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To assess the safety of, and subsequent allergy documentation associated with, an antimicrobial stewardship intervention consisting of test-dose challenge procedures prompted by an electronic guideline for hospitalized patients with reported β-lactam allergies.
Retrospective cohort study.
Large healthcare system consisting of 2 academic and 3 community acute-care hospitals between April 2016 and December 2017.
We evaluated β-lactam antibiotic test-dose outcomes, including adverse drug reactions (ADRs), hypersensitivity reactions (HSRs), and electronic health record (EHR) allergy record updates. HSR predictors were examined using a multivariable logistic regression model. Modification of the EHR allergy record after test doses considered relevant allergy entries added, deleted, and/or specified.
We identified 1,046 test-doses: 809 (77%) to cephalosporins, 148 (14%) to penicillins, and 89 (9%) to carbapenems. Overall, 78 patients (7.5%; 95% confidence interval [CI], 5.9%–9.2%) had signs or symptoms of an ADR, and 40 (3.8%; 95% CI, 2.8%–5.2%) had confirmed HSRs. Most HSRs occurred at the second (ie, full-dose) step (68%) and required no treatment beyond drug discontinuation (58%); 3 HSR patients were treated with intramuscular epinephrine. Reported cephalosporin allergy history was associated with an increased odds of HSR (odds ratio [OR], 2.96; 95% CI, 1.34–6.58). Allergies were updated for 474 patients (45%), with records specified (82%), deleted (16%), and added (8%).
This antimicrobial stewardship intervention using β-lactam test-dose procedures was safe. Overall, 3.8% of patients with β-lactam allergy histories had an HSR; cephalosporin allergy histories conferred a 3-fold increased risk. Encouraging EHR documentation might improve this safe, effective, and practical acute-care antibiotic stewardship tool.
In the recent years, the development of wind turbines has been so hectic in Taiwan. The design of the turbine blades directly impacts power effectiveness. In this study, the effects of manufacturing parameters and environmental factors on the mechanical properties of carbon fiber/epoxy composites that are used in turbine blades are discussed. Parameters of the manufacturing process affect the mechanical properties. Carbon composites made by a different numbers of layers are tested on various aspects of performance such as mechanical strength and corrosion resistance.
We report the utility of whole-genome sequencing (WGS) conducted in a clinically relevant time frame (ie, sufficient for guiding management decision), in managing a Streptococcus pyogenes outbreak, and present a comparison of its performance with emm typing.
A 2,000-bed tertiary-care psychiatric hospital.
Active surveillance was conducted to identify new cases of S. pyogenes. WGS guided targeted epidemiological investigations, and infection control measures were implemented. Single-nucleotide polymorphism (SNP)–based genome phylogeny, emm typing, and multilocus sequence typing (MLST) were performed. We compared the ability of WGS and emm typing to correctly identify person-to-person transmission and to guide the management of the outbreak.
The study included 204 patients and 152 staff. We identified 35 patients and 2 staff members with S. pyogenes. WGS revealed polyclonal S. pyogenes infections with 3 genetically distinct phylogenetic clusters (C1–C3). Cluster C1 isolates were all emm type 4, sequence type 915 and had pairwise SNP differences of 0–5, which suggested recent person-to-person transmissions. Epidemiological investigation revealed that cluster C1 was mediated by dermal colonization and transmission of S. pyogenes in a male residential ward. Clusters C2 and C3 were genomically diverse, with pairwise SNP differences of 21–45 and 26–58, and emm 11 and mostly emm120, respectively. Clusters C2 and C3, which may have been considered person-to-person transmissions by emm typing, were shown by WGS to be unlikely by integrating pairwise SNP differences with epidemiology.
WGS had higher resolution than emm typing in identifying clusters with recent and ongoing person-to-person transmissions, which allowed implementation of targeted intervention to control the outbreak.
A few studies have evaluated the impact of clinical trial results on practice in paediatric cardiology. The Infant Single Ventricle (ISV) Trial results published in 2010 did not support routine use of the angiotensin-converting enzyme inhibitor enalapril in infants with single-ventricle physiology. We sought to assess the influence of these findings on clinical practice.
