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To determine whether combinations of diagnosis and procedures codes can improve the detection of prosthetic hip and knee joint infections from administrative databases.
We performed a validation study of all readmissions from January 1, 2010, until December 31, 2016, following primary arthroplasty comparing the diagnosis and procedure codes obtained from an administrative database based upon the International Classification of Disease, Tenth Revision (ICD-10) to the reference standard of chart review.
Four tertiary-care hospitals in Toronto, Canada, from 2010 to 2016.
Individuals who had a primary arthroplasty were identified using procedure codes.
Chart review of readmissions identified the presence of a prosthetic joint infection and, if present, the surgical procedure performed.
Overall, 27,802 primary arthroplasties were performed. Among 8,844 readmissions over a median follow-up of 669 days (interquartile range, 256–1,249 days), a PJI was responsible for or present in 586 of 8,844 (6.6%). Diagnosis codes alone exhibited a sensitivity of 0.88 (95% CI, 0.85–0.92) and positive predictive value (PPV) of 0.78 (95% CI, 0.74–0.82) for detecting a PJI. Combining a PJI diagnosis code with procedure codes for an arthroplasty and the insertion of a peripherally inserted central catheter improved detection: sensitivity was 0.92 (95% CI, 0.88–0.94) and PPV was 0.78 (95% CI, 0.74–0.82). However, procedure codes were unable to identify the specific surgical approach to PJI treatment.
Compared to PJI diagnosis codes, combinations of diagnosis and procedure codes improve the detection of a PJI in administrative databases.
A female patient with multiple sclerosis (MS) suffered from an acute psychotic disorder after taking distigmine bromide for detrusor dysfunction. She showed a dramatic relief of her symptoms after the medication, distigmine bromide, was stopped. Distigmine is not supposed to penetrate the blood-brain barrier (BBB). However, in MS patients a leakage of the BBB could be hypothesized.
Simultaneous PET/MR/EEG (Positron Emission Tomography – Magnetic Resonance – Electroencephalography), a new tool for the investigation of neuronal networks in the human brain, is presented here within the framework of the European Union Project TRIMAGE. The trimodal, cost-effective PET/MR/EEG imaging tool makes use of cutting edge technology both in PET and in MR fields. A novel type of magnet (1.5T, non-cryogenic) has been built together with a PET scanner that makes use of the most advanced photodetectors (i.e., SiPM matrices), scintillators matrices (LYSO) and digital electronics. The combined PET/MR/EEG system is dedicated to brain imaging and has an inner diameter of 260 mm and an axial Field-of-View of 160 mm.
It enables the acquisition and assessment of molecular metabolic information with high spatial and temporal resolution in a given brain simultaneously. The dopaminergic system and the glutamatergic system in schizophrenic patients are investigated via PET, the same physiological/pathophysiological conditions with regard to functional connectivity, via fMRI, and its electrophysiological signature via EEG. In addition to basic neuroscience questions addressing neurovascular-metabolic coupling, this new methodology lays the foundation for individual physiological and pathological fingerprints for a wide research field addressing healthy aging, gender effects, plasticity and different psychiatric and neurological diseases.
The preliminary performances of two components of the imaging tool (PET and MR) are discussed. Initial results of the search of possible candidates for suitable schizophrenia biomarkers are also presented as obtained with PET/MR systems available to the collaboration.
Weed invasion is a prevailing problem in modestly managed lawns. Less attention has been given to the exploration of the role of arbuscular mycorrhizal fungi (AMF) under different invasion pressures from lawn weeds. We conducted a four-season investigation into a Zoysia tenuifolia Willd. ex Thiele (native turfgrass)–threeflower beggarweed [Desmodium triflorum (L.) DC.] (invasive weed) co-occurring lawn. The root mycorrhizal colonizations of the two plants, the soil AM fungal communities and the spore densities under five different coverage levels of D. triflorum were investigated. Desmodium triflorum showed significantly higher root hyphal and vesicular colonizations than those of Z. tenuifolia, while the root colonizations of both species varied significantly among seasons. The increased coverage of D. triflorum resulted in the following effects: (1) the spore density initially correlated with mycorrhizal colonizations of Z. tenuifolia but gradually correlated with those of D. triflorum. (2) Correlations among soil properties, spore densities, and mycorrhizal colonizations were more pronounced in the higher coverage levels. (3) Soil AMF community compositions and relative abundances of AMF operational taxonomic units changed markedly in response to the increased invasion pressure. The results provide strong evidence that D. triflorum possessed a more intense AMF infection than Z. tenuifolia, thus giving rise to the altered host contributions to sporulation, soil AMF communities, relations of soil properties, spore densities, and root colonizations of the two plants, all of which are pivotal for the successful invasion of D. triflorum in lawns.
