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Of 731 restricted antimicrobial prescriptions subject to antimicrobial stewardship program (ASP) prospective audit and feedback (PAF) over a 3-year period, 598 PAF recommendations (82%) were fully accepted. Physician auditors had an increased odds of PAF recommendation acceptance, reinforcing the complementary role of the ASP physician in the multidisciplinary ASP team.
Most mental disorders, when examined individually, are associated with an increased risk of cardiometabolic complications. However, these associations might be attributed to a general liability toward psychopathology or confounded by unmeasured familial factors.
To examine whether the associations between psychiatric diagnoses and increased risk of cardiometabolic complications are attributable to a general liability toward psychopathology, or confounded by unmeasured familial factors.
We conducted a cohort study in Sweden and identified all individuals and their siblings born in Sweden 1955-1962 with follow-up through 2013. After excluding individuals who died or emigrated before 1987, the final sample consisted 672 823 individuals. We extracted ICD-coded diagnoses (recorded 1973-1987) for ten psychiatric conditions and criminal convictions when participants were aged 18-25 years, and ICD-coded diagnoses (recorded 1987-2013) for five cardiometabolic complications (obesity, hypertensive diseases, hyperlipidemia, type 2 diabetes mellitus, and cardiovascular diseases) when the participants were 51-58 years old. Logistic regression models were used to estimate the bivariate associations between psychiatric conditions or criminal convictions and cardiometabolic complications in individuals. A general factor model was used to identify general, internalizing, externalizing, and psychotic factors based on the psychiatric conditions and criminal convictions. We then regressed the cardiometabolic complications on the latent general factor and three uncorrelated specific factors within a structural equation modeling framework in individuals and across sibling pairs.
Each psychiatric conditions significantly increased the risk of cardiometabolic complications; however, most of these associations were attributable to the general factor of psychopathology, rather than to specific psychiatric conditions. There were no or only small associations between individuals’ general psychopathology and their siblings’ cardiometabolic complications, suggesting that the associations were not attributable to genetic or environmental confounding factors shared within families. The same pattern was evident for the specific internalizing and psychotic factors.
Individuals with mental disorders in early life had an increased long term risk of cardiometabolic complications, which appeared attributable to a general liability toward psychopathology. Sibling analyses suggested that the elevated risk could not be attributed to confounds shared within families.This highlights the importance of transdiagnostic and lifestyle based interventions to reduce the risk of cardiometabolic complications, particularly in patients with several mental disorders.
We examined the effect of an antimicrobial stewardship program (ASP), procalcitonin testing and rapid blood-culture identification on hospital mortality in a prospective quality improvement project in critically ill septic adults. Secondarily, we have reported antimicrobial guideline concordance, acceptance of ASP interventions, and antimicrobial and health-resource utilization.
Background: The late-onset cerebellar ataxias (LOCAs) have until recently resisted molecular diagnosis. Contributing to this diagnostic gap is that non-coding structural variations, such as repeat expansions, are not fully accessible to standard short-read sequencing analysis. Methods: We combined bioinformatics analysis of whole-genome sequencing and long-read sequencing to search for repeat expansions in patients with LOCA. We enrolled 66 French-Canadian, 228 German, 20 Australian and 31 Indian patients. Pathogenic mechanisms were studied in post-mortem cerebellum and induced pluripotent stem cell (iPSC)-derived motor neurons from 2 patients. Results: We identified 128 patients who carried an autosomal dominant GAA repeat expansion in the first intron of the FGF14 gene. The expansion was present in 61%, 18%, 15% and 10% of patients in the French-Canadian, German, Australian and Indian cohorts, respectively. The pathogenic threshold was determined to be (GAA)≥250, although incomplete penetrance was observed in the (GAA)250-300 range. Patients developed a slowly progressive cerebellar syndrome at an average age of 59 years. Patient-derived post-mortem cerebellum and induced motor neurons both showed reduction in FGF14 RNA and protein expression compared to controls. Conclusions: This intronic, dominantly inherited GAA repeat expansion in FGF14 represents one of the most common genetic causes of LOCA uncovered to date.
