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To assess the impact of major interventions targeting infection control and diagnostic stewardship in efforts to decrease Clostridioides difficile hospital onset rates over a 6-year period.
Interrupted time series.
The study was conducted in an 865-bed academic medical center.
Monthly hospital-onset C. difficile infection (HO-CDI) rates from January 2013 through January 2019 were analyzed around 5 major interventions: (1) a 2-step cleaning process in which an initial quaternary ammonium product was followed with 10% bleach for daily and terminal cleaning of rooms of patients who have tested positive for C. difficile (February 2014), (2) UV-C device for all terminal cleaning of rooms of C. difficile patients (August 2015), (3) “contact plus” isolation precautions (June 2016), (4) sporicidal peroxyacetic acid and hydrogen peroxide cleaning in all patient areas (June 2017), (5) electronic medical record (EMR) decision support tool to facilitate appropriate C. difficile test ordering (March 2018).
Environmental cleaning interventions and enhanced “contact plus” isolation did not impact HO-CDI rates. Diagnostic stewardship via EMR decision support decreased the HO-CDI rate by 6.7 per 10,000 patient days (P = .0079). When adjusting rates for test volume, the EMR decision support significance was reduced to a difference of 5.1 case reductions per 10,000 patient days (P = .0470).
Multiple aggressively implemented infection control interventions targeting CDI demonstrated a disappointing impact on endemic CDI rates over 6 years. This study adds to existing data that outside of an outbreak situation, traditional infection control guidance for CDI prevention has little impact on endemic rates.
Asenapine and olanzapine reduced persistent negative symptoms (PNS) of schizophrenia in 2 double-blind, randomized 26-week studies and subsequent 26-week extensions; superiority of asenapine over olanzapine was observed in neither core study and only 1 extension.
Further explore the efficacy of asenapine on PNS using pooled data.
Demonstrate superiority of asenapine over olanzapine on PNS.
Core study participants were randomized to twice-daily asenapine 5 or 10 mg or once-daily olanzapine 5–20 mg; extension participants continued existing treatment. Changes from core study 16-item Negative Symptom Assessment (NSA-16) Scale baseline at Weeks 26 and 52 were estimated using MMRM.
Of 949 treated participants (asenapine, 485; olanzapine, 464), 613 (277; 336) completed the core studies and 412 (170; 242) completed the extensions. Discontinuation due to lack of therapeutic effect was significantly greater with asenapine vs olanzapine for the first 26 weeks (13.6% vs 7.3%, p = 0.0016) and during the extension (5.5% vs 2.1%, p = 0.0458) for core and extension study participants, respectively. Between-group differences in least squares mean ± SE NSA-16 score change from core study baseline were significantly greater with asenapine at Week 52 for core (-14.6 ± 0.8 vs -12.6 ± 0.7; p = 0.0497) and extension (-16.5 ± 0.9 vs -13.6 ± 0.7; p = 0.0083) participants, but were not significant at Week 26.
In pooled analyses, asenapine and olanzapine reduced PNS, with statistical superiority of asenapine observed at Week 52 but not Week 26. These results should be interpreted in view of the fact that participants who entered the extensions did so without rerandomization.
We sought to explore whether obstetric complications (OCs) are more likely to occur in the presence of familial/genetic susceptibility for schizophrenia or whether they themselves represent an independent environmental risk factor for schizophrenia.
The presence of OCs was assessed through maternal interview on 216 subjects, comprising 36 patients with schizophrenia from multiply affected families, 38 of their unaffected siblings, 31 schizophrenic patients with no family history of psychosis, 51 of their unaffected siblings and 60 normal comparison subjects. We examined the familiality of OCs and whether OCs were commoner in the patient and sibling groups than in the control group.
OCs tended to cluster within families, especially in multiply affected families. Patients with schizophrenia, especially those from multiply affected families, had a significantly higher rate of OCs compared to normal comparison subjects, but there was no evidence for an elevated rate of OCs in unaffected siblings.
Our data provides little evidence for a link between OCs and genetic susceptibility to schizophrenia. If high rates of OCs are related to schizophrenia genes, this relationship is weak and will only be detected by very large sample sizes.
