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To determine the effect of an electronic medical record (EMR) nudge at reducing total and inappropriate orders testing for hospital-onset Clostridioides difficile infection (HO-CDI).
An interrupted time series analysis of HO-CDI orders 2 years before and 2 years after the implementation of an EMR intervention designed to reduce inappropriate HO-CDI testing. Orders for C. difficile testing were considered inappropriate if the patient had received a laxative or stool softener in the previous 24 hours.
Four hospitals in an academic healthcare network.
All patients with a C. difficile order after hospital day 3.
Orders for C. difficile testing in patients administered a laxative or stool softener in <24 hours triggered an EMR alert defaulting to cancellation of the order (“nudge”).
Of the 17,694 HO-CDI orders, 7% were inappropriate (8% prentervention vs 6% postintervention; P < .001). Monthly HO-CDI orders decreased by 21% postintervention (level-change rate ratio [RR], 0.79; 95% confidence interval [CI], 0.73–0.86), and the rate continued to decrease (postintervention trend change RR, 0.99; 95% CI, 0.98–1.00). The intervention was not associated with a level change in inappropriate HO-CDI orders (RR, 0.80; 95% CI, 0.61–1.05), but the postintervention inappropriate order rate decreased over time (RR, 0.95; 95% CI, 0.93–0.97).
An EMR nudge to minimize inappropriate ordering for C. difficile was effective at reducing HO-CDI orders, and likely contributed to decreasing the inappropriate HO-CDI order rate after the intervention.
Activity of brown and beige adipocytes could contribute to breed differences in fat deposition. Therefore, we compared the abundance of markers for adipocyte types in steers from three cattle breeds differing in fat deposition (Japanese Black, Holstein, Charolais). Markers for white (leptin (LEP)), beige (transmembrane protein 26 (TMEM26), uncoupling protein 1 (UCP1)), and brown adipocytes (Zic family member 1 (ZIC1), UCP1) were analysed by quantitative reverse transcription PCR in subcutaneous fat (SCF), intramuscular fat (IMF), intermuscular fat (IRMF), perirenal fat (PF) and visceral fat (VF). LEP messenger RNA (mRNA) was less abundant in VF compared with other depots (P<0.05). TMEM26 was weakly but evenly expressed in all depots in all animals, whereas UCP1 mRNA showed higher individual variation in some depots. ZIC1 was not detectable in VF and PF but abundant in SCF, IMF and even more abundant in IRMF (P<0.05). No significant breed differences were detected. Using antibodies against UCP1, TMEM26 and ZIC1, we demonstrated that fat depots of 26-month-old cattle still comprise different adipocyte types. However, our results did not support the hypothesis that higher energy expenditure associated with higher abundance or activity of beige or brown adipocytes contributed to differences in fat deposition.
Direct numerical simulations of flows in cylinders subjected to both rapid rotation and axial precession are presented and analysed in the context of a stability theory based on the triadic resonance of Kelvin modes. For a case that was chosen to provide a finely tuned resonant instability with a small nutation angle, the simulations are in good agreement with the theory and previous experiments in terms of mode shapes and dynamics, including long-time-scale regularization of the flow and recurrent collapses. Cases not tuned to the most unstable triad, but with the nutation angle still small, are also in quite good agreement with theoretical predictions, showing that the presence of viscosity makes the physics of the triadic-resonance model robust to detuning. Finally, for a case with
nutation angle for which it has been suggested that resonance does not occur, the simulations show that a slowly growing triadic resonance predicted by theory is in fact observed if sufficient evolution time is allowed.
In order to understand enhanced mechanical properties of magnesium-yttrium (Mg-Y) alloys, applied stresses which were required to operate independent plastic deformation mechanisms on various stress axes were evaluated. Moreover, for this analysis, mechanical tests including newly-established testing method “pure-shear test” were conducted to evaluate Critical Resolved Shear Stresses (CRSSes) for various plastic deformation mechanisms of Mg-Y solid solution alloy single crystals with various Y concentration. Relatively higher solid solution strengthening of dominant plastic deformation mechanisms such as basal slip and extension twin at room temperature, results in increase in the activation of non-basal slip system. By a simple analysis based on von-Mises criterion with experimental CRSS values, it is revealed that enhanced mechanical properties of Mg-Y alloys might be attributed to the decrease of difference in the activity of plastic deformation mechanisms by Y addition.
