients at a multicampus, academic medical center between 2011 and 2015.
Phase 1 comprised best practices training and standardization of electronic documentation. Phase 2 comprised real-time electronic tracking of IUC duration. In phase 3, a triggered alert reminded clinicians of IUC duration. In phase 4, a new IUC order (1) introduced automated order expiration and (2) required consideration of alternatives and selection of an appropriate indication.
Overall, 2,121 CAUTIs, 179,070 new catheters, 643,055 catheter days, and 2,186 reinsertions occurred in 3·85 million hospitalized patient days during the study period. The CAUTI rate per 10,000 patient days decreased incrementally in each phase from 9·06 in phase 1 to 1·65 in phase 4 (relative risk [RR], 0·182; 95% confidence interval [CI], 0·153–0·216; P<·001). New catheters per 1,000 patient days declined from 53·4 in phase 1 to 39·5 in phase 4 (RR, 0·740; 95% CI, 0·730; P<·001), and catheter days per 1,000 patient days decreased from 194·5 in phase 1 to 140·7 in phase 4 (RR, 0·723; 95% CI, 0·719–0·728; P<·001). The reinsertion rate declined from 3·66% in phase 1 to 3·25% in phase 4 (RR, 0·894; 95% CI, 0·834–0·959; P=·0017).
The phased introduction of decision support tools was associated with progressive declines in new catheters, total catheter days, and CAUTIs. Clinical decision support tools offer a viable and scalable intervention to target hospital-wide IUC use and hold promise for other quality improvement initiatives.
School students are increasingly using apps for health-related purposes, either on their own or when recommended by psychologists or counsellors, as apps offer a way to assist students to change their behaviour. However, there is a growing need for psychologists and counsellors to be able to evaluate the quality and usefulness of such apps to effect behaviour change. This study was therefore undertaken to identify methods by which school psychologists and counsellors could evaluate health-related apps for clinical use or research purposes. After examining 15 studies of apps that met the inclusion criteria, it was clear that researchers used a number of taxonomies to evaluate the apps. There were seven taxonomies identified, of which five were generalisable to all health conditions, with the behaviour change technique (BCT) taxonomy being the most comprehensive, containing 13 key behaviour strategies. Despite the utility of the taxonomies to identify the amount of behaviour change content within the apps, it was difficult to determine how the behaviour change strategies were measured, thus reducing the ability to predict app effectiveness. Approaches to improving methods by which apps can be developed and evaluated are proposed.
Governing Medical Knowledge Commons makes three claims: first, evidence matters to innovation policymaking; second, evidence shows that self-governing knowledge commons support effective innovation without prioritizing traditional intellectual property rights; and third, knowledge commons can succeed in the critical fields of medicine and health. The editors' knowledge commons framework adapts Elinor Ostrom's groundbreaking research on natural resource commons to the distinctive attributes of knowledge and information, providing a systematic means for accumulating evidence about how knowledge commons succeed. The editors' previous volume, Governing Knowledge Commons, demonstrated the framework's power through case studies in a diverse range of areas. Governing Medical Knowledge Commons provides fifteen new case studies of knowledge commons in which researchers, medical professionals, and patients generate, improve, and share innovations, offering readers a practical introduction to the knowledge commons framework and a synthesis of conclusions and lessons. The book is also available as Open Access.
Results of a spectroscopic search for M32-like compact elliptical galaxies in the Fornax cluster are presented. None were found, which suggests that these objects represent the low luminosity end of the giant elliptical luminosity function, rather than being formed by tidal stripping. The sample is used to investigate the large-scale distribution of bright ellipticals.
Increased temporal and frontal slow-wave delta (1–4 Hz) and theta (4–7
Hz) activities are the most consistent resting-state neural abnormalities
reported in schizophrenia. The frontal lobe is associated with negative
symptoms and cognitive abilities such as attention, with negative
symptoms and impaired attention associated with poor functional
To establish whether frontal dysfunction, as indexed by slowing, would be
associated with functional impairments.
