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Prescribers who wrote at least 1 antibiotic prescription filled at a retail pharmacy in Tennessee in 2016.
Multivariable logistic regression, including prescriber gender, birth decade, specialty, and practice location, and patient gender and age group, to determine the association with high prescribing.
In 2016, 7,949,816 outpatient oral antibiotic prescriptions were filled in Tennessee: 1,195 prescriptions per 1,000 total population. Moreover, 50% of Tennessee’s outpatient oral antibiotic prescriptions were written by 9.3% of prescribers. Specific specialties and prescriber types were associated with high prescribing: urology (odds ratio [OR], 3.249; 95% confidence interval [CI], 3.208–3.289), nurse practitioners (OR, 2.675; 95% CI, 2.658–2.692), dermatologists (OR, 2.396; 95% CI, 2.365–2.428), physician assistants (OR, 2.382; 95% CI, 2.364–2.400), and pediatric physicians (OR, 2.340; 95% CI, 2.320–2.361). Prescribers born in the 1960s were most likely to be high prescribers (OR, 2.574; 95% CI, 2.532–2.618). Prescribers in rural areas were more likely than prescribers in all other practice locations to be high prescribers. High prescribers were more likely to prescribe broader-spectrum antibiotics (P < .001).
Targeting high prescribers, independent of specialty, degree, practice location, age, or gender, may be the best strategy for implementing cost-conscious, effective outpatient antimicrobial stewardship interventions. More information about high prescribers, such as patient volumes, clinical scope, and specific barriers to intervention, is needed.
A survey of hospital antimicrobial stewardship programs was performed to validate core element achievement data from the National Healthcare Safety Network’s (NHSN) Patient Safety Component Annual Survey. In total, 89% of hospitals met all 7 core elements, compared to only 68% according to the NHSN survey.
The Community Assessment of Psychic Experiences (CAPE) is a 42-item self-report questionnaire that has been developed and validated to measure the dimensions of psychosis in the general population. The CAPE has a three-factor structure with dimensions of positive, negative and depression. Assessing the cross-national equivalence of a questionnaire is an essential prerequisite before pooling data from different countries. In this study, our aim was to investigate the measurement invariance of the CAPE across different countries.
Data were drawn from the European Union Gene-Environment Interaction (EU-GEI) study. Participants (incident cases of psychotic disorder, controls and siblings of cases) were recruited in Brazil, France, Italy, the Netherlands, Spain and UK. To analyse the measurement invariance across these samples, we tested configural invariance (i.e. identical structures of the factors), metric invariance (i.e. equivalence of the factor loadings) and scalar invariance (i.e. equivalence of the thresholds) of the three CAPE dimensions using multigroup categorical confirmatory factor analysis methods.
The configural invariance model fits well, providing evidence for identical factorial structure across countries. In comparison with the configural model invariance, the fit indices were very similar in the metric and scalar invariance models, indicating that factor loadings and thresholds did not differ across the six countries.
We found that, across six countries, the CAPE showed equivalent factorial structure, factor loadings and thresholds. Thus, differences observed in scores between individuals from different countries should be considered as reflecting different levels of psychosis.
The Teotihuacan Mapping Project (TMP) provided vast quantities of invaluable data to our understanding of this famous ancient city. The ‘Documenting, Disseminating, and Archiving Data from the Teotihuacan Mapping Project’ aims to analyse, re-examine and ultimately coalesce TMP data for entry into The Digital Archaeological Record.
