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To evaluate the impact of implementing clinical decision support (CDS) tools for outpatient antibiotic prescribing in the emergency department (ED) and clinic settings.
We performed a before-and-after, quasi-experimental study that employed an interrupted time-series analysis.
The study institution was a quaternary, academic referral center in Northern California.
We included prescriptions for patients in the ED and 21 primary-care clinics within the same health system.
We implemented a CDS tool for azithromycin on March 1, 2020, and a CDS tool for fluoroquinolones (FQs; ie, ciprofloxacin, levofloxacin, and moxifloxacin) on November 1, 2020. The CDS added friction to inappropriate ordering workflows while adding health information technology (HIT) features to easily perform recommended actions. The primary outcome was the number of monthly prescriptions for each antibiotic type, by implementation period (before vs after).
Immediately after azithromycin-CDS implementation, monthly rates of azithromycin prescribing decreased significantly in both the ED (−24%; 95% CI, −37% to −10%; P < .001) and outpatient clinics (−47%; 95% CI, −56% to −37%; P < .001). In the first month after FQ-CDS implementation in the clinics, there was no significant drop in ciprofloxacin prescriptions; however, there was a significant decrease in ciprofloxacin prescriptions over time (−5% per month; 95% CI, −6% to −3%; P < .001), suggesting a delayed effect of the CDS.
Implementing CDS tools was associated with an immediate decrease in azithromycin prescriptions, in both the ED and clinics. CDS may serve as a valuable adjunct to existing antimicrobial stewardship programs.
In a quiet environment, even a small noise attracts the attention of the people around. In order to reduce the stress of speakers, listeners, and other people around them, we devised a tool to support conversation by converting voice into ultrasonic waves and outputting them from parametric speakers to deliver the sound to the conversation partner. Since light materials can be used for soundproofing ultrasonic waves, we used cardboard and newspaper as soundproofing materials. We confirmed that the sound converted by the tool can be used for conversation and soundproofed.
Primary deficit schizophrenia (DS) is characterized by enduring negative symptoms and represents a qualitatively different disease entity with respect to non-deficit schizophrenia (NDS). No studies investigated the association between the enzyme paraoxonase 1 (PON1) and DS and its phenomenology.
In this case-control study, Thai women and men, aged 18 to 65 years, were divided in DS (n = 40) and NDS (n = 40) and were compared to controls (n = 40). PON1 activities against 4-(chloromethyl)phenyl acetate (CMPA) and phenylacetate were determined. Moreover, subjects were genotyped for their PON1 Q192R polymorphism and immunoglobulin A (IgA) levels responses directed to Gram-negative bacteria were measured.
DS is significantly associated with the QQ genotype and the Q allele as compared with NDS and controls. PON1 activities are significantly and inversely associated with negative symptoms, formal thought disorders, psychomotor retardation, excitation and DS. The presence of the Q allele is associated with increased IgA responses to Pseudomonas aeruginosa, Morganella morganii, and Pseudomonas putida as compared with RR carriers.
The PON1 Q allele and lower PON1 activities especially against CMPA are associated with DS, indicating lowered quorum quenching abilities as well as lowered defenses against lipoperoxidation and immune activation. It is suggested that lowered PON1 activity in DS constitutes an impairment in the innate immune system which together with lowered natural IgM may cause lower immune regulation thereby predisposing toward greater neurotoxic effects of immune-inflammatory, oxidative and nitrosative pathways and Gram-negative microbiota.
Neurocognitive and functional neuroimaging studies point to frontal lobe abnormalities in schizophrenia. Molecular and behavioural genetic studies suggest that the frontal lobe is under significant genetic influence. We carried out structural magnetic resonance imaging (MRI) of the frontal lobe in monozygotic (MZ) twins concordant or discordant for schizophrenia and healthy MZ control twins.
The sample comprised 21 concordant pairs, 17 discordant affected and 18 discordant unaffected twins from 19 discordant pairs, and 27 control pairs. Groups were matched on sociodemographic variables. Patient groups (concordant, discordant affected) did not differ on clinical variables. Volumes of superior, middle, inferior and orbital frontal gyri were calculated using the Cavalieri principle on the basis of manual tracing of anatomic boundaries. Group differences were investigated covarying for whole-brain volume, gender and age.
Results for superior frontal gyrus showed that twins with schizophrenia (i.e. concordant twins and discordant affected twins) had reduced volume compared to twins without schizophrenia (i.e. discordant unaffected and control twins), indicating an effect of illness. For middle and orbital frontal gyrus, concordant (but not discordant affected) twins differed from non-schizophrenic twins. There were no group differences in inferior frontal gyrus volume.
These findings suggest that volume reductions in the superior frontal gyrus are associated with a diagnosis of schizophrenia (in the presence or absence of a co-twin with schizophrenia). On the other hand, volume reductions in middle and orbital frontal gyri are seen only in concordant pairs, perhaps reflecting the increased genetic vulnerability in this group.
The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural–geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.
Schizophrenia is associated with robust hippocampal volume deficits but subregion volume deficits, their associations with cognition, and contributing genes remain to be determined.
Hippocampal formation (HF) subregion volumes were obtained using FreeSurfer 6.0 from individuals with schizophrenia (n = 176, mean age ± s.d. = 39.0 ± 11.5, 132 males) and healthy volunteers (n = 173, mean age ± s.d. = 37.6 ± 11.3, 123 males) with similar mean age, gender, handedness, and race distributions. Relationships between the HF subregion volume with the largest between group difference, neuropsychological performance, and single-nucleotide polymorphisms were assessed.
This study found a significant group by region interaction on hippocampal subregion volumes. Compared to healthy volunteers, individuals with schizophrenia had significantly smaller dentate gyrus (DG) (Cohen's d = −0.57), Cornu Ammonis (CA) 4, molecular layer of the hippocampus, hippocampal tail, and CA 1 volumes, when statistically controlling for intracranial volume; DG (d = −0.43) and CA 4 volumes remained significantly smaller when statistically controlling for mean hippocampal volume. DG volume showed the largest between group difference and significant positive associations with visual memory and speed of processing in the overall sample. Genome-wide association analysis with DG volume as the quantitative phenotype identified rs56055643 (β = 10.8, p < 5 × 10−8, 95% CI 7.0–14.5) on chromosome 3 in high linkage disequilibrium with MOBP. Gene-based analyses identified associations between SLC25A38 and RPSA and DG volume.
This study suggests that DG dysfunction is fundamentally involved in schizophrenia pathophysiology, that it may contribute to cognitive abnormalities in schizophrenia, and that underlying biological mechanisms may involve contributions from MOBP, SLC25A38, and RPSA.
An epitaxial NdFeAs(O,F) thin film of 90 nm thickness grown by molecular beam epitaxy on MgO single crystal with Tc = 44.2 K has been investigated regarding a possible vortex glass–liquid transition. The voltage–current characteristics show excellent scalability according to the vortex-glass model with a static critical exponent ν of around 1.35 and a temperature-dependent dynamic exponent z increasing from 7.8 to 9.0 for the investigated temperature range. The large and non-constant z values are discussed in the frame of 3D vortex glass, thermally activated flux motion, and inhomogeneity broadening.
We investigate the two-photon absorption characteristics of hemicyanine dyes that exhibit a one-photon absorption at around 500 nm. The dyes exhibited two-photon-induced fluorescence upon irradiation with an Yb-doped femtosecond fiber laser operating at 1030 nm. Among the dyes, 4-[4-[4-(dimethylamino)phenyl]-1,3-butadienyl]-1-ethyl-pyridinium perchlorate exhibited the most efficient two-photon-induced fluorescence at 1030 nm. Since these dyes possess cationic moiety, the dyes accumulated in the mitochondria of a living cell. Two-photon images of mitochondria were obtained by staining living HEK293 cells with these dyes. When 4-[4-[4-(dimethylamino)phenyl]-1,3-butadienyl]-1-ethyl-pyridinium perchlorate was employed, a two-photon-induced fluorescence image could be obtained even when a 3 mW fiber laser beam was used as the excitation source.
Pd-rich PGM (platinum-group minerals) have been found in sulphide-bearing dunites and harzburgites from the Inazumi-yama ultramafic complex in southwestern Japan. In the dunite, potarite (PdHg0.85–0.88) is the most abundant PGM but other associated PGM include stibiopalladinite (Pd5Sb2) and rare sperrylite (PtAs2) and Pd-rich alloys. A Pd telluride has been found in the harzburgite. The PGM are enclosed usually by pentlandite-heazlewoodite composite grains and, rarely, by altered chrome-spinel. These minerals are characteristic of an ultramafic assemblage but they are accompanied by ubiquitous galena and minor sphalerite not usually associated with these ultramafic assemblages. The ultramafic part of this complex has been thermally metamorphosed (olivine-talc zone) within the contact aureole of an adjacent granite. The PGM, sulphides and altered spinel are all intergrown with antigorite and/or chlorite, indicating a metamorphic overprint on the primary igneous mineralogy. The Pd/Pt ratios of 9 suggest a process of hydrothermal concentration for the Pd and it is proposed that the Pd has been remobilized and reconcentrated by hydrothermal solutions derived from the granitic magma which reacted with the Pd concentrated in the primary magmatic sulphides. Mercury may have been leached from surrounding sediments by the hydrothermal solutions. It is possible that potarite and the other PGM formed at temperatures of up to 650°C and are likely to be found in other thermally metamorphosed ultramafic rocks showing a depleted character (spinel Cr/[Cr+Al]>0.7), common in orogenic belts.
Blazar OJ287 exhibits large thermal flares at least twice every 12 years. The times of these flares have been predicted successfully using the model of a quasi-Keplerian eccentric black hole binary where the secondary impacts the accretion disk of the primary, creating the thermal flares. New measurements of the historical light curve have been combined with the observations of the 2015 November/December flare to identify the impact record since year 1886, and to constrain the orbit of the binary. The orbital solution shows that the binary period, now 12.062 years, is decreasing at the rate of 36 days per century. This corresponds to an energy loss to gravitational waves that is 6.5 ± 4 % less than the rate predicted by the standard quadrupolar gravitational wave (GW) emission. We show that the difference is due to higher order gravitational radiation reaction terms that include the dominant order tail contributions.
Maternal dietary restriction is often associated with cardiovascular disease in offspring. The aim of this study was to investigate the effect of green tea extract (GTE) intake during lactation on macrophage infiltration, and activation of adenosine monophosphate (AMP)-activated protein kinase (AMPK) and serine-threonine kinase Akt (Akt) in the hearts of weanlings exposed to maternal dietary protein restriction. Pregnant Wistar rats were fed control (C) or low-protein diets (LP) throughout gestation. Following delivery, the dams received a control or a GTE-containing control diet during lactation: control diet during gestation and lactation (CC), low-protein diet during gestation and lactation (LPC), low-protein diet during gestation and 0.12% GTE-containing low-protein diet during lactation (LPL), and low-protein diet during gestation and 0.24% GTE-containing low-protein diet during lactation (LPH). The female offspring were sacrificed at day 22. Biochemical parameters in the plasma, macrophage infiltration, degree of fibrosis and expression levels of AMPK and Akt were examined. The plasma insulin level increased in LPH compared with LPC. Percentage of the fibrotic areas and the number of macrophages in LPC were higher than those in CC. Conversely, the fibrotic areas and the macrophage number in LPH were smaller (21 and 56%, respectively) than those in LPC. The levels of phosphorylated AMPK in LPL and LPH, and Akt in LPH were greater than those in LPC. In conclusion, maternal protein restriction may induce macrophage infiltration and the decrease of insulin levels. However, GTE intake during lactation may suppress macrophage infiltration and restore insulin secretion function via upregulation of AMPK and insulin signaling in weanlings.
The mode of onset and the course of schizophrenia illness exhibit substantial individual variations. Previous studies have pointed out that the mode of onset affects the duration of untreated psychosis (DUP) and clinical outcomes, such as cognitive and social functioning. This study attempted to clarify the association between the DUP and clinical features, taking the different modes of onset into consideration, in a prospective longitudinal study examining patients with first-episode schizophrenia.
This study was conducted in six areas of Japan. Patients with first-episode schizophrenia were followed for over 18 months. Cognitive function, psychopathology, and social functioning were assessed at baseline and at 6, 12, and 18-month follow-up points.
We identified 168 patients and sufficient information was available to determine the DUP and the mode of onset for 156 patients (92.9%): 79 had an acute onset, and 77 had an insidious onset. The DUP was significantly associated with quality of life (QOL), social functioning, and cognitive function at most of the follow-up points in the insidious-onset group. The DUP and negative symptoms at baseline were significant predictors of cognitive function at the 18-month follow-up in the insidious-onset group.
The present results further support the hypothesis that the DUP affects QOL, social functioning, and cognitive function over the course of illness, especially in patients with an insidious onset. Effective strategies for detecting and caring for individuals with insidious onset early during the course of schizophrenia will be essential for achieving a full patient recovery.
The superbubble (SB) 30 Dor C with the strong non-thermal X-ray emission is one of the best targets for study of the cosmic-ray (CR) acceleration. We investigated X-ray spectral properties of the SB with a high spatial resolution of ~10 pc. Consequently, the spectra in the east regions can be described with a combination of absorbed thermal and non-thermal models while the spectra in the west regions can be fitted with an absorbed non-thermal model. We found that the observed photon index and intensity in 2-10 keV show variations of 2.0-3.5 and (0.6-8.0) × 10−7 erg s−1 cm−2 str−1, respectively. The results are possibly caused by the spatial variation of the CR acceleration efficiency and/or the circumstellar environment.
Bone contouring is currently the best treatment for fibro-osseous lesions after bone growth arrest. Navigation systems available for this surgery allow intra-operative visualisation with improved cosmetic outcomes. However, conventional navigation systems using superficial skin registration cannot prevent subtle discrepancies.
To address this problem, we used a non-invasive cranial bone registration that uses patient-specific dental templates to maintain exact registration. We created the preset goal using the mirror image of the unaffected side for unilateral lesions, and using images obtained before the onset of symptoms for bilateral lesions. This system achieved precise pre-operative simulation. A sound aid in the navigation system provided information regarding proximity to critical structures and to the preset goal.
We used this system to contour fibro-osseous lesions in three patients. All patients achieved good facial contours and improvement in symptoms.
This method offers a safe, rapid surgical aid in treating orbital fibro-osseous lesions.
To investigate the characteristic physical properties of the oscillating system in the intact middle ear using a high-speed camera.
We analysed the oscillation of the guinea pig stapes using a high-speed camera. The specimens were prepared so that the middle-ear structures were intact. Tones of various frequencies were delivered into the external auditory canal.
We found that the stapes showed a damped oscillation after the sound stimulation had stopped. The damped oscillation after the sound stimulation showed a specimen-specific frequency that was independent of the frequency of the stimulating sound. An injury to the bony labyrinth, which removed most of the mass from the oscillating system, attenuated the damped oscillation. Therefore, this damped oscillation is likely a passive motion, rather than a reverberation of the stimulating sound.
Analysing the passive damped oscillation may reveal the characteristic physical properties of the oscillating system in the near-intact middle ear. Further refinement of this simple and straightforward system may enhance basic and clinical research on the middle ear in a more intuitive way.
We investigated the ossicular movement in the near-intact middle ear in response to acoustic stimulation using a high-speed video camera and video analysis software program.
We have designed a good visual access to the middle ear of the guinea pig by opening the ventral wall of the otic capsule, without injuring the sound-conducting structures, from the external auditory canal to the oval window. The high-speed video camera could record analysable ossicular motion up to 4000 frames per second.
The stapes showed reciprocal movement in the same frequency as the stimulating tone, and with an amplitude proportional to the stimulating sound intensity. Injury to the tympanic membrane attenuated the stapedial motion, which was recovered to that of the control level by patch repair of the perforation.
Our experimental set-up was capable of evaluating the conductive hearing, regardless of the status of the animal's sensorineural hearing or even life. Such a video analysis may provide a powerful tool to investigate the physiology of the middle ear.
A feeding station is the area of forage a grazing animal can reach without moving its forefeet. Grazing behavior can be divided into residence within feeding stations (with bites as benefits) and movement between feeding stations (with steps as costs). However, relatively little information has been reported on how grazing animals modify their feeding station behavior seasonally and interannually in response to varying environmental conditions. The feeding station behavior of beef cows (Japanese Black) stocked on a tropical grass pasture (bahiagrass dominant) was monitored for 4 years (2010 to 2013) in order to investigate the association of feeding station behavior with meteorological and sward conditions across the seasons and years. Mean air temperature during stocking often exceeded 30°C during summer months. A severe summer drought in 2013 decreased herbage mass and sward height of the pasture and increased nitrogen concentration of herbage from summer to autumn. A markedly high feeding station number per unit foraging time, low bite numbers per feeding station and a low bite rate were observed in summer 2013 compared with the other seasons and years. Bite number per feeding station was explained by a multiple regression equation, where sward height and dry matter digestibility of herbage had a positive effect, whereas air temperature during stocking had a negative effect (R2=0.658, P<0.01). Feeding station number per minute was negatively correlated with bite number per feeding station (r=–0.838, P<0.001). It was interpreted that cows modified bite number per feeding station in response to the sward and meteorological conditions, and this largely determined the number of feeding stations the animals visited per minute. The results indicate potential value of bite number per feeding station as an indicator of daily intake in grazing animals, and an opportunity for livestock and pasture managers to control feeding station behavior of animals through managements (e.g. fertilizer application, manipulation of stocking intensity and stocking time within the day).
Electrical conductions in insulators such as resistance switching, conduction at interfaces, and conduction at domain boundaries and free surface of ferroelectrics are of interest. These conductions are often attributed to novel mechanism such as ferroelectric polarization. On the other hand, these interpretations appear not fully accepted, because the recent advanced theories of ferroelectric domains disregard screening indicated by these conduction phenomena. That is, these conduction phenomena are quietly regarded as the classical conduction originating from defects. In this paper, we examine these conductions in pure wide bandgap insulators in view of defects, using the direct-accessibility (tangibility) of conduction at free surfaces. Although most of these conductions in ferroelectrics may not be useful in large-scale applications, we show that they have fundamental implications on renovations of ferroelectric basics.