Low-perigee aerodynamic heating during orbital flight of an atmosphere Explorer

An extensive, low-perigee orbital aerodynamic heating study was undertaken in support of the Atmosphere Explorer-C Temperature Alarm. State of the art of low-density, high-speed flows, some models of the earth's atmosphere, external flow-field definition, thermodynamic and transport properties of atmospheric gases, the accommodation coefficient orbital thermal environment, and correlation of theory and measurements are discussed. Aerodynamic heating rates are determined for eight selected orbits by means of a reduced, analytical model verified by both ground test and flight data. These heating rates are compared with classical free-molecule and first-order collision regime values

Short-patch correction of C/C mismatches in human cells

We examined whether the human nucleotide excision repair complex, which is specialized on the removal of bulky DNA adducts, also displays a correcting activity on base mismatches. The cytosine/cytosine (C/C) lesion was used as a model substrate to monitor the correction of base mismatches in human cells. Fibroblasts with different repair capabilities were transfected with shuttle vectors that contain a site-directed C/C mismatch in the replication origin, accompanied by an additional C/C mismatch in one of the flanking sequences that are not essential for replication. Analysis of the vector progeny obtained from these doubly modified substrates revealed that C/C mismatches were eliminated before DNA synthesis not only in the repair-proficient background, but also when the target cells carried a genetic defect in long-patch mismatch repair, in nucleotide excision repair, or when both pathways were deleted. Furthermore, cells deficient for long-patch mismatch repair as well as a cell line that combines mismatch and nucleotide excision repair defects were able to correct multiple C/C mispairs, placed at distances of 21-44 nt, in an independent manner, such that the removal of each lesion led to individual repair patches. These results support the existence of a concurrent short-patch mechanism that rectifies C/C mismatche

The Visual Patient Avatar ICU Facilitates Information Transfer of Written Information by Visualization: A Multicenter Comparative Eye-Tracking Study

Patient monitoring is crucial in critical care medicine. Perceiving and interpreting multiple vital signs requires a high workload that can lead to decreased situation awareness and consequently inattentional blindness, defined as impaired perception of unexpectedly changing data. To facilitate information transfer, we developed and validated the Visual-Patient avatar. Generated by numerical data, the animation displays the status of vital signs and patient installations according to a user-centered design to improve situation awareness. As a surrogate parameter for information transfer in patient monitoring, we recorded visual attention using eye-tracking data. In this computer-based study, we compared the correlation of visually perceived and correctly interpreted vital signs between a Visual-Patient-avatar ICU and conventional patient monitoring. A total of 50 recruited study participants (25 nurses, 25 physicians) from five European study centers completed five randomized scenarios in both modalities. Using a stationary eye tracker as the primary endpoint, we recorded how long different areas of interest of the two monitoring modalities were viewed. In addition, we tested for a possible association between the length of time an area of interest was viewed and the correctness of the corresponding question. With the conventional monitor, participants looked at the installation site the longest (median 2.13–2.51 s). With the Visual-Patient-avatar ICU, gaze distribution was balanced; no area of interest was viewed for particularly long. For both modalities, the longer an area was viewed, the more likely the associated question was answered incorrectly (OR 0.97, 95% CI 0.95–0.99, p = 0.008). The Visual-Patient-avatar ICU facilitates and improves information transfer through its visualizations, especially with written information. The longer an area of interest was viewed, the more likely the associated question was answered incorrectly

Prolonged decrease in heart rate variability after elective hip arthroplasty

The pattern of postoperative heart rate variability may provide insight into the response of the autonomic nervous system to anaesthesia and surgery. We have obtained spectral (fast Fourier transform) and non-spectral indices of heart rate variability from electrocardiographic recordings, sampled during continuous perioperative Holter monitoring in 15 otherwise healthy patients with an uncomplicated postoperative course, undergoing elective hip arthroplasty with either spinal or general anaesthesia. In both groups, total spectral energy (0.01-1 Hz), low-frequency spectral energy (0.01-0.15 Hz) and high-frequency spectral energy (0.15-0.40 Hz) decreased after surgery to 32% (95% confidence interval (Cl) 10.5; P <0.01), 29% (95% Cl 12.5; P <0.07; and 33% (95% Cl 12.5; P <0.01) of their preoperative values, respectively, and these indices remained suppressed for up to 5 days. Non-spectral indices decreased to a similar extent. These findings indicate a substantial and prolonged postoperative decrease in both parasympathetic and sympathetic influence on the sinus nod