We previously found that guar gum (GG) and chickpea flour (CPF) added to flatbread wheat flour lowered postprandial blood glucose (PPG) and insulin responses dose dependently. However, rates of glucose influx cannot be determined from PPG, which integrates rates of influx, tissue disposal and hepatic glucose production. The objective was to quantify rates of glucose influx and related fluxes as contributors to changes in PPG with GG and CPF additions to wheat-based flatbreads. In a randomised cross-over design, twelve healthy males consumed each of three different 13C-enriched meals: control flatbreads (C), or C incorporating 15 % CPF with either 2 % (GG2) or 4 % (GG4) GG. A dual isotope technique was used to determine the time to reach 50 % absorption of exogenous glucose (T50 %abs, primary objective), rate of appearance of exogenous glucose (RaE), rate of appearance of total glucose (RaT), endogenous glucose production (EGP) and rate of disappearance of total glucose (RdT). Additional exploratory outcomes included PPG, insulin, glucose-dependent insulinotropic peptide and glucagon-like peptide 1, which were additionally measured over 4 h. Compared with C, GG2 and GG4 had no significant effect on T50 %abs. However, GG4 significantly reduced 4-h AUC values for RaE, RaT, RdT and EGP, by 11, 14, 14 and 64 %, respectively, whereas GG2 showed minor effects. Effect sizes over 2 and 4 h were similar except for significantly greater reduction in EGP for GG4 at 2 h. In conclusion, a soluble fibre mix added to flatbreads only slightly reduced rates of glucose influx, but more substantially affected rates of postprandial disposal and hepatic glucose production.
Awareness of illness (insight) has been found to have contradictory effects for different functional outcomes after the early course of psychosis. Whereas it is related to psychotic symptom reduction and medication adherence, it is also associated with increased depressive symptoms. In this line, the specific effects of insight on the evolution of functioning over time have not been identified, and social indicators, such as socio-occupational functioning have barely been considered. Drawing from social identity theory we investigated the impact of insight on the development of psychosocial outcomes and the interactions of these variables over time.
The participants, 240 patients in early phase of psychosis from the Treatment and Early Intervention in Psychosis Program (TIPP) of the University Hospital of Lausanne, Switzerland, were assessed at eight time points over 3 years. Cross-lagged panel analyses and multilevel analyses were conducted on socio-occupational and general functioning [Social and Occupational Functioning Assessment Scale (SOFAS) and Global Assessment of Functioning (GAF)] with insight, time and depressive symptoms as independent variables.
Results from multilevel analyses point to an overall positive impact of insight on psychosocial functioning, which increases over time. Yet the cross-lagged panel analysis did not reveal a systematic positive and causal effect of insight on SOFAS and GAF scores. Depressive symptoms seem only to be relevant in the beginning of the treatment process.
Our results point to a complex process in which the positive impact of insight on psychosocial functioning increases over time, even when considering depressive symptoms. Future studies and treatment approaches should consider the procedural aspect of insight.
The aim of this Research Communication was to investigate the changes in physicochemical, colour, apparent viscosity and texture properties in low-fat goat milk yogurts prepared with cupuassu pulp by the addition of inulin (SI), maltodextrin (SM), whey protein (SW) and skim milk powder (SP). Three batches of each cupuassu goat milk yogurt were prepared and analysed on the 1st day of storage by pH, proximate composition, colour, apparent viscosity, and texture. In comparison to yogurts from whole (W) or skimmed milk (S), all of the fat replacers improved the physicochemical properties (P < 0·05). The addition of the carbohydrates (inulin and maltodextrin) and proteins (whey protein and skim milk powder) also influenced the colour of the low-fat cupuassu goat milk yogurt (P < 0·05). All fat replacer treatments (SI, SM, SW and SP) presented a higher (P < 0·05) apparent viscosity than W and S yogurts. However, only the addition of skim milk powder increased the texture parameters (firmness and consistency) (P < 0·05). These results suggest that skim milk powder can be used to improve the texture properties of low-fat cupuassu goat milk. Furthermore, inulin, maltodextrin, and whey protein can potentially be applied in the goat dairy industry to increase the viscosity of yogurts.
Oak twig pruner (Anelaphus parallelus (Newman); Coleoptera: Cerambycidae) larvae develop inside twigs pruned from host plants. Reasons for this behaviour are unknown and differential emergence due to twig diameter has not been explored. Twigs pruned from walnuts (Juglans nigra Linnaeus; Juglandaceae) (n=179) and oaks (Quercus Linnaeus; Fagaceae) (n=84) were collected in Pennsylvania, United States of America in 2010; 118 pruned oak twigs were collected in New York State, United States of America in 2012. Twigs from 2012 were dissected to determine rates of emergence and larval mortality; both samples were examined for parasitoids. As the diameter of oak twigs (range of 3–16 mm) increased, larval mortality increased and adult emergence decreased. Date of collection did not influence twig diameter nor emergence rates. Three new parasitoids were associated with the oak twig pruner: Atanycolus Förster (Hymenoptera: Braconidae), Eubazus denticulatus (Martin) (Hymenoptera: Braconidae), and a potentially new genus of wasp (Hymenoptera: Braconidae, Hormiinae near Pambolus Haliday). Parasitism rates were an order of magnitude greater among twigs that contained more than one larva or pupa (23.1%; n=26) compared to those that contained only one (2.3%; n=341).
Oxysterols (oxidised cholesterol) may play a role in the pathogenesis of CVD. Similar to cholesterol, plant sterols are susceptible to oxidation. However, less is known about the potential atherogenicity of oxidised plant sterols (oxyphytosterols). In the present study, the atherogenicity of a mixture of oxyphytosterols was examined by feeding female LDL receptor-deficient (LDLR+/ −) mice for 35 weeks a control diet (atherogenic high-fat diet; n 9), an oxysterol diet (control diet+0·025 % (w/w) oxysterols; n 12) or an oxyphytosterol diet (control diet+0·025 % (w/w) oxyphytosterols; n 12). In the LDLR+/ − mice, serum levels of cholesterol, lipoprotein profiles, cholesterol exposure and inflammatory markers at the end of the experiment were comparable between the three diet groups. Nevertheless, the proportion of severe atherosclerotic lesions was significantly higher after oxysterol (41 %; P= 0·004) and oxyphytosterol (34 %; P= 0·011) diet consumption than after control diet consumption (26 %). Oxyphytosterol levels in the lesions were the highest in the oxyphytosterol group. Here, we show that not only dietary oxysterols but also dietary oxyphytosterols increase the proportion of severe atherosclerotic lesions. This suggests that plant sterols when oxidised may increase atherosclerotic lesion severity instead of lowering the size and severity of lesions when fed in their non-oxidised form. Therefore, this finding might give an indication as to where to find the answer in the current hot debate about the potential atherogenicity of plant sterols. However, to what extent these results can be extrapolated to the human situation warrants further investigation.
Tuberculosis (TB) in livestock, caused by Mycobacterium bovis, persists in many countries. In the UK and Ireland, efforts to control TB through culling of badgers (Meles meles), the principal wildlife host, have failed and there is significant interest in vaccination of badgers as an alternative or complementary strategy. Using a simulation model, we show that where TB is self-contained within the badger population and there are no external sources of infection, limited-duration vaccination at a high level of efficacy can reduce or even eradicate TB from the badger population. However, where sources of external infection persist, benefits in TB reduction in badgers can only be achieved by ongoing, annual vaccination. Vaccination is likely to be most effective as part of an integrated disease management strategy incorporating a number of different approaches across the entire host community.
The microquasar GX 339-4 experienced an outburst in 2010. We focus on observations that are quasi-simultaneous with those made by INTEGRAL and RXTE in March–April 2010 with radio, NIR, optical and UV data. X-ray transients are extreme systems, often harboring a black hole, known to emit throughout the whole electromagnetic spectrum in outburst. We studied the source evolution and correlated changes in all wavelengths. The bolometric flux increased from 0.8 to 2.9 × 10−8 erg cm−2 s−1 while the relative contribution of the hot medium decreased. The radio, NIR and optical emission from jets was detected and observed to fade as the source softened; reprocessing in the disc was strong at the end.
Plant sugars are often considered as primary feeding stimuli, conditioning host plant acceptance by herbivorous insects. Of the nine sugars identified from methanolic extracts of seven grass species, only turanose, a sucrose isomer, was negatively correlated with the survival and growth of the noctuid larva of cereal stemborer, Busseola fusca. Sucrose was the most abundant sugar, although it did not vary significantly in concentration among the plant species studied. Using Styrofoam™ cylinders impregnated with increasing concentrations of turanose or sucrose, the two sugars had opposing effects: turanose appeared phagodeterrent while sucrose was phagostimulatory. Electrophysiological studies indicated that B. fusca larvae were able to detect both sugars via their styloconic sensilla located on the mouthparts. The findings indicate that, whereas sucrose is a feeding stimulant and positively influences food choice by B. fusca larvae, turanose negatively contributes to larval food choice. The balance in concentrations of both sugars, however, somehow influences the overall host plant choice made by the larvae. This can partly explain host plant suitability and choice by this caterpillar pest in the field.
The hydrogen adsorption capacity of various carbon nanostructures including single-wall carbon nanotubes, graphitic nanofibers, activated carbon, and graphite has been measured as a function of pressure and temperature. Our results show that at room temperature and a pressure of 80 bar the hydrogen storage capacity is less than 1 wt.% for all samples. Upon cooling, the capacity of hydrogen adsorption increases with decreasing temperature and the highest value was observed to be 2.9 wt. % at 50 bar and 77 K. The correlation between hydrogen storage capacity and specific surface area is discussed.
Systematic relations between porosity and compressional velocity Vp in the three component (sand, grains, clay and brine) systems (1) porous sandstone, (2) sands, and (3) suspensions, were obtained using experimental data and models. In Cemented Shaley Sandstones Vp was found to correlate linearly with porosity and clay content. The velocities in clean sandstones are about 7% higher than those predicted by the linear fit, indicating that a small amount of clay significantly reduces the elastic moduli of sandstones.
For uncemented shaley sand, a model for the dependence of sonic velocity and porosity on clay content and compaction was developed for sand with clay dispersed in the pore space and for shale with suspened sand grains. The model closely mimics the experimentally observed minimum for porosity and the peak in velocity versus clay content. The results explain much of the scatter in velocity data in-situ. Velocity in suspensions at ϕ = 39% of grains in brine is close to values predicted by the Reuss (Isostress) average. Velocity dispersion, as suggested by Biot (1956 a,b) is calculated and observed in coarser sediments such as sand, whereas velocities in the finer clay and silt follow Biot's low frequency value.
In total, our results provide the complete dependence of velocity on porosity in brine saturated sediment with clays, ranging from pure quartz to pure clay and water. Our results also highlight the crucial role of the critical porosity ϕ at about 39%, and the transition from cemented to uncemented sands.
This paper discusses the kinetics of aging and its implications for the evaluation of changes in the aging process, especially as applied to accelerated aging. The problem of comparing accelerated aging conditions is shown to be separate from that of evaluating changes occurring under one specific set of conditions. Thus tests and measurements that can be used to evaluate the results of a specific accelerated aging experiment are not necessarily valid for use in determining whether two sets of aging conditions are comparable. This distinction is crucial in trying to determine whether a set of aging conditions is comparable to, or accurately simulates, natural aging. The criteria for comparing two sets of aging conditions are defined, and applied to the problem of evaluating accelerated aging conditions. Data from the analysis of individual reaction products of artificially aged paper samples are used to determine the effects of temperature and relative humidity (RH) on the rates of individual reactions. Changes in the distribution of reaction products are used as indicators of changes in the aging process. The aging process of cellulose under the conditions studied (60–90°C, 30–80% RH) is shown to be RH dependent, but relatively temperature independent. Thus raising the temperature at constant RH speeds up the aging process without significantly altering it. If the RH is changed, then the aging process is altered and equivalent states of aging cannot be reached. Accelerated aging should be conducted at the same relative humidity as the conditions to which the results are to be applied. The data also indicate that lowering the relative humidity from 50% to 30% slows the rate of hydrolysis by a factor of three to five times.
Wood is common as a structural material throughout Art and Archaeological collections. While there is a considerable amount of information on the behavior of wood in the longitudinal direction, failure is often perpendicular to the grain direction. This study concentrated on the cross-grained mechanical behavior of several woods and their response to changes in relative humidity. The mechanical behavior of these woods coupled with the dimensional response to relative humidity can be used to assess the potential for damage to restrained wood objects as well as determine allowable museum environmental fluctuations.