A web-based survey was distributed via e-mail to over 2000 paediatric cardiologists, intensivists, cardiothoracic surgeons, and cardiac advance practice nurses during three distribution periods. The results were analysed using McNemar’s test for paired data and Fisher’s exact test.
The response rate was 31.5% (69% cardiologists and 65% with >10 years of experience). Among respondents familiar with trial results, 74% reported current practice consistent with trial findings versus 48% before trial publication (p<0.001); 19% used angiotensin-converting enzyme inhibitor in this population “almost always” versus 36% in the past (p<0.001), and 72% reported a change in management or improved confidence in treatment decisions involving this therapy based on the trial results. Respondents familiar with trial results (78%) were marginally more likely to practise consistent with the trial results than those unfamiliar (74 versus 67%, p=0.16). Among all respondents, 28% reported less frequent use of angiotensin-converting enzyme inhibitor over the last 3 years.
Within 5 years of publication, the majority of respondents was familiar with the Infant Single Ventricle Trial results and reported less frequent use of angiotensin-converting enzyme inhibitor in single-ventricle infants; however, 28% reported not adjusting their clinical decisions based on the trial’s findings.
Researchers have studied psychological disorders extensively from a common cause perspective, in which symptoms are treated as independent indicators of an underlying disease. In contrast, the causal systems perspective seeks to understand the importance of individual symptoms and symptom-to-symptom relationships. In the current study, we used network analysis to examine the relationships between and among depression and anxiety symptoms from the causal systems perspective.
We utilized data from a large psychiatric sample at admission and discharge from a partial hospital program (N = 1029, mean treatment duration = 8 days). We investigated features of the depression/anxiety network including topology, network centrality, stability of the network at admission and discharge, as well as change in the network over the course of treatment.
Individual symptoms of depression and anxiety were more related to other symptoms within each disorder than to symptoms between disorders. Sad mood and worry were among the most central symptoms in the network. The network structure was stable both at admission and between admission and discharge, although the overall strength of symptom relationships increased as symptom severity decreased over the course of treatment.
Examining depression and anxiety symptoms as dynamic systems may provide novel insights into the maintenance of these mental health problems.
Ontario has the highest proportion of for-profit nursing homes in Canada. These facilities, which are known in Ontario as long-term care (LTC) homes, offer 24-hour custodial as well as nursing care to individuals who cannot live independently. Increasingly, they are also operating as members of multi-facility chains. Using longitudinal data (1996–2011) from the Residential Care Facilities Survey (n = 627), our analysis revealed discernible differences in staffing levels by profit status and chain affiliation. We found for-profit LTC homes – especially those owned by a chain organization – provided significantly fewer hours of care, after adjusting for variation in the residents’ care needs. Findings from this study offer new information on the impact of organizational structure on staffing levels in Ontario’s LTC homes and have implications for other jurisdictions where a growing presence of private, chain-affiliated operators has been observed.
With good combustion characteristics, hydrogen has been developing as a clean alternative fuel of engines. This study is to develop a diesel/hydrogen dual fuel engine. The hydrogen was added at inlet port in a 4-cylinder direct injection turbocharged diesel engine with an EGR (Exhaust Gas Recirculation) system to investigate engine performance and exhaust pollutant. The measured items are composed of the gas pressure of cylinder, crank angle, consumption rate of diesel, consumption rate of hydrogen, air flow rate, emissions (HC, CO2, NOX, and Smoke), and so on. The authors analyze how the addition of hydrogen with EGR system influences the engine performance and emissions. The diesel/hydrogen dual fuel turbocharged engine can increase the brake thermal efficiency with a greater decrease in emissions compared with the turbocharged diesel engine. Furthermore, the authors little altered the engine structure to get the positive effect of energy saving and pollutant decreasing.
