Development and validaton of an indicator to compare antibiotic usage in secondary care in England

The use of antibiotics was investigated in twelve acute hospitals in England. Data was collected electronically and by questionnaire for the financial years 2001/2, 2002/3 and 2003/4. Hospitals were selected on the basis of their Medicines Management Self-Assessment Scores (MMAS) and included a cohort of three hospitals with integrated electronic prescribing systems. The total sample size was 6.65% of English NHS activity for 2001/2 based on Finished Consultant Episode (FCE) numbers. Data collected included all antibiotics dispensed (ATC category J01), hospital activity FCE's and beddays, Medicines Management Self-assessment scores, Antibiotic Medicines Management scores (AMS), Primary Care Trust (PCT) of origin of referral populations, PCT antibiotic prescribing rates, Index of Multiple Deprivation for each PCT. The DDD/FCE (Defined Daily Dose/FCE) was found to correlate with the DDD 100beddays (r = 0.74 p<O.O I) indicating this is a useful additional indicator for identifying hospitals that require further study. Antibiotic use increased from a mean 4.16 DDD/FCE in 2001/2 to 4.35 DDD/FCE in 2003/4. Antibiotic use in the electronic prescribing cohort was found to be lower, than the sample mean at 3.48 DDD/FCE in 2001/2 and 3.34 DDD/FCE in 2003/4. The MMAS and AMS were found to correlate (r = 0.74 p<O.O I) thus validating the use of the MMAS as an indication of control of antibiotic use. No correlation was found between the MMAS and a range of qualitative indicators of antibiotic use. A number of indicators are proposed as triggers for further investigation including a proportion of 0.24 for the ratio of third generation to first/second generation cephalosporin use, and five percent as the limit for parenteral quinolone DOD of total quinolone DOD usage. It was possible to demonstrate a correlation between the IMD 2000 and primary care antibiotic prescribing rates but not between primary and secondary care antibiotic prescribing rates for the same referral population or between the weighted mean IMD 2000 for each hospital's referral population and the hospital antibiotic prescribing rate

COVID Anxiety and Stress in Higher Ed (CASH)

Access the online Pressbooks version of this article here. College is a time of increased stress and anxiety. The current changes in attendance and methods of instruction due to COVID-19 have demonstrated even higher levels of stress, anxiety, and mental health issues. Tailoring interventions to the specific needs of a campus community has been proposed as an appropriate means to the current crisis. This study identifies the mental health needs of students at a rural college as they pertain to the effects of the pandemic. Questionnaires collected data from college students (N=33) at Athens State University, a rural university in north Alabama, to understand the effects of the COVID-19 pandemic on their mental health and well-being. Data obtained from the 58-question instrument were analyzed through quantitative and qualitative methods. Results Data revealed that 33/33 (100%) students indicated higher levels of anxiety and stress due to the outbreak. Stressors contributing to the increased anxiety, stress, and depressive symptoms included anticipated duration of the pandemic (31/33, 93.9%), stress of current financial situation (24/33, 72.7%), uncertainty of the future (31/33, 93.9%), decreased social interactions and sense of community with peers (29/33, 87.9%), concerns about the health of loved ones and self (33/33, 100%). Students described a high level of comfort in participation in a flexible learning environment (31/33, 93.9%). Students identified various coping mechanisms. The results of our study underscore the need for directed mental health interventions for college students and flexible platforms of study. Consideration of developing a flexible learning environment should be included as part of directed mental health interventions

Algal genomes reveal evolutionary mosaicism and the fate of nucleomorphs

Cryptophyte and chlorarachniophyte algae are transitional forms in the widespread secondary endosymbiotic acquisition of photosynthesis by engulfment of eukaryotic algae. Unlike most secondary plastid-bearing algae, miniaturized versions of the endosymbiont nuclei (nucleomorphs) persist in cryptophytes and chlorarachniophytes. To determine why, and to address other fundamental questions about eukaryote–eukaryote endosymbiosis, we sequenced the nuclear genomes of the cryptophyte Guillardia theta and the chlorarachniophyte Bigelowiella natans. Both genomes have \u3e21,000 protein genes and are intron rich, and B. natans exhibits unprecedented alternative splicing for a single-celled organism. Phylogenomic analyses and subcellular targeting predictions reveal extensive genetic and biochemical mosaicism, with both host- and endosymbiont-derived genes servicing the mitochondrion, the host cell cytosol, the plastid and the remnant endosymbiont cytosol of both algae. Mitochondrion-to-nucleus gene transfer still occurs in both organisms but plastid-to-nucleus and nucleomorph-to-nucleus transfers do not, which explains why a small residue of essential genes remains locked in each nucleomorph