Ergebnisse einer Umfrage zur ­Verschreibung von Antibiotika in der ­Veterinärmedizin

English Outcome of a survey on antibiotic prescribing in veterinary medicine As part of the national strategy on antibiotic resistance (StAR), a therapy guide for the prudent prescription of antimicrobial agents in animals was developed. To facilitate its implementation in the veterinary practice, the therapy recommendations contained therein have been translated to the user-friendly decision support AntibioticScout.ch. In this context, we conducted a non-representative survey to assess the level of awareness as well as usage of this guide and the AntibioticScout.ch decision support. Based on case studies with typical diseases in dogs, cats and cattle, it was shown that the veterinarians participating in the survey strive to handle antibiotics responsibly and to prescribe them with restraint. Nevertheless, the survey points to possible improvements in the antibiotic therapy. In particular, the StAR guidelines or AntibioticScout.ch can be useful to the practicing veterinarians for taking into account all relevant decision criteria in the optimal selection of a suitable antimicrobial agent. Keywords: AntibioticScout; Decision support; Prescribing behavior; Survey; Veterinary medicine Deutsch Ergebnisse einer Umfrage zur ­Verschreibung von Antibiotika in der ­Veterinärmedizin Im Rahmen der nationalen Strategie Antibiotikaresistenzen (StAR) wurde ein Therapieleitfaden für die umsichtige Verschreibung von antimikrobiellen Wirkstoffen bei Tieren erarbeitet. Um dessen Umsetzung in der tierärztlichen Praxis zu erleichtern, sind die darin enthaltenen Therapieempfehlungen in die benutzerfreundliche Entscheidungshilfe AntibioticScout.ch überführt worden. In diesem Zusammenhang haben wir eine nicht-repräsentative Umfrage durchgeführt um Bekanntheitsgrad und Nutzung dieses Leitfadens bzw. der Entscheidungshilfe AntibioticScout.ch einzuschätzen. Anhand von Fallbeispielen mit typischen Erkrankungen bei Hunden, Katzen und Rindern zeigte sich, dass die an der Befragung teilnehmenden Tierärztinnen und Tierärzte bestrebt sind, verantwortungsvoll mit Antibiotika umzugehen und diese Wirkstoffe zurückhaltend zu verschreiben. Trotzdem weist die Umfrage auf Verbesserungsmöglichkeiten in der Antibiotikatherapie hin. Der StAR-Therapieleitfaden und AntibioticScout.ch können insbesondere für die Berücksichtigung aller relevanten Entscheidungskriterien bei der optimalen Auswahl eines geeigneten antimikrobiellen Wirkstoffes der Tierärzteschaft dienlich sein. Schlüsselwörter: AntibioticScout; Entscheidungshilfe; ­Umfrage; Verschreibungsverhalten; Veterinärmedizin Français Résultats d’une enquête sur la ­prescription d’antibiotiques en ­médicine vétérinaire Dans le cadre de la stratégie nationale de résistance aux antibiotiques (StAR), un guide thérapeutique pour la prescription prudente d'agents antimicrobiens chez les animaux a été élaboré. Pour faciliter son application dans la pratique vétérinaire, les recommandations thérapeutiques qu'il contient ont été transférées dans l'aide à la décision conviviale en-ligne AntibioticScout.ch. Dans ce contexte, nous avons mené une enquête non représentative pour évaluer le niveau de connaissance et l’utilisation de ce guide de l'aide à la decision AntibioticScout.ch. Sur la base d'études de cas portant sur des maladies typiques des chiens, des chats et des bovins, il a été démontré que les vétérinaires participant à l'enquête s'efforcent d’ utiliser les antibiotiques de manière responsable et de les prescrire avec modération. Néanmoins, l'enquête met en évidence les améliorations possibles de la thérapie antibiotique. Le guide thérapeutique StAR ou AntibioticScout.ch peut être particulièrement utile à la profession vétérinaire pour prendre en compte tous les critères de décision pertinents dans la sélection optimale d'un agent antimicrobien approprié. Mots-clés: AntibioticScout; aide à la décision; enquéte; comportement de prescription; médecine vétérinaire Italiano Risultati di un sondaggio sulla ­prescrizione di antibiotici in medicina veterinaria Come parte della strategia nazionale di resistenza agli antibiotici (StAR), è stata sviluppata una guida terapeutica per la prescrizione prudente di agenti antimicrobici negli animali. Per facilitarne l'attuazione nella pratica veterinaria, le raccomandazioni terapeutiche ivi contenute sono state trasferite nell'aiuto decisionale di facile utilizzo AntibioticScout.ch. In questo contesto, abbiamo condotto un sondaggio non rappresentativo per valutare il livello di conoscenza e l’utilizzo di questa guida e del supporto decisionale AntibioticScout.ch. Sulla base di studi di casi con malattie tipiche di cani, gatti e bovini, è stato dimostrato che i veterinari che hanno partecipato all'indagine si sforzano di gestire gli antibiotici in modo responsabile e di prescriverli con moderazione. Tuttavia, il sondaggio indica possibili miglioramenti nella terapia antibiotica. La guida alla terapia StAR o AntibioticScout.ch può essere particolarmente utile ai professionisti veterinari per tenere conto di tutti i criteri decisionali rilevanti nella scelta ottimale di un agente antimicrobico adatto. Parole chiavi: AntibioticScout; supporto alle decisioni; sondaggio; comportamento prescrittivo; medicina veterinari