Physical activity (PA) may help maintain brain structure and function in aging. Since the intensity of PA needed to effect cognition and cerebrovascular health remains unknown, we examined associations between PA and cognition, regional white matter hyperintensities (WMH), and regional cerebral blood flow (CBF) in older adults.
Forty-three older adults without cognitive impairment underwent magnetic resonance imaging (MRI) and comprehensive neuropsychological assessment. Waist-worn accelerometers objectively measured PA for approximately one week.
Higher time spent in moderate to vigorous PA (MVPA) was uniquely associated with better memory and executive functioning after adjusting for all light PA. Higher MVPA was also uniquely associated with lower frontal WMH volume although the finding was no longer significant after additionally adjusting for age and accelerometer wear time. MVPA was not associated with CBF. Higher time spent in all light PA was uniquely associated with higher CBF but not with cognitive performance or WMH volume.
Engaging in PA may be beneficial for cerebrovascular health, and MVPA in particular may help preserve memory and executive function in otherwise cognitively healthy older adults. There may be differential effects of engaging in lighter PA and MVPA on MRI markers of cerebrovascular health although this needs to be confirmed in future studies with larger samples. Future randomized controlled trials that increase PA are needed to elucidate cause-effect associations between PA and cerebrovascular health.
Prior evidence indicates that negative symptom severity and cognitive deficits, in people with schizophrenia (PSZ), relate to measures of reward-seeking and loss-avoidance behavior (implicating the ventral striatum/VS), as well as uncertainty-driven exploration (reliant on rostrolateral prefrontal cortex/rlPFC). While neural correlates of reward-seeking and loss-avoidance have been examined in PSZ, neural correlates of uncertainty-driven exploration have not. Understanding neural correlates of uncertainty-driven exploration is an important next step that could reveal insights to how this mechanism of cognitive and negative symptoms manifest at a neural level.
We acquired fMRI data from 29 PSZ and 36 controls performing the Temporal Utility Integration decision-making task. Computational analyses estimated parameters corresponding to learning rates for both positive and negative reward prediction errors (RPEs) and the degree to which participates relied on representations of relative uncertainty. Trial-wise estimates of expected value, certainty, and RPEs were generated to model fMRI data.
Behaviorally, PSZ demonstrated reduced reward-seeking behavior compared to controls, and negative symptoms were positively correlated with loss-avoidance behavior. This finding of a bias toward loss avoidance learning in PSZ is consistent with previous work. Surprisingly, neither behavioral measures of exploration nor neural correlates of uncertainty in the rlPFC differed significantly between groups. However, we showed that trial-wise estimates of relative uncertainty in the rlPFC distinguished participants who engaged in exploratory behavior from those who did not. rlPFC activation was positively associated with intellectual function.
These results further elucidate the nature of reinforcement learning and decision-making in PSZ and healthy volunteers.
Effects of plasma non-uniformities and kinetic dispersiveness on the spontaneous excitation of geodesic acoustic mode (GAM) by reversed shear Alfvén eigenmode (RSAE) are investigated numerically. It is found that, due to the turning points induced by the shear Alfvén continuum structure, the nonlinear excitation of GAM is a quasiexponentially growing absolute instability. As the radial dependence of GAM frequency and pump RSAE mode structure are accounted for, the radially inward propagating GAM is preferentially excited, leading to core localized thermal plasma heating by GAM collisionless damping. Our work, thus, suggests that GAM excitation plays a crucial role in not only RSAE nonlinear saturation, but also anomalous fuel ion heating in future reactors.
To compare the effectiveness of radiofrequency Coblation assisted excision and cold steel excision in the treatment of idiopathic vocal process granulomas.
A retrospective study was performed of patients with idiopathic vocal process granulomas who underwent radiofrequency Coblation excision or cold steel excision between January 2013 and January 2020. The recurrence rate was compared among the two groups at six months post-operatively.