The purpose of this study was to identify the clinical outcomes of ambulatory-treated Clostridium difficile infection (CDI) and risk factors associated with community-associated CDI (CA-CDI). Adult patients diagnosed with CDI in the institutional or ambulatory-care setting between 1 April 2005 and 30 April 2011, with no other CDI diagnosis in the previous 180 days, and who purchased an ambulatory, anti-CDI agent within 7 days of CDI diagnosis were included. A total of 1201 patients were included with 914 (76%) and 287 (24%) identified with CA-CDI and nosocomial CDI (N-CDI), respectively. Patients with N-CDI were more likely to have had a recurrent CDI (P = 0·043) and died from any cause (P < 0·001). Patients with CA-CDI were younger, healthier, and had fewer traditional risk factors compared to patients with N-CDI. To prevent CA-CDI, clinicians should be aware that patients at risk for CA-CDI are unique from those at risk for N-CDI.
Making confident statements about the evolution of an ice-sheet–shelf system with a numerical model requires the capability to reproduce the migration of the grounding line. Here we show that the shallow-ice approximation/shallow-shelf approximation hybrid-type Parallel Ice Sheet Model (PISM), with its recent improvements, is capable of modeling the grounding line motion in a perturbed ice-sheet–shelf system. The model is set up according to the three-dimensional Marine Ice-Sheet Model Intercomparison Project (MISMIP3d), and simulations are carried out across a broad range of spatial resolutions. Using (1) a linear interpolation of the grounding line with locally interpolated basal friction and (2) an improved driving-stress computation across the grounding line, the reversibility of the grounding line (i.e. its retreat after an advance forced by a local perturbation of basal resistance) is captured by the model even at medium and low resolutions (∆x > 10 km). The transient model response is qualitatively similar to that of higher-order models but reveals a higher initial sensitivity to perturbations on very short timescales. Our findings support the application of PISM to the Antarctic ice sheet from regional up to continental scales and on relatively low spatial resolutions.
Patients with attention deficit-hyperactivity disorder (ADHD) exhibit difficulties in multiple attentional functions. Although high heritability rates suggest a strong genetic impact, aetiological pathways from genes and environmental factors to the ADHD phenotype are not well understood. Tracking the time course of deviant task processing using event-related electrophysiological brain activity should characterize the impact of familiality on the sequence of cognitive functions from preparation to response control in ADHD.
Preparation and response control were assessed using behavioural and electrophysiological parameters of two versions of a cued continuous performance test with varying attentional load in boys with ADHD combined type (n = 97), their non-affected siblings (n = 27) and control children without a family history of ADHD (n = 43).
Children with ADHD and non-affected siblings showed more variable performance and made more omission errors than controls. The preparatory Cue-P3 and contingent negative variation (CNV) following cues were reduced in both ADHD children and their non-affected siblings compared with controls. The NoGo-P3 was diminished in ADHD compared with controls whilst non-affected siblings were located intermediate but did not differ from both other groups. No clear familiality effects were found for the Go-P3. Better task performance was further associated with higher CNV and P3 amplitudes.
Impairments in performance and electrophysiological parameters reflecting preparatory processes and to some extend also for inhibitory response control, especially under high attentional load, appeared to be familially driven in ADHD and may thus constitute functionally relevant endophenotypes for the disorder.
National and international policies have encouraged the establishment of a representative network of marine protected areas (MPAs) in South Africa, with the aim of protecting marine biodiversity. The extent to which these marine and estuarine protected areas (EPAs) represent marine fish species and communities was assessed by comparing their species compositions with those of exploited areas, as sampled using four fishing techniques. Seven hundred fish species were sampled, representing one-third of South Africa's marine fishes. MPAs in coastal habitats scored c. 40% on the Bray-Curtis measure of similarity for species representativeness, but this score declined markedly for offshore ‘trawlable’ fishing grounds. The combined effects of sampling error, temporal variation and the effects of fishing on relative abundance suggest that 80% similarity would be the maximum achieveable. Forty-nine per cent of all fish species that were recorded were found in the 14 MPAs sampled. Redundancy in the MPA network was low, with fish species most commonly being represented in only one MPA or absent. There was greater redundancy in the 33 EPAs, with 40% of species being found in two or more EPAs, but many of these estuaries were adjacent to each other and embedded in large MPAs. Deep water fish communities (>80 m deep) and communities located on the west and south-east coasts of South Africa were most poorly represented by MPAs. Routine fishery surveys provide a robust and repeatable opportunity to assess species representativeness in MPAs, and the method used could form the basis of an operational definition of ‘representative’. In contrast to an assessment based on presence-absence data, this analysis of quantitative data presents a more pessimistic assessment of protection.
This paper describes a semi-automated conductive ink process used for packaging MEMS devices. The method is applied to packaging of MEMS sensors for wind tunnel testing. The primary advantage of the method is a reduction in surface topology between the package and the integrated MEMS sensors. In this paper we explore the relationship between trace dimensions, resistivity, and deposition parameters such as feed rate, tip-substrate separation and tip diameter. Using this procedure it is possible to generate interconnects between a PC board and MEMS sensor chip with a topology of less than 25 micrometers.
Our previous studies proved the occurrence of the shape memory effect (SME) in a biocompatible porous nitinol (inter-metallic phase NiTi), obtained by the selective laser sintering (SLS) method. In this report we propose to use the SME peculiar to the nitinol, for a functional design of the drug delivery system and to discuss the process flow pattern. In living tissues (flesh) the elevated temperature at the disease origination leads to the nitinol pores size reduction caused by the austenite phase transformation, and to the pharmaceutical composition extrusion from the pores. And vice versa, during the cooling stage when the tissue temperature reverts to normal level, the drug intake will stop. Depending on the type of the three dimensional structure of a porous matrix (scaffold) identified at the stage of a computer-aid-design, the velocity of penetration can be controllable.
Biofilms are a common cause of persistent infections on medical devices as they are easy to form and hard to treat. Selenium and its compounds are considered to be a novel material for a wide range of applications including anticancer applications and antibacterial applications. The objective of this study was to coat selenium nanoparticles on the surface of polycarbonate medical devices and examine their effectiveness at preventing biofilm formation. The results of this in vitro study showed that the selenium coating significantly inhibited Staphylococcus aureus growth on the surface of polycarbonate after 24 hours. Thus, this study suggests that coating polymers with nanostructured selenium is a fast and effective way to reduce bacteria functions leading to medical device infections.
The electrochemiluminescence (ECL) and surface plasmon resonance (SPR) based immunosensors for measuring a trace level of disease markers are shown. It is well known that thiols form a self-assembled monolayer on a metal surface, and this has been widely used to modify metal surfaces. We employed this characteristic for a highly sensitive immunosensors by obtaining a surface pre-concentration of thiol molecules formed by the enzymatic reaction of labeled antibody.
Gallium nitride (GaN) is a robust piezoelectric semiconductor with excellent thermal and chemical stability, making it an attractive material for surface acoustic wave (SAW) sensors operating in high temperature and harsh environments. The sensitivity of SAW devices is proportional to the square of the operating frequency. Therefore, high operating frequencies into the GHz regime are desirable for SAW sensors. For GaN, this requires sub-micron interdigital transducers (IDTs) when devices are designed to operate at the fundamental Rayleigh mode frequency. The necessity for sub-micron IDTs can increase fabrication costs and complexity. By designing SAW devices to operate at harmonic frequencies, GHz operation can be realized with relatively large IDTs, resulting in simpler and more cost effective solutions for GaN based SAW sensors. Devices have previously been designed to operate at the 5th and higher harmonics on lithium niobate, but there are no reports of using this technique on GaN in the literature. In this study, GaN thin films have been grown via metal organic vapor phase epitaxy on sapphire substrates. SAW devices designed to operate at the fundamental frequency and higher harmonics have been fabricated and measured. Operating frequencies greater than 2 GHz have been achieved using IDTs with 5 μm fingers. In addition, reduction of electromagnetic feedthrough around the 5th and 7th harmonic is demonstrated through varying ground electrode geometries.