Evaluation of the Yard Gard Ultrasonic Yard Protector for Repelling White-Tailed Deer

Ultrasonic devices are marketed for pest control because some manufacturers believe they possess properties aversive to animals. However, there is little evidence that ultrasound is more aversive to animals than is audible sound. In this study, we examined the efficacy of the Yard Gard ultrasonic device for deterring deer (Odocoileus virginianus) from feeding on apples. Four deer feeding stations were established at private residential properties with a history of deer damage to ornamental plants, so that control (A1 and B1) and experimental (A2 and B2) stations existed at each site. Apples were placed at each feeding station and restocked daily from mid-February to mid-March 1995. Yard Gard devices were set up at one station at each site, and we monitored daily deer activity by counting: (1) apples remaining, (2) deer tracks, and (3) deer fecal pellet groups at all feeding stations. Of the 360 total apples offered at site A while the devices were on, 175.0 (97.2%) and 179.5 (99.7%) apples were consumed at control (A1) and experimental (A2) stations, respectively. Of the 400 total apples offered at site B while the devices were on, 188 (94.0%) and 196.5 (98.3%) apples were consumed at control (B1) and experimental (B2) stations, respectively. Apple consumption at feeding stations proved to be the only quantitative data which provided a consistent measure of deer activity. Behavioral observations made at each site revealed that several deer visited the control and experimental feeding stations while Yard Gard devices were on. Apparently, the deer were alerted by the ultrasonic emissions but were not deterred from consuming apples. In conclusion, this study produced no evidence that the Yard Gard ultrasonic device protected the area from deer activity, or preferred foods from deer damage

Development of a prescribing indicator for objective quantification of antibiotic usage in secondary care

Objectives: To compare the recognized defined daily dose per 100 bed-days (DDD/100 bed-days) measure with the defined daily dose per finished consultant episode (DDD/FCE) in a group of hospitals with a variety of medicines management strategies. To compare antibiotic usage using the above indicators in hospitals with and without electronic prescribing systems. Methods: Twelve hospitals were used in the study. Nine hospitals were selected and split into three cohorts (three high-scoring, three medium-scoring and three low-scoring) by their 2001 medicines management self-assessment scores (MMAS). An additional cohort of three electronic prescribing hospitals was included for comparison. MMAS were compared to antibiotic management scores (AMS) developed from a questionnaire relating specifically to control of antibiotics. FCEs and occupied bed-days were obtained from published statistics and statistical analyses of the DDD/100 bed-days and DDD/FCE were carried out using SPSS. Results: The DDD/100 bed-days varied from 81.33 to 189.37 whilst the DDD/FCE varied from 2.88 to 7.43. The two indicators showed a high degree of correlation with r = 0.74. MMAS were from 9 to 22 (possible range 0-23) and the AMS from 2 to 13 (possible range 0-22). The two scores showed a high degree of correlation with r = 0.74. No correlation was established between either indicator and either score. Conclusions: The WHO indicator for medicines utilization, DDD/100 bed-days, exhibited the same level of conformity as that exhibited from the use of the DDD/FCE indicating that the DDD/FCE is a useful additional indicator for identifying hospitals which require further study. The MMAS can be assumed to be an accurate guide to antibiotic medicines management controls. No relationship has been found between a high degree of medicines management control and the quantity of antibiotic prescribed. © The British Society for Antimicrobial Chemotherapy; 2004 all rights reserved

Characterization of Prepreg Tack for Composite Manufacturing by Automated Fiber Placement

Automated fiber placement (AFP) has become the industry standard for large-scale production of carbon fiber reinforced plastics (CFRP) to improve rate and reduce defects associated with manual layup. Still, defects generated during AFP processes require manual, painstaking inspection by technicians and rework of the part when substantial defects are found. Prepreg (carbon fiber infused with uncured epoxy resin) tack is one of the primary factors that influences the generation of defects that arise during auto-mated fiber placement (AFP). Tack, as it relates to AFP processes and defect formation, can be understood as a combination of two stages, cohesion and decohesion. During the cohesion phase, two pieces of prepreg are brought into contact under elevated temperature and pressure. Compaction of the resin within the contact area will result in a degree of intimate contact, I, between the mating prepreg surfaces. Defect formation, as a result of decohesion between prepreg surfaces, occurs after the cohesion phase and arises due to stress from events such as fiber placement over an existing defect, on a contoured path, etc. (Figure 1). Tack strength resists the displacement of prepreg on a surface due to stresses developed during deposition

Fire effects on temperate forest soil C and N storage

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/116995/1/eap20112141189.pd

Airborne Simulation of Launch Vehicle Dynamics

In this paper we present a technique for approximating the short-period dynamics of an exploration-class launch vehicle during flight test with a high-performance surrogate aircraft in relatively benign endoatmospheric flight conditions. The surrogate vehicle relies upon a nonlinear dynamic inversion scheme with proportional-integral feedback to drive a subset of the aircraft states into coincidence with the states of a time-varying reference model that simulates the unstable rigid body dynamics, servodynamics, and parasitic elastic and sloshing dynamics of the launch vehicle. The surrogate aircraft flies a constant pitch rate trajectory to approximate the boost phase gravity-turn ascent, and the aircraft's closed-loop bandwidth is sufficient to simulate the launch vehicle's fundamental lateral bending and sloshing modes by exciting the rigid body dynamics of the aircraft. A novel control allocation scheme is employed to utilize the aircraft's relatively fast control effectors in inducing various failure modes for the purposes of evaluating control system performance. Sufficient dynamic similarity is achieved such that the control system under evaluation is optimized for the full-scale vehicle with no changes to its parameters, and pilot-control system interaction studies can be performed to characterize the effects of guidance takeover during boost. High-fidelity simulation and flight test results are presented that demonstrate the efficacy of the design in simulating the Space Launch System (SLS) launch vehicle dynamics using NASA Dryden Flight Research Center's Full-scale Advanced Systems Testbed (FAST), a modified F/A-18 airplane, over a range of scenarios designed to stress the SLS's adaptive augmenting control (AAC) algorithm

Airborne Simulation of Launch Vehicle Dynamics

In this paper we present a technique for approximating the short-period dynamics of an exploration-class launch vehicle during flight test with a high-performance surrogate aircraft in relatively benign endoatmospheric flight conditions. The surrogate vehicle relies upon a nonlinear dynamic inversion scheme with proportional-integral feedback to drive a subset of the aircraft states into coincidence with the states of a time-varying reference model that simulates the unstable rigid body dynamics, servodynamics, and parasitic elastic and sloshing dynamics of the launch vehicle. The surrogate aircraft flies a constant pitch rate trajectory to approximate the boost phase gravity turn ascent, and the aircraft's closed-loop bandwidth is sufficient to simulate the launch vehicle's fundamental lateral bending and sloshing modes by exciting the rigid body dynamics of the aircraft. A novel control allocation scheme is employed to utilize the aircraft's relatively fast control effectors in inducing various failure modes for the purposes of evaluating control system performance. Sufficient dynamic similarity is achieved such that the control system under evaluation is configured for the full-scale vehicle with no changes to its parameters, and pilot-control system interaction studies can be performed to characterize the effects of guidance takeover during boost. High-fidelity simulation and flight-test results are presented that demonstrate the efficacy of the design in simulating the Space Launch System (SLS) launch vehicle dynamics using the National Aeronautics and Space Administration (NASA) Armstrong Flight Research Center Fullscale Advanced Systems Testbed (FAST), a modified F/A-18 airplane (McDonnell Douglas, now The Boeing Company, Chicago, Illinois), over a range of scenarios designed to stress the SLS's Adaptive Augmenting Control (AAC) algorithm