Eyes-closed magnetoencephalography data were collected in 41 participants
with schizophrenia and 37 healthy controls, and frequency-domain source
imaging localised delta and theta activity.
Elevated delta and theta activity in right frontal and right
temporoparietal regions was observed in the schizophrenia
v. control group. In schizophrenia, right-frontal
delta activity was uniquely associated with negative but not positive
symptoms. In the full sample, increased right-frontal delta activity
predicted poorer attention and functional capacity.
Our findings suggest that treatment-associated decreases in slow-wave
activity could be accompanied by improved functional outcome and thus
Due to the wide bandgap and other key materials properties of 4H-SiC, SiC MOSFETs
offer performance advantages over competing Si-based power devices. For example,
SiC can more easily be used to fabricate MOSFETs with very high voltage ratings,
and with lower switching losses. Silicon carbide power MOSFET development has
progressed rapidly since the market release of Cree’s 1200V 4H-SiC
power MOSFET in 2011. This is due to continued advancements in SiC substrate
quality, epitaxial growth capabilities, and device processing. For example,
high-quality epitaxial growth of thick, low-doped SiC has enabled the
fabrication of SiC MOSFETs capable of blocking extremely high voltages (up to
15kV); while dopant control for thin highly-doped epitaxial layers has helped
enable low on-resistance 900V SiC MOSFET production. Device design and
processing improvements have resulted in lower MOSFET specific on-resistance for
each successive device generation. SiC MOSFETs have been shown to have a long
device lifetime, based on the results of accelerated lifetime testing, such as
high-temperature reverse-bias (HTRB) stress and time-dependent dielectric
Barramundi (Lates calcarifer), a catadromous teleost of significant and growing commercial importance, are reported to have limited fatty acid bioconversion capability and therefore require preformed long-chain PUFA (LC-PUFA) as dietary essential fatty acid (EFA). In this study, the response of juvenile barramundi (47·0 g/fish initial weight) fed isolipidic and isoenergetic diets with 8·2 % added oil was tested. The experimental test diets were either devoid of fish oil (FO), and thus with no n-3 LC-PUFA (FO FREE diet), or with a low inclusion of FO (FO LOW diet). These were compared against a control diet containing only FO (FO CTRL diet) as the added lipid source, over an 8-week period. Interim samples and measurements were taken fortnightly during the trial in order to define the aetiology of the onset and progression of EFA deficiency. After 2 weeks, the fish fed the FO FREE and FO LOW diets had significantly lower live-weights, and after 8 weeks significant differences were detected for all performance parameters. The fish fed the FO FREE diet also had a significantly higher incidence of external abnormalities. The transcription of several genes involved in fatty acid metabolism was affected after 2 weeks of feeding, showing a rapid nutritional regulation. This experiment documents the aetiology of the onset and the progression of EFA deficiency in juvenile barramundi and demonstrates that such deficiencies can be detected within 2 weeks in juvenile fish.
Al-Tijānī was a highly-placed scholar and man of letters at Tunis. At the beginning of the fourteenth century A.D., the eighth century A.H., he made a devious and slow journey from Tunis to a point between Tripoli and Misurata, returning much more directly. On the way he employed his considerable leisure to correspond with his acquaintances, often in verse, and still more to collect, by diligent inquiry, the material for the account which he wrote of his adventure. The journey itself became the thread upon which were strung descriptions of each place he visited, first the topography, then the history, the men of religion, and finally the poets illustrated by generous quotations from their works. In this way he managed to provide a great deal of information, at first and second hand, about the route and its interest, contemporary and antiquarian, for an educated gentleman with a taste for literature and literary composition. Some of this information is known to us from other sources; al-Tijānī belonged to the classical Arab literary tradition of the Maghrib as it grew by constant repetition. Some of it is new, because the author drew on works which have not otherwise survived. The rest is al-Tijānī's own contribution, his invaluable tale of what he did and saw. The resultant work, known as the Riḥla or Journey of al-Tijānī, was published in a French translation by Alphonse Rousseau in the Journal Asiatique in 1852–3; this excluded the poetry and a great deal of anecdote, which the translator considered to be ‘sujet de nul intérêt’. The translation itself is not always accurate; nevertheless it is valuable as a guide. The full Arabic text was published at Tunis in 1927, and in a critical edition in 1958.