Many MRI studies have cited major depression, with or without anti-depressive treatment, associated with structural plasticity changing in several brain regions. Few of these studies researched the effect of the anti-depressive treatment, electroconvulsive therapy (ECT), on depression.
To assess the influence of ECT on the brain structure change during the treatment process by utilizing the voxel-based morphometry (VBM) analysis.
To determine whether ECT alter brain structure.
We performed HAMD ratings and MRI scans on 12 depressive patients during ECT, analyzing the data by VBM with SPM8 software's family-wise error correction (FWE).
The researchers found volumes changes in white matter in 37 regions between pre-ECT and post-ECT1, but only one region changing between pre-ECT and post-ECT8. Seven regions changing in grey matter between pre-ECT and post-ECT 1⌧but none regions changing between pre-ECT and post-ECT8.
The density changes in several brain regions after a single ECT stimuli, but return to the original level after completing the eighth ECT. Our finding supports that ECT may play a temporary role in treating major depression but do not permanently alter the structures of brain.
Assess the incidence and time-course of somnolence in placebo- and active-controlled asenapine schizophrenia and bipolar I disorder (BD) trials.
Data were from schizophrenia (4 short-term [6wk]; 3 long-term [26-52wk]) and BD (2 short-term [3wk]; one 12-wk adjunct therapy to mood stabilizers) trials. Data were pooled across asenapine doses (5or10 mg BID); active controls were risperidone 3 mg BID, olanzapine 5-20 mg QD, and haloperidol 4 mg BID.
For schizophrenia, incidence of somnolence was higher with active treatment than placebo in short-term trials; (asenapine,13.1%; placebo, 6.9%; active controls, 5–20%); and comparable for asenapine and olanzapine in long-term trials; (asenapine,18.4–18.5%; olanzapine, 19.6–21.1%); severe somnolence was infrequent (0–8%). Somnolence onset (median [days]) occurred early in short-term (asenapine, 2.0; placebo, 7.0; active controls, 2–6) and long-term (asenapine, 9.0; olanzapine, 7.5–9.0) trials; median somnolence duration (days) was relatively brief in short-term (asenapine,15.0; placebo, 4.5; active controls; 3.0–22.5) and long-term (asenapine, 22.0–25.0; olanzapine, 21.0–25.0) trials. For BD, incidence of somnolence was higher with active treatment than placebo in short-term (asenapine, 23.8%; placebo, 6.4%; olanzapine, 26.4%) and adjunctive therapy (asenapine, 24.1%; placebo, 10.2%) trials; severe somnolence was infrequent (0–3%). Somnolence onset (median [days]) occurred early in short-term (asenapine, 1.0; placebo, 2.0; olanzapine, 1.0) and adjunctive therapy (asenapine,1.5; placebo,2.0) trials; median somnolence duration (days) was brief in short-term (asenapine, 7.0; placebo, 5.0; olanzapine, 8.5) and adjunctive therapy (asenapine,12.5; placebo, 7.0) trials.
The analyses show, on average, an early onset and a limited duration of treatment-emergent somnolence with asenapine, which may be clinically useful in certain clinical situations.
Although numerous studies have investigated the individual effects of salinity, irrigation and fertilization on soil microbial communities, relatively less attention has been paid to their combined influences, especially using molecular techniques. Based on the field of orthogonal designed test and deoxyribonucleic acid sequencing technology, the effects of saline water irrigation amount, salinity level of irrigation water and nitrogen (N) fertilizer rate on soil bacterial community structure were investigated. The results showed that the irrigation amount was the most dominant factor in determining the bacterial richness and diversity, followed by the irrigation water salinity and N fertilizer rate. The values of Chao1 estimator, abundance-based coverage estimator and Shannon indices decreased with an increase in irrigation amount while increased and then decreased with an increase in irrigation water salinity and N fertilizer rate. The highest soil bacterial richness and diversity were obtained under the least irrigation amount (25 mm), medium irrigation water salinity (4.75 dS/m) and medium N fertilizer rate (350 kg/ha). However, different bacterial phyla were found to respond distinctively to these three factors: irrigation amount significantly affected the relative abundances of Proteobacteria and Chloroflexi; irrigation water salinity mostly affected the members of Actinobacteria, Gemmatimonadetes and Acidobacteria; and N fertilizer rate mainly influenced the Bacteroidetes' abundance. The results presented here revealed that the assessment of soil microbial processes under combined irrigation and fertilization treatments needed to be more careful as more variable consequences would be established by comparing with the influences based on an individual factor, such as irrigation amount or N fertilizer rate.