Whether the latitudinal distribution of climate-sensitive lithologies is stable through greenhouse and icehouse regimes remains unclear. Previous studies suggest that the palaeolatitudinal distribution of palaeoclimate indicators, including coals, evaporites, reefs and carbonates, has remained broadly similar since the Permian period, leading to the conclusion that atmospheric and oceanic circulation control their distribution rather than the latitudinal temperature gradient. Here we revisit a global-scale compilation of lithologic indicators of climate, including coals, evaporites and glacial deposits, back to the Devonian period. We test the sensitivity of their latitudinal distributions to the uneven distribution of continental areas through time and to global tectonic models, correct the latitudinal distributions of lithologies for sampling- and continental area-bias, and use statistical methods to fit these distributions with probability density functions and estimate their high-density latitudinal ranges with 50% and 95% confidence intervals. The results suggest that the palaeolatitudinal distributions of lithologies have changed through deep geological time, notably a pronounced poleward shift in the distribution of coals at the beginning of the Permian. The distribution of evaporites indicates a clearly bimodal distribution over the past ~400 Ma, except for Early Devonian, Early Carboniferous, the earliest Permian and Middle and Late Jurassic times. We discuss how the patterns indicated by these lithologies change through time in response to plate motion, orography, evolution and greenhouse/icehouse conditions. This study highlights that combining tectonic reconstructions with a comprehensive lithologic database and novel data analysis approaches provide insights into the nature and causes of shifting climatic zones through deep time.
Elastic strain is an effective and thus widely used parameter to control and modify the electrical, optical, and magnetic properties of crystalline solid-state materials. It has a large impact on device performance and enables adjusting the materials functionality. Here, we promote a micromechanical strain enhancement technology to achieve ultra-high strain in semiconductors. The here presented suspended membranes enable the accurate control of the strain on a wafer-scale by standard top-down fabrication methods making it attractive for both device applications and also, thanks to the simplicity of the method, for fundamental research. This review aims at discussing the process of strain enhancement and its usage as an investigation platform for strain-related physical properties. Furthermore, we present design rules and a detailed analysis of fracture effects limiting the strain enhancement.
Between 2010 and 2012, 3 outbreaks of nosocomial infections in German neonatal intensive care units (NICUs) attracted considerable public interest. Headlines on national television channels and in newspapers had important consequences for the involved institutions and a negative impact on the relationship between families and staff in many German NICUs.
To determine whether NICU outbreaks reported in the media influenced provider behavior in the community of neonatal care and led to more third-line antibiotic prescribing.
Observational cohort study.
To investigate secular trends, we evaluated data for very-low-birth-weight infants (VLBWIs, birth weight <1,500 g) enrolled in the German Neonatal Network (GNN) between 2009 and 2014 (N=10,253). For outbreak effects, we specifically analyzed data for VLBWIs discharged 6 months before (n=2,428) and 6 months after outbreaks (n=2,508).
The exposure of all VLBWIs to third-line antibiotics increased after outbreaks (19.4% before vs 22.5% after; P=.007). This trend particularly affected male infants (4.6% increase; P=.005) and infants with a birth weight between 1,000 and 1,499 g (3.5% increase; P=.001)
In a logistic regression analysis, month of discharge as linear variable of time was associated with increased exposure to third-line antibiotics (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.009–1.014; P<.001), and discharge within the 6-month period after outbreak reports independently contributed to this long-term trend (OR, 1.14; 95% CI, 1.017–1.270; P=.024).
Media reports directly affect medical practice, eg, overuse of third-line antibiotics. Future communication and management strategies must be based on objective dialogues between the scientific community and investigative journalists.