Capacitive CMOS MEMS sensors are usually defined by anisotropic dry etching processes (RIE and DRIE). These processes can provide clean and vertical sidewall geometry. However, during the dry-etching processes, charges are added to the gate electrodes of the on-chip MOSFET’s through metal pads and micro-structures, and the voltage may be raised to the level of breaking down the gate oxide, which leads to large leakage current and fails the circuit. On another hand, the thin spring beams in capacitive CMOS MEMS accelerometers suffer from in-plane curling and out-of-plane curling caused by stress gradient. Furthermore, the stress in the layers of MEMS structure is a function of temperature. Therefore, the in-plane curling and out-of-plane curling vary with temperature, leading to varying electrode coupling area in the sensing beams. This in turn causes variation in the sensitivity and the DC offset of sensors, meaning that usually the thermal stability of CMOS MEMS capacitive accelerometers is very poor. To cope with these problems, this work develops a new wafer-level post-CMOS process for fabricating thermally stable capacitive accelerometers. The resultant MEMS structures have high aspect ratio (e.g. 2-2.5 μm gaps versus 57 μm depth) and are insensitive to residual stress as well as temperature change. Excellent thermal stability was achieved intrinsically by making the crystalline Si layer in the sensors thick. Moreover, this process totally avoids the charge damage problem during the dry-etching procedure. For demonstration, an accelerometer sensor was fabricated by using the proposed process and was integrated with an on-chip sensing circuit in commercial 0.35 μm 2P4M CMOS process. High detection sensitivity of 595 mV/g and very low thermal variation of 1.68 mg/°C were successfully achieved.
A unique simulation method of epoxy-based chemically-amplified resist by coarse-grained molecular dynamics was proposed. The mechanical properties of an epoxy-based chemically-amplified resists with various cross-linking ratios were simulated using a newly developed coarse-grained molecular dynamics simulation that employs a bead-spring model. Models with the different cross-linking ratios were created in the molecular dynamics calculation step and uniaxial elongation simulations were performed. The results reveal that the simulated elastic modulus of the resist modeled by the bead-spring model with an extended angle bending potential depends on the cross-linking ratio; its dependency exhibits good agreement with that determined by nanoindentation tests.
We have investigated the criterion of interfacial crack initiation in nanometer-scale components (nano-components) by means of a loading facility built in a transmission electron microscope (TEM). Three types of experiments are conducted in this project. (1) In order to clarify the applicability of conventional continuum mechanics to the nano-components, we prepare cantilever specimens with different size, which introduce different stress fields, containing an interface between a 20 nm-thick copper (Cu) thin film and a silicon (Si) substrate. These demonstrate the validity of the “stress” criterion even for the nano-scale fracture. (2) In order to examine the effect of microscopic structure on the mechanical property, we fabricate a bending specimen in the nano-scale with thin Cu bi-crystal (the thickness of about 100 nm) formed on Si substrate, of which understructure can be observed in situ by means of a TEM during the mechanical experiment. The initial plastic deformation takes place near the interface edge in a grain with a high critical resolved shear stress and expands preferentially in the grain. Then, the plasticity appears near the between Cu grain boundary and Cu/Si interface, and this development brings about the interfacial cracking from the junction. These indicate the governing influence of understructure on the mechanical property in the nano-components. (3) In order to investigate the fatigue behavior of metal in a nano-component, a cyclic bending experiment is carried out using nano-cantilever specimens with a 20 nm-thick Cu constrained by highly rigid materials (Si and SiN). The high strain region is in the size of 20-40 nm near the interface edge. The specimen breaks along the Cu/Si interface before the maximum load under the fatigue loading. The load-displacement curve shows nonlinear behavior and a distinct hysteresis loop, indicating plasticity in the Cu film. Reverse yielding appearing after the 2nd cycle suggests the development of a cyclic substructure in the Cu film. These indicate that the crack is caused by characteristic understructure owing to fatigue cycles.
We are developing a new non-contact and non-destructive imaging technique which requires no sample preparation and provides similar content information as FTIR or Raman spectroscopy while being immune to fluorescence and offers a potentially faster scan rate and/or higher spatial resolution. It utilizes photo-thermal heating of the sample with a quantum cascade laser (or other suitable infrared laser) and measuring the resulting increase in thermal emissions by either an infrared (IR) detector or a laser probe consisting of a visible laser reflected from the sample. The latter case allows for further increases in the spatial resolution from ∼10 μm to ∼1 μm or better, with suitable experimental conditions. Since the thermal emission signal is proportional to the absorption coefficient, by tuning the wavelength of the IR laser we can directly measure the IR spectrum of the sample. By raster scanning over the surface of the sample we can obtain maps of the chemical composition of the sample surface. We demonstrate this technique by imaging the surface of a micro-fabricated flow-through chemical vapor preconcentrator consisting of a silicon frame and a suspended-perforated polyimide membrane with a pair of platinum heater traces, coated with a custom sorbent polymer for selective sorption of analyte. We measure the spatial resolution of our photo-thermal imaging system as well as discuss the conditions under which the spatial resolution can be further increased from the far-field diffraction limited resolution given by the combination of the imaging optic and IR excitation laser wavelength.