Of the 47 patients with vocal process granulomas, 28 were in the cold steel excision (control) group and 19 were in the Coblation-assisted group. The recurrence rate in the control group was significantly higher than that in the Coblation-assisted group (60.7 per cent vs 5.3 per cent; p < 0.001). In addition, the voice recovery of the Coblation-assisted group was significantly better than that of the control group; vocal quality recovered one month after surgery in the Coblation-assisted group.
Radiofrequency Coblation should be considered the optimal method when approaching idiopathic vocal process granulomas surgically.
The great demographic pressure brings tremendous volume of beef demand. The key to solve this problem is the growth and development of Chinese cattle. In order to find molecular markers conducive to the growth and development of Chinese cattle, sequencing was used to determine the position of copy number variations (CNVs), bioinformatics analysis was used to predict the function of ZNF146 gene, real-time fluorescent quantitative polymerase chain reaction (qPCR) was used for CNV genotyping and one-way analysis of variance was used for association analysis. The results showed that there exists CNV in Chr 18: 47225201-47229600 (5.0.1 version) of ZNF146 gene through the early sequencing results in the laboratory and predicted ZNF146 gene was expressed in liver, skeletal muscle and breast cells, and was amplified or overexpressed in pancreatic cancer, which promoted the development of tumour through bioinformatics. Therefore, it is predicted that ZNF146 gene affects the proliferation of muscle cells, and then affects the growth and development of cattle. Furthermore, CNV genotyping of ZNF146 gene was three types (deletion type, normal type and duplication type) by Real-time fluorescent quantitative PCR (qPCR). The association analysis results showed that ZNF146-CNV was significantly correlated with rump length of Qinchuan cattle, hucklebone width of Jiaxian red cattle and heart girth of Yunling cattle. From the above results, ZNF146-CNV had a significant effect on growth traits, which provided an important candidate molecular marker for growth and development of Chinese cattle.
Customer survey data is critical to supporting customer preference modeling in engineering design. We present a framework of information retrieval and survey design to ensure the collection of quality customer survey data for analyzing customers’ preferences in their consideration-then-choice decision-making and the related social impact. The utility of our approach is demonstrated through the survey design for customers in the vacuum cleaner market. Based on the data, we performed descriptive analysis and network-based modeling to understand customers’ preferences in consideration and choice.
Flutter suppression is an important measure to improve fatigue life and enhance the performance of aircraft in modern aircraft design. In order to design more effective controllers for flutter suppression with high efficiency, an efficient reduced-order framework for active/passive hybrid flutter suppression is proposed. The traditional CFD-based ROMs have been successfully applied to active flutter suppression with high accuracy and efficiency. But, when a structure modification is made such as in aeroelastic tailoring and aeroelastic structural optimisation, the structural model should be updated, and the expensive, time-consuming CFD-based ROMs have to be reconstructed; such a process is impractical for passive flutter suppression. To overcome the realistic challenge, an efficient reduced-order framework for active/passive hybrid flutter suppression is proposed by extending an efficient aeroelastic CFD-based POD/ROM which we have developed. The proposed framework is demonstrated and evaluated using an improved AGARD 445.6 wing model. The results show that the proposed framework can accurately predict the aeroelastic response for active/passive hybrid flutter suppression with high efficiency. It provides a powerful tool for active/passive hybrid flutter suppression, and therefore, is ideally suited to design more effective controllers, and may have the potential to reduce the overall cost of aircraft design.
There is a lack of evidence related to the prevalence of mental health symptoms as well as their heterogeneities during the coronavirus disease 2019 (COVID-19) pandemic in Latin America, a large area spanning the equator. The current study aims to provide meta-analytical evidence on mental health symptoms during COVID-19 among frontline healthcare workers, general healthcare workers, the general population and university students in Latin America.
Bibliographical databases, such as PubMed, Embase, Web of Science, PsycINFO and medRxiv, were systematically searched to identify pertinent studies up to August 13, 2021. Two coders performed the screening using predefined eligibility criteria. Studies were assigned quality scores using the Mixed Methods Appraisal Tool. The double data extraction method was used to minimise data entry errors.