Effect of antimicrobial stewardship on antimicrobial prescriptions for selected diseases of dogs in Switzerland.

BACKGROUND Antimicrobial stewardship programs (ASPs) are important tools to foster prudent antimicrobial use. OBJECTIVE To evaluate antimicrobial prescriptions by Swiss veterinarians before and after introduction of the online ASP AntibioticScout.ch in December 2016. ANIMALS Dogs presented to 2 university hospitals and 14 private practices in 2016 or 2018 for acute diarrhea (AD; n = 779), urinary tract infection (UTI; n = 505), respiratory tract infection (RTI; n = 580), or wound infection (WI; n = 341). METHODS Retrospective study. Prescriptions of antimicrobials in 2016 and 2018 were compared and their appropriateness assessed by a justification score. RESULTS The proportion of dogs prescribed antimicrobials decreased significantly between 2016 and 2018 (74% vs 59%; P < .001). The proportion of prescriptions in complete agreement with guidelines increased significantly (48% vs 60%; P < .001) and those in complete disagreement significantly decreased (38% vs 24%; P < .001) during this time. Antimicrobial prescriptions for dogs with AD were significantly correlated with the presence of hemorrhagic diarrhea in both years, but a significantly lower proportion of dogs with hemorrhagic diarrhea were unnecessarily prescribed antimicrobials in 2018 (65% vs 36%; P < .001). In private practices, in 2018 a bacterial etiology of UTI was confirmed in 16% of dogs. Prescriptions for fluoroquinolones significantly decreased (29% vs 14%; P = .002). Prescriptions for antimicrobials decreased significantly in private practices for RTI (54% vs 31%; P < .001). CONCLUSION Antimicrobials were used more prudently for the examined indications in 2018 compared to 2016. The study highlights the continued need for ASPs in veterinary medicine

