Determinants of antibiotic prescribing for upper respiratory tract infections in an emergency department with good primary care access: a qualitative analysis

Upper respiratory tract infections (URTIs) account for substantial attendances at emergency departments (EDs). There is a need to elucidate determinants of antibiotic prescribing in time-strapped EDs – popular choices for primary care despite highly accessible primary care clinics. Semi-structured in-depth interviews were conducted with purposively sampled physicians (n = 9) in an adult ED in Singapore. All interviews were analysed using thematic analysis and further interpreted using the Social Ecological Model to explain prescribing determinants. Themes included: (1) reliance on clinical knowledge and judgement, (2) patient-related factors, (3) patient–physician relationship factors, (4) perceived practice norms, (5) policies and treatment guidelines and (6) patient education and awareness. The physicians relied strongly on their clinical knowledge and judgement in managing URTI cases and seldom interfered with their peers’ clinical decisions. Despite departmental norms of not prescribing antibiotics for URTIs, physicians would prescribe antibiotics when faced with uncertainty in patients’ diagnoses, treating immunocompromised or older patients with comorbidities, and for patients demanding antibiotics, especially under time constraints. Participants had a preference for antibiotic prescribing guidelines based on local epidemiology, but viewed hospital policies on prescribing as a hindrance to clinical judgement. Participants highlighted the need for more public education and awareness on the appropriate use of antibiotics and management of URTIs. Organisational practice norms strongly influenced antibiotic prescribing decisions by physicians, who can be swayed by time pressures and patient demands. Clinical decision support tools, hospital guidelines and patient education targeting at individual, interpersonal and community levels could reduce unnecessary antibiotic use

Search for Gravitational Waves Associated with Gamma-Ray Bursts Detected by Fermi and Swift during the LIGO-Virgo Run O3b

We search for gravitational-wave signals associated with gamma-ray bursts (GRBs) detected by the Fermi and Swift satellites during the second half of the third observing run of Advanced LIGO and Advanced Virgo (2019 November 1 15:00 UTC-2020 March 27 17:00 UTC). We conduct two independent searches: A generic gravitational-wave transients search to analyze 86 GRBs and an analysis to target binary mergers with at least one neutron star as short GRB progenitors for 17 events. We find no significant evidence for gravitational-wave signals associated with any of these GRBs. A weighted binomial test of the combined results finds no evidence for subthreshold gravitational-wave signals associated with this GRB ensemble either. We use several source types and signal morphologies during the searches, resulting in lower bounds on the estimated distance to each GRB. Finally, we constrain the population of low-luminosity short GRBs using results from the first to the third observing runs of Advanced LIGO and Advanced Virgo. The resulting population is in accordance with the local binary neutron star merger rate. © 2022. The Author(s). Published by the American Astronomical Society

Narrowband Searches for Continuous and Long-duration Transient Gravitational Waves from Known Pulsars in the LIGO-Virgo Third Observing Run

Isolated neutron stars that are asymmetric with respect to their spin axis are possible sources of detectable continuous gravitational waves. This paper presents a fully coherent search for such signals from eighteen pulsars in data from LIGO and Virgo's third observing run (O3). For known pulsars, efficient and sensitive matched-filter searches can be carried out if one assumes the gravitational radiation is phase-locked to the electromagnetic emission. In the search presented here, we relax this assumption and allow both the frequency and the time derivative of the frequency of the gravitational waves to vary in a small range around those inferred from electromagnetic observations. We find no evidence for continuous gravitational waves, and set upper limits on the strain amplitude for each target. These limits are more constraining for seven of the targets than the spin-down limit defined by ascribing all rotational energy loss to gravitational radiation. In an additional search, we look in O3 data for long-duration (hours-months) transient gravitational waves in the aftermath of pulsar glitches for six targets with a total of nine glitches. We report two marginal outliers from this search, but find no clear evidence for such emission either. The resulting duration-dependent strain upper limits do not surpass indirect energy constraints for any of these targets. © 2022. The Author(s). Published by the American Astronomical Society

Development of an integrated CAD-FEA process for below-knee prosthetic sockets

10.1016/j.clinbiomech.2005.02.005Clinical Biomechanics206623-629CLBI

Steady and unsteady thermal analysis of a triple stack cold plate with heat losses

Purpose - To provide some new and additional data for the design of a triple stack cold plate. Design/methodology/approach - A detailed finite element formulation for the triple stack cold plate with and without heat losses from the top and bottom surfaces of the stack is presented to determine its performance under steady as well as unsteady conditions. The effects of the number of unit cells, different heat losses as well as the governing dimensionless parameter, M (involving stack dimension, properties of the stack material and the variation in the heat transfer coefficient) on the performance of the stack are investigated. The detailed formulation of the asymptotic waveform. evaluation scheme is also given and applied to determine the transient performance of the stack. Findings - The methods of analysis described are quite simple to use to determine the steady and unsteady performance of the triple stack cold plate under different operating conditions. The heat losses from the top and bottom surfaces of the stack do affect the maximum temperature of the stack and in such case, the assembled stack should be analysed. Research limitations/implications - The analysis is limited to an incompressible fluid. The effect of varying mass flow rate of the fluid in the stack passages is also not considered. Practical implications - New and additional generated data will be helpful in the design of cold plates used in the cooling of electronic components. Originality/value - The asymptotic waveform evaluation scheme is used for the first time to determine the transient performance of the triple stack cold plate under different operating conditions. The results thus obtained are compared well with those found from the finite element analysis (FEM), but the computational effort and time required in the analysis is much small as compared to those required in the FEM analysis

In-vitro function of upstream visfatin polymorphisms that are associated with adverse cardiometabolic parameters in obese children

10.1186/s12864-016-3315-9BMC Genomics17197

Differences in AMY1 gene copy numbers derived from blood, buccal cells and saliva using quantitative and droplet digital PCR methods: Flagging the pitfall

10.1371/journal.pone.0170767PLoS ONE121e017076

Dengue virus activates cGAS through the release of mitochondrial DNA

10.1038/s41598-017-03932-1Scientific Reports71359

Infectivity and development of Metagonimus yokogawai in experimentally infected domestic ducks (Cairina moschata)

Information concerning whether fowl Such as duck is a suitable reservoir host of Metagonimus yokogawai is largely unclear to date In the present Study, the growth and development of M yokogawai metacercaria (Mc) in domestic duck (Carma moschata) was determined by worm recovery rate (WRR) and morphological changes e.g, the size of fluke's body as well as their internal organs was assessed by using Semichon's acetocarmine staining. Each duck was orally inoculated with 50 Mcs of M yokogawal and infected ducks were deeply anesthetized with ether and killed at 1, 2, 3. 4, 5, 6, 7, and 14 days post-infection (DPI) On each date, two infected ducks were killed and the small intestines of each duck were separated into four parts then they were opened longitudinally to harvest the flukes. Results revealed that WRR of M yokogawal from inoculated ducks increased during early infection with a peak as seen at 4 DPI (28 5 +/- 6 9%), thereafter it gradually decreased and a drastic decline was observed Ill 14 DPI (2 0 +/- 1 1%) in the trial. The preference sites for M yokogawai were low portions of the small intestine. nevertheless the size Of fluke's body and organs developed increasingly with time and they maturated to produce ova from 4 DPI onward in the trial However. present results indicated that ducks. based oil the findings of this study, are not suitable hosts for establishment of M yokogawai infection because most flukes were expelled from duck's intestine within 14 days Nevertheless, it was proposed that ducks might play a certain role in transmitting M yokogawai when they deposited the ova via feces into marsh where snails and fish were abundant since they could presumably establish transient and possibly patent infections with this parasite Crown Copyright (C) 2009 Published by Elsevier B V All rights reserve