Tornadoes are one type of violent flow phenomenon and occur in many places in the world. There are many research methods that aim to reduce the loss of human lives and material damage caused by tornadoes. One effective method is numerical simulation such as that in Ishihara et al. (J. Wind Engng Ind. Aerodyn., vol. 99, 2011, pp. 239–248). The swirling structure of the Navier–Stokes flow is significant for both the mathematical analysis and numerical simulations of tornadoes. In this paper, we try to clarify the swirling structure. More precisely, we performed numerical computations on axisymmetric Navier–Stokes flows with a no-slip flat boundary. We compared a hyperbolic flow with swirl and one without swirl, and observed that the following phenomenon occurs only in the swirl case: the distance between the point with the maximum magnitude of velocity
-axis changed drastically at a specific time (which we call the turning point). Besides, an ‘increasing velocity phenomenon’ occurred near the boundary, and the maximum value of
was obtained near the axis of symmetry and the boundary when the time was close to the turning point in the swirl case.
Taiwan is a young and seismically active mountain belt, where a series of strong earthquakes (M>7) have occurred over the past hundred years. Identifying historical earthquakes around Taiwan is a key to better constrain the geodynamic of this active region. Sedimentological and geochemical analyses of surface sediments from one station offshore east Taiwan revealed the presence of coarse-grained layers interpreted as turbidites. The age of these layers have been determined by 210Pb, 137Cs, and 241Am chronology. Dating of the three most recent turbidites provides ages of AD 2001±3, AD 1950±5, and AD 1928±10. The results show striking temporal correspondence of turbidite layers to large (M≥6.8) earthquakes recorded in the region since the 20th century. The chronologies of sediment layers lead us to believe that turbidites resulted from the 2003 Taitung earthquake (M 6.8), the 1951 Chengkong earthquake (M 7.1), and the 1935 Lutao earthquake (M 7.0), respectively. Such a good correlation between turbidites and high-magnitude (M≥6.8) historical and instrumental seismic events suggests that turbidite paleoseismology constitutes a valuable tool for earthquake assessment in the eastern Taiwan margin. Moreover, the modern reservoir radiocarbon age and the regional marine reservoir correction (ΔR) of the Kuroshio Current off Taiwan were estimated by comparing accelerator mass spectrometry (AMS) 14C ages with ages derived from corrected 210Pb profiles and historical accounts of identifiable seismic events. Such a determination is important to calibrate the 14C ages of marine materials for accurate comparison of marine and continental geological records. Our calculated mean ΔR value of 232±54 14C yr (n=2) is higher than its modern value of 86±40 14C yr. This high value can be explained by the presence of local upwelling cells and turbulence in the Kuroshio Current, north of Green Island. These upwelling cells bring 14C-depleted water to the surface, resulting in an increase of the modern ΔR value in this portion of the Kuroshio Current.
Recent meta-analyses of resting-state networks in major depressive disorder (MDD) implicate network disruptions underlying cognitive and affective features of illness. Heterogeneity of findings to date may stem from the relative lack of data parsing clinical features of MDD such as phase of illness and the burden of multiple episodes.
Resting-state functional magnetic resonance imaging data were collected from 17 active MDD and 34 remitted MDD patients, and 26 healthy controls (HCs) across two sites. Participants were medication-free and further subdivided into those with single v. multiple episodes to examine disease burden. Seed-based connectivity using the posterior cingulate cortex (PCC) seed to probe the default mode network as well as the amygdala and subgenual anterior cingulate cortex (sgACC) seeds to probe the salience network (SN) were conducted.
Young adults with remitted MDD demonstrated hyperconnectivity of the left PCC to the left inferior frontal gyrus and of the left sgACC to the right ventromedial prefrontal cortex (PFC) and left hippocampus compared with HCs. Episode-independent effects were observed between the left PCC and the right dorsolateral PFC, as well as between the left amygdala and right insula and caudate, whereas the burden of multiple episodes was associated with hypoconnectivity of the left PCC to multiple cognitive control regions as well as hypoconnectivity of the amygdala to large portions of the SN.