The spatial and temporal structure of the resonant fluid response in a narrow gap (the so-called gap resonance) between two identical fixed boxes is investigated experimentally. Transient wave groups are used to excite the gap resonance from different wave approach directions. This shows a strong beating pattern and a very long duration, reflecting that gap resonance is a multi-mode resonant and weakly damped phenomenon. For head sea excitation the linear transfer function of the
gap mode is as significant as that of the
mode. Gap resonance can be driven through different mechanisms, e.g. linear excitation and a nonlinear frequency-doubling process. Significant wave group structure is shown in the gap, and the group structure is more distinct in the case with frequency doubling, i.e. long wave, excitation. Then it is clearer visually that the groups originate at the end of the gap, propagate along the gap and are then partially reflected from the other end. The groups within the gap are very clear because the group velocity is close to constant for the first few gap resonance modes, and much smaller than that for free waves on the open sea. In contrast, the phase speed of waves in the gap is larger than that for free waves outside. Only in the limit of short waves do the group velocity and phase speed of the gap modes tend to those of deep-water free waves. The group and phase speeds from these experiments match well the theoretical forms given by Molin et al. (Appl. Ocean Res., vol. 24 (5), 2002, pp. 247–260), albeit for a slightly different box cross-sectional shape.
To retrospectively study the primary laryngeal lymphoma cases in China reported in Chinese-language literature.
Chinese-language literature was searched for papers on primary laryngeal lymphoma published in the last 25 years.
The selected papers comprised a total of 115 cases. The male-to-female ratio was 3.4:1. Non-Hodgkin's lymphoma was the exclusive pathological type. The estimated 3-year, 5-year and 10-year survival rates were 70.9 ± 6.4 per cent, 63.4 ± 7.6 per cent and 56.4 ± 9.5 per cent respectively, as determined by Kaplan–Meier analysis. B-cell non-Hodgkin's lymphoma patients had a better prognosis than T-cell non-Hodgkin's lymphoma patients (p = 0.032). Patients with lymph node involvement at diagnosis had a poorer prognosis (p < 0.01).
Primary laryngeal lymphoma is a rare disease with no specific clinical features. More than one biopsy might be needed to obtain the correct diagnosis. Proper treatment could lead to promising outcomes. The T-cell subtype and lymph node involvement at diagnosis might indicate worse prognosis.
Accumulating evidence supports that the hormone prolactin (PRL) is galactopoietic in dairy ruminants. Accordingly, the inhibition of PRL secretion by the dopamine agonists quinagolide and cabergoline causes a sharp decline in milk production and could be useful in several critical periods. First, PRL inhibition may reduce the incidence during the periparturient period of metabolic disorders caused by the abrupt increase in energy demand for milk production. Metabolic disturbances can be lessened by reducing milk output by milking once a day or incompletely in the first few days of lactation. The injection of cows with quinagolide for the first 4 days of lactation reduced milk production during the first week of lactation without any residual effects. Blood glucose and calcium concentrations were higher and β-hydroxybutyric acid concentration was lower in the quinagolide-treated cows. Second, PRL inhibition may help sick or injured lactating cows, considering that they can fall into severe negative energy balance when they are unable to consume enough feed to support their milk production. This leads to a weakened immune system and increased susceptibility to diseases. When cows were subjected to feed restriction and were treated with quinagolide, the decrease in milk production was accelerated without any residual effects. The quinagolide-treated cows had higher glucose and lower β-hydroxybutyric acid and non-esterified fatty acid concentrations than the control cows did. Third, PRL inhibition may facilitate drying-off in high-yielding cows, because they are often dried off while still producing significant quantities of milk, which delays mammary involution and increases risk of mastitis. Therefore, strategies that reduce milk production before drying-off and accelerate mammary gland involution could be an important management tool. In this context, inhibition of PRL was utilised to accelerate mammary gland dry-off. Quinagolide decreased milk production within the first day of treatment, and both quinagolide and cabergoline induced more rapid changes in several markers of mammary gland involution after drying-off. In addition, quinagolide improved the animals’ resistance to intramammary infection. These results suggest that the inhibition of PRL could be a strategy for facilitating drying-off, reducing metabolic stress during the postpartum period, and alleviating acute nutritional stress during illness without compromising the overall productivity of dairy ruminants.