A total of 62 studies with 196 950 participants in Latin America were identified. The pooled prevalence of anxiety, depression, distress and insomnia was 35%, 35%, 32% and 35%, respectively. There was a higher prevalence of mental health symptoms in South America compared to Central America (36% v. 28%, p < 0.001), in countries speaking Portuguese (40%) v. Spanish (30%). The pooled prevalence of mental health symptoms in the general population, general healthcare workers, frontline healthcare workers and students in Latin America was 37%, 34%, 33% and 45%, respectively.
The high yet heterogenous level of prevalence of mental health symptoms emphasises the need for appropriate identification of psychological interventions in Latin America.
The rotating opportunistic prevalence audit (ROPA) methodology is described with ciprofloxacin prescriptions in adults hospitalized at a tertiary-care center. Prescription appropriateness was assessed. ROPA captured 82% of all ciprofloxacin prescriptions; 69% were inappropriate. ROPA is feasible and may overcome resource barriers of prospective audit and feedback.
Dementia assessment includes cognitive and behavioral testing with informant verification. Conventional testing is resource-intensive, with uneven access. Online unsupervised assessments could reduce barriers to risk assessment. The aim of this study was to assess the relationship between informant-rated behavioral changes and participant-completed neuropsychological test performance in older adults, both measured remotely via an online unsupervised platform, the Brain Health Registry (BHR).
Observational cohort study.
Community-dwelling older adults participating in the online BHR. Informant reports were obtained using the BHR Study Partner Portal.
The final sample included 499 participant–informant dyads.
Participants completed online unsupervised neuropsychological assessment including Forward Memory Span, Reverse Memory Span, Trail Making B, and Go/No-Go tests. Informants completed the Mild Behavioral Impairment Checklist (MBI-C) via the BHR Study Partner portal. Cognitive performance was evaluated in MBI+/− individuals, as was the association between cognitive scores and MBI symptom severity.
Mean age of the 499 participants was 67, of which 308/499 were females (61%). MBI + status was associated with significantly lower memory and executive function test scores, measured using Forward and Reverse Memory Span, Trail Making Errors and Trail Making Speed. Further, significant associations were found between poorer objectively measured cognitive performance, in the domains of memory and executive function, and MBI symptom severity.
These findings support the feasibility of remote, informant-reported behavioral assessment utilizing the MBI-C, supporting its validity by demonstrating a relationship to online unsupervised neuropsychological test performance, using a previously validated platform capable of assessing early dementia risk markers.
Reinforced cables are usually installed on flexible airship structures to enhance their load-bearing capability. However, reinforced cables also increase the total weight of the airship. In order to find a balance between large loading-bear capability and light weight, a multi-objective optimisation scheme based on the genetic algorithm NSGA-II is put forward for the reinforced cable distribution on the airship. Firstly, different cable distribution schemes are presented according to engineering experience and the optimal one is determined by load analysis. Then, the CAE method and optimisation analysis are combined to achieve structure design optimisation. The parametric model of the airship structure with reinforced cables is established by ABAQUS secondary development and the load analysis is carried out. Parameter passing and optimisation algorithm are operated by Isight software and the optimisation analysis is conducted based on the NSGA-II algorithm. Finally, we draw some conclusions of the rules of optimised reinforcing cable distribution. The work of this paper has crucial engineering significance for improving performance of the airship structure design.
Pneumatic launch systems for Unmanned Aerial Vehicles (UAVs), including mechanical and pneumatic systems, are complex and non-linear. They are subjected to system parameters during launch, which leads to difficulty in engineering research analysis. For example, the mismatch between the UAV parameters and the parameter design indices of the launch system as well as the unclear design indices of the launching speed and overload of UAVs have a great impact on launch safety. Considering this situation, some studies are presented in this paper. Taking the pneumatic launch system as a research object, a pneumatic launcher dynamic simulation model is built based on co-simulation considering the coupling characteristics of the mechanical structure and transmission system. Its accuracy was verified by laboratory test results. Based on this model, the paper shows the effects of the key parameters, including the mass of the UAV, cylinder volume, pressure and moment of inertia of the pulley block, on the performance of the dynamic characteristics of the launch process. Then, a method for matching the parameter characteristics between the UAV and launch system based on batch simulation is proposed. The set of matching parameter values of the UAV and launch system that satisfy the launch take-off safety criteria are calculated. Finally, the influence of the system parameters of the launch process on the launch performance was analysed in detail, and the design optimised. Meaningful conclusions were obtained. The analysis method and its results can provide a reference for engineering and theoretical research and development of pneumatic launch systems.
The degree to which suicide risk aggregates in US families is unknown. The authors aimed to determine the familial risk of suicide in Utah, and tested whether familial risk varies based on the characteristics of the suicides and their relatives.
A population-based sample of 12 160 suicides from 1904 to 2014 were identified from the Utah Population Database and matched 1:5 to controls based on sex and age using at-risk sampling. All first through third- and fifth-degree relatives of suicide probands and controls were identified (N = 13 480 122). The familial risk of suicide was estimated based on hazard ratios (HR) from an unsupervised Cox regression model in a unified framework. Moderation by sex of the proband or relative and age of the proband at time of suicide (<25 v. ⩾25 years) was examined.
Significantly elevated HRs were observed in first- (HR 3.45; 95% CI 3.12–3.82) through fifth-degree relatives (HR 1.07; 95% CI 1.02–1.12) of suicide probands. Among first-degree relatives of female suicide probands, the HR of suicide was 6.99 (95% CI 3.99–12.25) in mothers, 6.39 in sisters (95% CI 3.78–10.82), and 5.65 (95% CI 3.38–9.44) in daughters. The HR in first-degree relatives of suicide probands under 25 years at death was 4.29 (95% CI 3.49–5.26).
Elevated familial suicide risk in relatives of female and younger suicide probands suggests that there are unique risk groups to which prevention efforts should be directed – namely suicidal young adults and women with a strong family history of suicide.
Considering the shortcomings of current methods for real-time resolution of two-aircraft flight conflicts, a geometric optimal conflict resolution and recovery method based on the velocity obstacle method for two aircraft and a cooperative conflict resolution method for multiple aircraft are proposed. The conflict type was determined according to the relative position and velocity of the aircraft, and a corresponding conflict mitigation strategy was selected. A resolution manoeuvre and a recovery manoeuvre were performed. On the basis of a two-aircraft conflict resolution model, a multi-aircraft cooperative conflict resolution game was constructed to identify an optimal solution for maximising group welfare. The solution and recovery method is simple and effective, and no new flight conflicts are introduced during track recovery. For multi-aircraft conflict resolution, an equilibrium point that maximises the welfare function of the group was identified, and thus, an optimal strategy for multi-aircraft conflict resolution was obtained.
To assess executive functions (EFs) in patients with body dysmorphic disorder (BDD) and obsessive–compulsive disorder (OCD) compared with healthy controls.
Adults diagnosed with BDD (n = 26) or OCD (n = 29) according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and healthy controls (n = 28) underwent validated and computerized neuropsychological tests, spatial working memory (SWM), intra–extra-dimensional set shifting (IED), and stop signal task (SST), from the Cambridge Neuropsychological Test Automated Battery (CANTAB). Test performance was compared between groups, and correlated with standardized symptom severity of BDD and OCD. Significance level was set to P < .05.
There were no statistically significant between-group differences on key outcome measures in SWM, IED, or SST. There was a weak positive correlation between symptom severity and test errors on SWM and IED in both OCD and BDD groups; increased clinical severity was associated with more errors in these tests. Furthermore, there was a negative correlation between symptom severity and SST in the BDD group.
Patients with BDD or OCD did not differ from healthy control subjects in terms of test performance; however, there were several statistically significant correlations between symptom severity and performance in those with BDD or OCD. More studies on EFs in BDD and OCD are required to elucidate if there are differences in EFs between these two disorders.