A population of Eurasian lynx Lynx lynx was established by reintroductions in the Bohemian Forest Ecosystem in the 1970s and 1980s. The most recent information on the population status indicates that the distribution has stagnated since the late 1990s, for unknown reasons. We assessed the availability of suitable habitat along the Austrian–German–Czech border, and hypothesized that the Bohemian–Bavarian lynx population is not in equilibrium with habitat suitability. Based on global positioning system data from 10 radio-collared lynx, we used a maximum entropy approach to model suitable habitat. Variables reflecting anthropogenic influence contributed most to the model and were negatively associated with the occurrence of lynx. We evaluated the model prediction using independent records of lynx from monitoring in Bavaria, Germany. Using our habitat approach we estimated the area of potential habitat, based on a mean annual home range of 445 km2 for males and 122 km2 for females. Our results indicated there were 12,415 km2 of suitable habitat, distributed among 13 patches, for a potential population of c. 142 (93–160) resident lynx. We assessed connectivity via least-cost paths and found that all suitable patches could be reached by the lynx. A comparison with the current distribution of lynx, however, confirms that a significant proportion of suitable habitat is not occupied, which indicates that the distribution is limited by factors other than habitat, with illegal killing being the most likely cause. Our study provides crucial information for the development of a conservation strategy and regional planning for the Bohemian–Bavarian lynx population.
An experimental methodology compliant with industrial constraints was deployed to uncover the origin of soft breakdown events in large planar silicon-based NMOS capacitors. Complementary advanced failure analysis techniques were advantageously employed to localize, isolate and observe structural defects at nanoscale. After an accurate localization of the failing area by optical beam-induced resistance change (OBIRCH), focused ion beam (FIB) technique enabled preparing thin specimens adequate for transmission electron microscopy (TEM). Characterization of the gate oxide microstructure was performed by highresolution TEM imaging and energy-filtered spectroscopy. A dedicated experimental protocol relying on iterative FIB thinning and TEM observation enabled improving the quality of electron imaging of defects at atom scale. In that way, the gate oxide integrity was evaluated and an electrical stress-induced silicon epitaxy was detected concomitantly to soft breakdown events appearing during constant voltage stress. The growth of silicon hillocks enables consuming a part of the breakdown energy and may prevent the soft breakdown event to evolve towards a hard breakdown that is catastrophic for device functionality.
The European Convention on Human Rights (hereafter ECHR, or Convention) has gained more importance within the multi-level system of judicial protection of human rights in Germany in recent years. The number of adverse judgments against Germany delivered by the European Court of Human Rights (hereafter ECtHR, or Strasbourg Court) has been relatively low compared with other member states of the Council of Europe. In 2007 and 2008, the ECtHR found a violation of the Convention in seven and six judgments respectively. The number is even lower when one looks into the records before the Strasbourg Court became a permanent institution in 1998. However, since 2009 an increase of adverse judgments against Germany can be observed, with the ECtHR delivering twenty-nine adverse judgments in 2010 and thirty-one in 2011. Even though several of the judgments concerned repetitive cases, the Strasbourg Court has for the first time decided on significant topics like preventive detention in Germany. It also issued its first pilot judgment against Germany regarding excessive length of court proceedings, as well as judgments on freedom of expression and the protection of whistleblowers. The increase in adverse judgments, as well as the importance of the issues they involve, raise significant questions concerning the role of the ECtHR's judgments in the domestic system of human rights protection.
We provide a framework for studying randomly coloured point sets in a locally compact second-countable space on which a metrizable unimodular group acts continuously and properly. We first construct and describe an appropriate dynamical system for uniformly discrete uncoloured point sets. For point sets of finite local complexity, we characterize ergodicity geometrically in terms of pattern frequencies. The general framework allows us to incorporate a random colouring of the point sets. We derive an ergodic theorem for randomly coloured point sets with finite-range dependencies. Special attention is paid to the exclusion of exceptional instances for uniquely ergodic systems. The setup allows for a straightforward application to randomly coloured graphs
In this paper we present a microfabricated SiC based alternative to glass-fiber optogenetic stimulation. The glass fiber system currently used for stimulation has numerous drawbacks. First, the very presence of glass can evoke an immune response in cortical tissue that can impede the light-to-neuron optical interface. This glial scarring of brain tissue effectively lowers the spatial resolution and power output of the system. Second, the fragility of an implanted glass fiber is a problem that has yet to be fully addressed. Using SiC the proposed optical structure will address these problems by significantly lowering the amount glial scarring and astrocytic activity expressed as a result of the implant. In addition, single crystal SiC allows for a flexible device that can move with the surrounding tissue without fracturing. Finally, the current glass fibers tend be single channel devices with a single ended emitter. The proposed microfabricated device will allow for multiple channels, multiple wavelengths of stimulation, and electrical feedback on each channel improving upon the current standard.