Antioxidants have been always used to improve post-slaughter meat quality in broilers subjected to stress. Forsythia suspensa extract (FSE), a traditional Chinese herbal medicine, is generally regarded as a natural source of antioxidants. Therefore, the objective of this study was to test the hypothesis that FSE could protect post-slaughter breast muscles against oxidative injury induced by dexamethasone (DEX) mimicking chronic physiological stress in poultry production. Average daily gain and feed efficiency of poultry were suppressed by DEX and improved by FSE (P < 0.05). Dexamethasone caused the decrease in the redness value and the increase in the lightness and yellowness values and drip loss of the breast muscles (P < 0.05), and FSE had the converse effects (P < 0.05). Dietary FSE supplementation decreased monounsaturated fatty acid (FA) and increased polyunsaturated FA in breast muscles of broilers (P < 0.05). In addition, FSE decreased malondialdehyde and carbonyl content in the breast muscles of DEX-treated broilers (P < 0.05). The inhibition of 1,1-diphenyl-2-picryl-hydrazyl in the breast muscles was decreased by DEX and increased by FSE (P < 0.05). Total-antioxidant capacity and glutathione peroxidase activity in the breast muscles were decreased in birds subjected to DEX and increased in birds supplemented with FSE (P < 0.05). Totally, DEX suppressed growth performance and induced breast muscle oxidative injury in broilers, and FSE supplementation improved antioxidant capacity to attenuate these adverse effects. Therefore, FSE could be a potential natural antioxidant to alleviate oxidative injury of the breast muscles in broilers and to improve the meat quality for human consumption.
Wave run-up phenomena driven by nonlinear wave interactions with a fixed rectangular box are investigated. Experiments are carried out in different types of uni-directional waves with normal incidence. Significant wave run-ups featuring tertiary interaction effects, similar to those reported by Molin et al. (J. Fluid Mech., vol. 528, 2005, pp. 323–354) for a fixed vertical plate, are observed in regular wave tests. Transient wave group tests are conducted for comparison, to facilitate the analysis of the tertiary interactions in irregular waves. The most striking observation is that the wave surface elevations at the centre of the front face of the fixed box can reach
the incident waves even in irregular waves, much larger than the
predicted from linear theory and observed for the transient groups. The extra amplification builds up slowly and is localized on the weather side of the box. It is believed to result from tertiary interactions between the incident and reflected wave fields upstream, which induce a local lensing effect and thus wave focusing on the weather side. These interactions, though a nonlinear process, occur at the first harmonic quantities rather than high harmonics. Supporting evidence is extracted from random wave runs using NewWave analysis, where surface amplifications and phase lag – both key characteristics of tertiary wave interactions – are identified. The identification of these tertiary interactions in irregular waves is new, and may be of practical importance.
Free surface oscillations in a narrow gap between elongated parallel bodies are studied numerically. As this represents both a highly resonant system and an arrangement of relevance to offshore operations, the nature of the damping is of primary interest, and has a critical role in determining the response. Previous experimental work has suggested that the damping could be attributed to laminar boundary layers; here our numerical wave tank successfully resolves both wave and boundary layer scales to provide strong numerical evidence in support of this conclusion. The simulations follow the experiments in using wave groups so that the computation is tractable, and both linear and second harmonic excitation of the gap are demonstrated.
The seasonality of individual influenza subtypes/lineages and the association of influenza epidemics with meteorological factors in the tropics/subtropics have not been well understood. The impact of the 2009 H1N1 pandemic on the prevalence of seasonal influenza virus remains to be explored. Using wavelet analysis, the periodicities of A/H3N2, seasonal A/H1N1, A/H1N1pdm09, Victoria and Yamagata were identified, respectively, in Panzhihua during 2006–2015. As a subtropical city in southwestern China, Panzhihua is the first industrial city in the upper reaches of the Yangtze River. The relationship between influenza epidemics and local climatic variables was examined based on regression models. The temporal distribution of influenza subtypes/lineages during the pre-pandemic (2006–2009), pandemic (2009) and post-pandemic (2010–2015) years was described and compared. A total of 6892 respiratory specimens were collected and 737 influenza viruses were isolated. A/H3N2 showed an annual cycle with a peak in summer–autumn, while A/H1N1pdm09, Victoria and Yamagata exhibited an annual cycle with a peak in winter–spring. Regression analyses demonstrated that relative humidity was positively associated with A/H3N2 activity while negatively associated with Victoria activity. Higher prevalence of A/H1N1pdm09 and Yamagata was driven by lower absolute humidity. The role of weather conditions in regulating influenza epidemics could be complicated since the diverse viral transmission modes and mechanism. Differences in seasonality and different associations with meteorological factors by influenza subtypes/lineages should be considered in epidemiological studies in the tropics/subtropics. The development of subtype- and lineage-specific prevention and control measures is of significant importance.
Music or other background sounds are often played in barns as environmental enrichment for animals on farms or to mask sudden disruptive noises. Previous studies looking at the effects of this practice on non-human animal well-being and productivity have found contradictory results. However, there is still a lack of discussion on whether piglets have the ability to distinguish different types of music. In this study, we exposed piglets to different music conditions to investigate whether the piglets preferred certain music types, in which case those types would have the potential to be used as environmental enrichment. In total, 30 piglets were tested for music type preference to determine whether growing pigs respond differently to different types of music. We used music from two families of instruments (S: string, W: wind) and with two tempos (S: slow, 65 beats/min (bpm); F: fast, 200 bpm), providing four music-type combinations (SS: string-slow; SF: string-fast; WS: wind-slow; WF: wind-fast). The piglets were given a choice between two chambers, one with no music and the other with one of the four types of music, and their behaviour was observed. The results showed that SS and WF music significantly increased residence time (P<0.01) compared with the other music conditions. Compared with the control group (with no music), the different music conditions led to different behavioural responses, where SS music significantly increased lying (P<0.01) and exploration behaviour (P<0.01); SF music significantly increased tail-wagging behaviour (P<0.01); WS music significantly increased exploration (P<0.01); and WF music significantly increased walking, lying, standing and exploration (all P<0.01). The results also showed that musical instruments and tempo had little effect on most of the behaviours. Fast-tempo music significantly increased walking (P=0.02), standing (P<0.01) and tail wagging (P=0.04) compared with slow-tempo music. In conclusion, the results of this experiment show that piglets are more sensitive to tempo than to musical instruments in their response to musical stimulation and seem to prefer SS and WF music to the other two types. The results also suggest a need for further research on the effect of music types on animals.
Subcutaneous immunotherapy is an effective and safe treatment for allergic rhinitis and allergic asthma. Different symptom scores are used to evaluate the efficacy of subcutaneous immunotherapy in clinical trials.
A total of 58 allergic rhinitis patients sensitised to house dust mites, with or without mild asthma, were included. Symptom score, medication score, visual analogue scale score and quality of life were assessed before and after 6, 12 and 24 months of subcutaneous immunotherapy.
After two years of subcutaneous immunotherapy, asthma symptom scores nearly reached zero, whereas the scores remained higher for nasal symptoms. The changes in asthma symptom scores were markedly different (p < 0.05) and occurred faster than the changes in nasal symptom scores when compared between monosensitised and polysensitised groups. Significant reductions in visual analogue scale score and medication score were demonstrated after subcutaneous immunotherapy.
Two-year subcutaneous immunotherapy with house dust mite vaccine is an effective treatment for both monosensitised and polysensitised allergic patients. The changes in asthma symptom scores were markedly different and occurred quicker than the changes in nasal symptom scores in Chinese house dust mite allergic patients.
Heading date (HD) and flowering date (FD) are critical for yield potential and stability, so understanding their genetic foundation is of great significance in wheat breeding. Three related recombinant inbred line populations with a common female parent were developed to identify quantitative trait loci (QTL) for HD and FD in four environments. In total, 25 putative additive QTL and 20 pairwise epistatic effect QTL were detected in four environments. The additive QTL were distributed across 17 wheat chromosomes. Of these, QHd-1A, QHd-1D, QHd-2B, QHd-3B, QHd-4A, QHd-4B and QHd-6D were major and stable QTL for HD. QFd-1A, QFd-2B, QFd-4A and QFd-4B were major and stable QTL for FD. In addition, an epistatic interaction test showed that epistasis played important roles in controlling wheat HD and FD. Genetic relationships between HD/FD and five yield-related traits (YRTs) were characterized and ten QTL clusters (C1–C10) simultaneously controlling YRTs and HD/FD were identified. The present work laid a genetic foundation for improving yield potential in wheat molecular breeding programmes.
Although application of organic fertilizers has become a recommended way for developing sustainable agriculture, it is still unclear whether above-ground and below-ground crops have similar responses to chemical fertilizers (CF) and organic manure (OM) under the same farming conditions. The current study investigated soil quality and crop yield response to fertilization of a double-cropping system with rapeseed (above-ground) and sweet potato (below-ground) in an infertile red soil for 2 years (2014–16). Three fertilizer treatments were compared, including CF, OM and organic manure plus chemical fertilizer (MCF). Organic fertilizers (OM and MCF) increased the yield of both above- and below-ground crops and improved soil biochemical properties significantly. The current study also found that soil-chemical properties were the most important and direct factors in increasing crop yields. Also, crop yield was affected indirectly by soil-biological properties, because no significant effects of soil-biological activities on yield were detected after controlling the positive effects of soil-chemical properties. Since organic fertilizers could not only increase crop yield, but also improve soil nutrients and microbial activities efficiently and continuously, OM application is a reliable agricultural practice for both above- and below-ground crops in the red soils of China.
Major depression is a complex disorder with no single, direct causal mechanism. Morbidity has been linked to genetic processes, developmental history, and unique environmental exposures. Epigenetic mechanisms, especially DNA methylation, are also likely important factors in the pathogenesis of major depressive disorder (MDD). A community-based twin sample has many advantages for epigenetic studies, given the shared genetic and developmental histories of same-sex twin pairs. This article describes the rationale and study design for the Mood and Methylation Study in which 133 twin pairs (101 monozygotic and 32 dizygotic), both discordant and concordant for lifetime history of MDD, were evaluated on a large number of variables related to MDD. The twins also provided blood samples for an epigenome-wide association study of differentially methylated regions (DMR) relevant to MDD. Although MDD is typically considered a disorder of the central nervous system, it is unfeasible to obtain a large sample of brain tissues. However, epigenetic variation is not limited to the affected tissue but can also be detected in peripheral blood leukocytes. Thus, this study focused on monocytes for the major analyses. Additional plans for the study include gene expression analysis from the same set of twins using RNA-seq and validation of significant DMRs in postmortem brain tissues from a separate sample. Moreover, sufficient samples have been collected to perform future ‘multi-omic’ analyses, including metabolome, microbiome, and transcriptome. Our long-term goal is to understand how epigenomic and other ‘omic’ factors can be manipulated for diagnostic, preventive, and therapeutic purposes for MDD and its related conditions.
Precious metals represent some of the least abundant elements in the earth’s crust. There is an urgent need to maximize the utilization efficiency of these metals and thereby attain affordable and sustainable products. One approach for achieving this goal is based on the development of hollow nanocrystals with a well-controlled surface structure, together with a wall thickness kept below 2 nm, or roughly 10 layers of atoms. The hollow structure eliminates the waste of interior atoms and creates an inner surface, while the controllable surface structures contribute to the optimization of catalytic activity and selectivity. In this article, we begin with a brief introduction to two methods that have been developed for the synthesis of hollow nanocrystals: the first relying on the galvanic replacement with a sacrificial template, and the second involving layer-by-layer deposition of metal atoms followed by etching. We then showcase some remarkable properties and applications of this novel class of nanostructures, including their use as effective catalysts for energy conversion, photoresponsive carriers for controlled release and drug delivery, and theranostic agents. A discussion of the existing barriers to their commercialization is also presented.