Morphology, flow dynamics and evolution of englacial conduits in cold ice

Meltwater routing through ice masses exerts a fundamental control over glacier dynamics and mass balance, and proglacial hydrology. However, despite recent advances in mapping drainage systems in cold, Arctic glaciers, direct observations of englacial channels and their flow conditions remain sparse. Here, using Terrestrial Laser Scanning (TLS) surveys of the main englacial channel of cold-based Austre Brøggerbreen (Svalbard), we map and compare an entrance moulin reach (122 m long) and exit portal reach (273 m long). Analysis of channel planforms, longitudinal profiles, cross-sections and morphological features reveals evidence of spatial variations in water flow conditions and channel incision mechanisms, and the presence of vadose, epiphreatic and phreatic conditions. The entrance reach, located at the base of a perennial moulin, was characterised by vadose, uniform, channel lowering at annual timescales, evidenced by longitudinal grooves, whereas the exit portal reach showed both epiphreatic and vadose conditions, along with upstream knickpoint migration at intra-annual timescales. Fine-scale features, including grooves and scallops, were readily quantified from the TLS point cloud, highlighting the capacity of the technique to inform palaeoflow conditions, and reveal how pulses of meltwater from rainfall events may adjust englacial conduit behaviour. With forecasts of increasing Arctic precipitation in the coming decades, and a progressively greater proportion of glaciers comprising cold ice, augmenting the current knowledge of englacial channel morphology is essential to constrain future glacier hydrological system change

Technical and Clinical Outcomes After Transcatheter Edge-to-Edge Repair of Mitral Regurgitation in Male and Female Patients: Is Equality Achieved?

Currently, no clear impact of sex on short- and long-term survival following transcatheter edge-to-edge mitral valve repair (TEER) is evident, although no data are available on postprocedural life expectancy. Our aim was to assess sex-specific differences in outcomes of patients with mitral regurgitation (MR) treated by TEER. Short-term and 5-year outcomes in men and women undergoing TEER between 2011 and 2018 who were included in the large, multicenter, real-world MitraSwiss registry were analyzed. Outcomes were compared stratified by sex and according to MR cause (primary versus secondary). The impact of TEER on postprocedural life expectancy was estimated by relative survival analysis. Among 1142 patients aged 60 to 89 years, 39.8% were women. They were older, with fewer cardiovascular risk factors and lower functional capacity compared with men. Thirty-day mortality was higher in men than in women (3.3% versus 1.1%; odds ratio, 3.16 [95% CI, 1.16-10.7]; P=0.020). Five-year survival was comparable in both sexes (adjusted hazard ratio for 5-year mortality in men, 1.14 [95% CI, 0.90-1.44], P=0.275). Both men and women with either primary or secondary MR showed similar clinical efficacy over time. TEER provided high relative survival estimates among all groups, and fully restored predicted life expectancy in women with primary MR (5-year relative survival estimate, 97.4% [95% CI, 85.5-107.0]). TEER is not associated with increased short-term mortality in women, whereas 5-year outcomes are comparable between sexes. Moreover, TEER completely restored normal life expectancy in women with primary MR. A residual excess mortality persists in secondary MR, independently of sex

Antimicrobial use for selected diseases in cats in Switzerland.

BACKGROUND Antibiotic use in human and veterinary medicine is considered a main driver of antimicrobial resistance. Although guidelines to promote appropriate use of antimicrobials in veterinary patients have been developed, antibiotic overprescription is assumed to be a common problem. The goal of this study was to investigate antimicrobial use in cats in Switzerland with acute upper respiratory tract disease (aURTD), feline lower urinary tract disease (FLUTD) and abscesses, and to assess compliance of prescription with consensus guidelines. A total of 776 cases (aURTD, n = 227; FLUTD, n = 333; abscesses, n = 216) presented to two university hospitals and 14 private veterinary practices in Switzerland during 2016 were retrospectively evaluated. Clinical history, diagnostic work-up and antimicrobial prescription (class, dosage, duration) were assessed. RESULTS A total of 77% (aURTD), 60% (FLUTD) and 96% (abscesses) of the cases received antibiotic therapy; 13-24% received combination or serial therapy. The cats were treated for a median of 7 (abscesses) and 10 days (aURTD, FLUTD). Treatments with potentiated aminopenicillins (40-64%), third generation cephalosporins (25-28%), aminopenicillins (12-24%) and fluoroquinolones (3-13%) were most common. Prescriptions were judged in complete accordance with consensus guidelines in 22% (aURTD), 24% (FLUTD) and 17% (abscesses) of the cases. Antibiotics were prescribed although not indicated in 34% (aURTD), 14% (FLUTD) and 29% (abscesses) of the cases. The presence of lethargy, anorexia or fever in cats with aURTD, and the detection of bacteriuria in cats with FLUTD were significantly associated with antibiotic therapy. