165 research outputs found
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Evaluation of uncomplicated acute respiratory tract infection management in veterans: A national utilization review.
BackgroundAntibiotics are overprescribed for acute respiratory tract infections (ARIs). Guidelines provide criteria to determine which patients should receive antibiotics. We assessed congruence between documentation of ARI diagnostic and treatment practices with guideline recommendations, treatment appropriateness, and outcomes.MethodsA multicenter quality improvement evaluation was conducted in 28 Veterans Affairs facilities. We included visits for pharyngitis, rhinosinusitis, bronchitis, and upper respiratory tract infections (URI-NOS) that occurred during the 2015-2016 winter season. A manual record review identified complicated cases, which were excluded. Data were extracted for visits meeting criteria, followed by analysis of practice patterns, guideline congruence, and outcomes.ResultsOf 5,740 visits, 4,305 met our inclusion criteria: pharyngitis (n = 558), rhinosinusitis (n = 715), bronchitis (n = 1,155), URI-NOS (n = 1,475), or mixed diagnoses (>1 ARI diagnosis) (n = 402). Antibiotics were prescribed in 68% of visits: pharyngitis (69%), rhinosinusitis (89%), bronchitis (86%), URI-NOS (37%), and mixed diagnosis (86%). Streptococcal diagnostic testing was performed in 33% of pharyngitis visits; group A Streptococcus was identified in 3% of visits. Streptococcal tests were ordered less frequently for patients who received antibiotics (28%) than those who did not receive antibiotics 44%; P < .01). Although 68% of visits for rhinosinusitis had documentation of symptoms, only 32% met diagnostic criteria for antibiotics. Overall, 39% of patients with uncomplicated ARIs received appropriate antibiotic management. The proportion of 30-day return visits for ARI care was similar for appropriate (11%) or inappropriate (10%) antibiotic management (P = .22).ConclusionsAntibiotics were prescribed in most uncomplicated ARI visits, indicating substantial overuse. Practice was frequently discordant with guideline diagnostic and treatment recommendations
Repurposeable Learning Objects Based on Teaching and Learning Styles
Multimedia learning objects are an essential
component of high quality, technology-mediated
instruction. Learning objects allow the student to use
the content learned in a particular part of a course and;
1. demonstrate mastery of the content, 2. apply that
knowledge to solving a problem, and 3. use the
content in a critical thinking exercise that both
demonstrates mastery and allows the student to place
the content within the context of the larger topic of the
course. The difficulty associated with the use of
learning objects on a broad scale is that they require
programming skills most professors and instructors do
not possess. Learning objects also tend to be custom
productions and are defined in terms of the
programming and code terminology, further limiting
the professorâs ability to understand how they are
created. Learning objects defined in terms of styles of
learning and teaching allow professors and instructors
to develop a deeper understanding of the learning
objects and the design process.
A set of learning objects has been created that are
designed for some of the important styles of learning
and teaching. They include; visual learning, writing
skills, critical thinking, time-revealed scenarios, case
studies and empirical observation. The learning
objects are designed and described in terms that the
average instructor can readily understand , redesign
and incorporate into their own courses. They are also
designed in such a way that they can readily be
repurposed for new applications in other courses and
subject areas, with little or no additional
programming. (Authors' abstract
Pre-conception maternal helminth infection transfers via nursing long-lasting cellular immunity against helminths to offspring
Maternal immune transfer is the most significant source of protection from early-life infection, but whether maternal transfer of immunity by nursing permanently alters offspring immunity is poorly understood. Here, we identify maternal immune imprinting of offspring nursed by mothers who had a pre-conception helminth infection. Nursing of pups by helminth-exposed mothers transferred protective cellular immunity to these offspring against helminth infection. Enhanced control of infection was not dependent on maternal antibody. Protection associated with systemic development of protective type 2 immunity in T helper 2 (TH2) impaired IL-4R-/- offspring. This maternally acquired immunity was maintained into maturity and required transfer (via nursing) to the offspring of maternally derived TH2-competent CD4 T cells. Our data therefore reveal that maternal exposure to a globally prevalent source of infection before pregnancy provides long-term nursing-acquired immune benefits to offspring mediated by maternally derived pathogen-experienced lymphocytes. © 2019 by the Authors
First narrow-band search for continuous gravitational waves from known pulsars in advanced detector data
Spinning neutron stars asymmetric with respect to their rotation axis are potential sources of
continuous gravitational waves for ground-based interferometric detectors. In the case of known pulsars a
fully coherent search, based on matched filtering, which uses the position and rotational parameters
obtained from electromagnetic observations, can be carried out. Matched filtering maximizes the signalto-
noise (SNR) ratio, but a large sensitivity loss is expected in case of even a very small mismatch
between the assumed and the true signal parameters. For this reason, narrow-band analysis methods have
been developed, allowing a fully coherent search for gravitational waves from known pulsars over a
fraction of a hertz and several spin-down values. In this paper we describe a narrow-band search of
11 pulsars using data from Advanced LIGOâs first observing run. Although we have found several initial
outliers, further studies show no significant evidence for the presence of a gravitational wave signal.
Finally, we have placed upper limits on the signal strain amplitude lower than the spin-down limit for 5 of
the 11 targets over the bands searched; in the case of J1813-1749 the spin-down limit has been beaten for
the first time. For an additional 3 targets, the median upper limit across the search bands is below the
spin-down limit. This is the most sensitive narrow-band search for continuous gravitational waves carried
out so far
Kainate Receptor-Mediated Modulation of Hippocampal Fast Spiking Interneurons in a Rat Model of Schizophrenia
Kainate receptor (KAR) subunits are believed to be involved in abnormal GABAergic neurotransmission in the hippocampus (HIPP) in schizophrenia (SZ) and bipolar disorder. Postmortem studies have shown changes in the expression of the GluR5/6 subunits of KARs in the stratum oriens (SO) of sectors CA2/3, where the basolateral amygdala (BLA) sends a robust projection. Previous work using a rat model of SZ demonstrated that BLA activation leads to electrophysiological changes in fast-spiking interneurons in SO of CA2/3. The present study explores KAR modulation of interneurons in CA2/3 in response to BLA activation. Intrinsic firing properties of these interneurons through KAR-mediated activity were measured with patch-clamp recordings from rats that received 15 days of picrotoxin infusion into the BLA. Chronic BLA activation induced changes in the firing properties of CA2/3 interneurons associated with modifications in the function of KARs. Specifically, the responsiveness of these interneurons to activation of KARs was diminished in picrotoxin-treated rats, while the after-hyperpolarization (AHP) amplitude was increased. In addition, we tested blockers of KAR subunits which have been shown to have altered gene expression in SO sector CA2/3 of SZ subjects. The GluR5 antagonist UBP296 further decreased AP frequency and increased AHP amplitude in picrotoxin-treated rats. Application of the GluR6/7 antagonist NS102 suggested that activation of GluR6/7 KARs may be required to maintain the high firing rates in SO interneurons in the presence of KA. Moreover, the GluR6/7 KAR-mediated signaling may be suppressed in PICRO-treated rats. Our findings indicate that glutamatergic activity from the BLA may modulate the firing properties of CA2/3 interneurons through GluR5 and GluR6/7 KARs. These receptors are expressed in GABAergic interneurons and play a key role in the synchronization of gamma oscillations. Modulation of interneuronal activity through KARs in response to amygdala activation may lead to abnormal oscillatory rhythms reported in SZ subjects
Understanding and explaining the marginalization of part time British Army Reservists
Recent changes in the British Army mean part time Reservists and full time Regulars need to become better integrated. However, there has been a long history of workplace tensions between the full time and part time elements in the British Army. This mirrors those found in many civilian workplaces. Focus group data with 105 full time Regular British Army soldiers confirmed that time and emotional commitment are strongly linked in a full time professional workplace that has strong, definite and enduring boundaries. This, alongside demands for conformity and stratification by rank explained the high risk of marginalization of part time Reservists. The legitimacy of part time Reservists, especially in the combat arms, was often challenged. Using this explanatory framework some implications and practical ways that tensions may be reduced between full time and part time members of the British Army, and other Armed Forces facing similar tensions, were highlighted
Searches for gravitational waves from known pulsars at two harmonics in 2015-2017 LIGO data
International audienceWe present a search for gravitational waves from 222 pulsars with rotation frequencies âł10 Hz. We use advanced LIGO data from its first and second observing runs spanning 2015â2017, which provides the highest-sensitivity gravitational-wave data so far obtained. In this search we target emission from both the l = m = 2 mass quadrupole mode, with a frequency at twice that of the pulsarâs rotation, and the l = 2, m = 1 mode, with a frequency at the pulsar rotation frequency. The search finds no evidence for gravitational-wave emission from any pulsar at either frequency. For the l = m = 2 mode search, we provide updated upper limits on the gravitational-wave amplitude, mass quadrupole moment, and fiducial ellipticity for 167 pulsars, and the first such limits for a further 55. For 20 young pulsars these results give limits that are below those inferred from the pulsarsâ spin-down. For the Crab and Vela pulsars our results constrain gravitational-wave emission to account for less than 0.017% and 0.18% of the spin-down luminosity, respectively. For the recycled millisecond pulsar J0711â6830 our limits are only a factor of 1.3 above the spin-down limit, assuming the canonical value of 1038 kg m2 for the starâs moment of inertia, and imply a gravitational-wave-derived upper limit on the starâs ellipticity of 1.2 Ă 10â8. We also place new limits on the emission amplitude at the rotation frequency of the pulsars
Search for continuous gravitational wave emission from the Milky Way center in O3 LIGO--Virgo data
We present a directed search for continuous gravitational wave (CW) signals
emitted by spinning neutron stars located in the inner parsecs of the Galactic
Center (GC). Compelling evidence for the presence of a numerous population of
neutron stars has been reported in the literature, turning this region into a
very interesting place to look for CWs. In this search, data from the full O3
LIGO--Virgo run in the detector frequency band have been
used. No significant detection was found and 95 confidence level upper
limits on the signal strain amplitude were computed, over the full search band,
with the deepest limit of about at .
These results are significantly more constraining than those reported in
previous searches. We use these limits to put constraints on the fiducial
neutron star ellipticity and r-mode amplitude. These limits can be also
translated into constraints in the black hole mass -- boson mass plane for a
hypothetical population of boson clouds around spinning black holes located in
the GC.Comment: 25 pages, 5 figure
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