In the Seventh Annual Report of the Society I published an account of the journey of the shaykh Al-Tijānī to Tripoli at the beginning of the fourteenth century A. D./eighth century A. H., with particular reference to the Arab tribes and chiefs whom he encountered.
What follows is a translation of the passages from the Riḥla in which he describes the city of Tripoli as he saw it during the eighteen months of his residence. Page references are to the 1958 Tunis edition of the work, followed by references to the nineteenth century French translation by Alphonse Rousseau. The latter is incomplete, and not always accurate.
221, trans. 1853, 135
Our entry into (Tripoli) took place on Saturday, 19th Jumāḍā II (707).
237, trans. 1853, 135–6
As we approached Tripoli and came upon it, its whiteness almost blinded the eye with the rays of the sun, so that I knew the truth of their name for it, the White City. All the people came out, showing their delight and raising their voices in acclaim. The governor of the city vacated the place of his residence, the citadel of the town, so that we might occupy it. I saw the traces of obvious splendour in the citadel (qaṣba), but ruin had gained sway. The governors had sold most of it, so that the houses which surrounded it were built from its stones. There are two wide courts, and outside is the mosque (masjid), formerly known as the Mosque of the Ten, since ten of the shaykhs of the town used to gather in it to conduct the affairs of the city before the Almohads took possession. When they did so, the custom ceased, and the name was abandoned.
Speaking of Tripoli, the fourteenth-century writer al-Tijāni says: ‘when the Zughba killed Sacīd ibn Khazrūn in the year 429’. Sacīd was the Zanāta lord of the city, and al-Tijānī is explaining that the venerable faqīh Ibn Munammar was driven into exile because, when Sacīd was killed, he opened the gates to a cousin of the dead man who was promptly expelled by a brother. The reference to the Zughba is thus contained within an account of the dynasty of the Banū Khazrūn which is itself contained within a biographical notice of the jurist Ibn Munammar. There is no further explanation of the killing, and no mention of it by any other writer apart from Ibn Khaldūn, who has borrowed the story from Al-Tijānī, and repeats it twice. This presents a problem. The Zughba were Arabs, a branch of the Banū Hilāl. In that case they should not have been at Tripoli at all, as Ibn Khaldūn observes, because the Banū Hilāl did not enter Ifrīqiya until they were sent from Egypt to punish the Zīrīd sultan al-Mucizz ibn Bādīs for breaking his allegiance to the Fāṭimid caliph in Cairo, and recognising the cAbbāsid caliph in Baghdad. That would have been some time after 1048, more specifically, after 1050, when the man who is usually held responsible for the invasion, al-Yāzūrī, became the Fāṭimid wazīr. The story of the invasion at the behest of al-Yāzūrī is accepted by the principal modern authority, Hady Roger Idris, who tries to explain the reference to the Zughba at Tripoli in 1037–8 by suggesting that a fraction of the tribe may have accompanied their relatives the Banū Qurra, a people settled to the west of Alexandria, when these were sent by Cairo to support an attack upon the Zīrīds of Ifrīqiya by an Ifrīqiyan pretender, Yaḥyā ibn cAlī ibn Hamdūn, in 1001–2. The Banū Qurra had helped Ya…yā to attack Tripoli, but had then returned to Egypt. Idris wonders if this hypothetical fraction of the Zughba had not stayed behind in the neighbourhood of the city.