This is the first study of a homogeneous sample of unmedicated young adults with a history of adolescent-onset MDD illustrating brain-based episodic features of illness.
Several previous cross-sectional studies have shown that vegetarians have a better metabolic profile than non-vegetarians, suggesting that a vegetarian dietary pattern may help prevent chronic degenerative diseases. However, longitudinal studies on the impact of vegetarian diets on metabolic traits are scarce. We studied how several sub-types of vegetarian diets affect metabolic traits, including waist circumference, BMI, systolic blood pressure (SBP), diastolic blood pressure, fasting blood glucose, total cholesterol (TC), HDL, LDL, TAG and TC:HDL ratio, through both cross-sectional and longitudinal study designs. The study used the MJ Health Screening database, with data collected from 1994 to 2008 in Taiwan, which included 4415 lacto-ovo-vegetarians, 1855 lacto-vegetarians and 1913 vegans; each vegetarian was matched with five non-vegetarians based on age, sex and study site. In the longitudinal follow-up, each additional year of vegan diet lowered the risk of obesity by 7 % (95 % CI 0·88, 0·99), whereas each additional year of lacto-vegetarian diet lowered the risk of elevated SBP by 8 % (95 % CI 0·85, 0·99) and elevated glucose by 7 % (95 % CI 0·87, 0·99), and each additional year of ovo-lacto-vegetarian diet increased abnormal HDL by 7 % (95 % CI 1·03, 1·12), compared with non-vegetarians. In the cross-sectional comparisons, all sub-types of vegetarians had lower likelihoods of abnormalities compared with non-vegetarians on all metabolic traits (P<0·001 for all comparisons), except for HDL and TAG. The better metabolic profile in vegetarians is partially attributable to lower BMI. With proper management of TAG and HDL, along with caution about the intake of refined carbohydrates and fructose, a plant-based diet may benefit all aspects of the metabolic profile.
The Helicon-Cathode(HelCat) device is a medium-size linear experiment suitable for a wide range of basic plasma science experiments in areas such as electrostatic turbulence and transport, magnetic relaxation, and high power microwave (HPM)-plasma interactions. The HelCat device is based on dual plasma sources located at opposite ends of the 4 m long vacuum chamber – an RF helicon source at one end and a thermionic cathode at the other. Thirteen coils provide an axial magnetic field B ⩾ 0.220 T that can be configured individually to give various magnetic configurations (e.g. solenoid, mirror, cusp). Additional plasma sources, such as a compact coaxial plasma gun, are also utilized in some experiments, and can be located either along the chamber for perpendicular (to the background magnetic field) plasma injection, or at one of the ends for parallel injection. Using the multiple plasma sources, a wide range of plasma parameters can be obtained. Here, the HelCat device is described in detail and some examples of results from previous and ongoing experiments are given. Additionally, examples of planned experiments and device modifications are also discussed.
We have carried out a series of lateral epitaxial overgrowths (LEO) of GaN through thin oxide windows by the hydride vapor phase epitaxy (HVPE) technique at different growth temperatures. High lateral growth rate at 1100°C allows coalescing of neighboring islands into a continuous and flat film, while the lower lateral growth rate at 1050°C produces triangular-shaped ridges over the growth windows. In either case, threading dislocations bend into laterally grown regions to relax the shear stress developed in the film during growth. In regions close to the mask edge, where the shear stress is highest, dislocations interact and multiply into arrays of edge dislocations lying parallel to the growth window. This multiplication and pileup of dislocations cause a large-angle tilting of the laterally grown regions. The tilt angle is high (∼8 degrees) when the growth is at 1050°C and becomes smaller (3-5 degrees) at 1100°C. At the coalescence of growth facets, a tilt-type grain boundary is formed. During the high-temperature lateral growth, the tensile stress in the GaN seed layer and the thermal stress from the mask layer both contribute to a high shear stress at the growth facets. Finite element stress simulations suggest that this shear stress may be sufficient to cause the observed excessive dislocation activities and tilting of LEO regions at high growth temperatures.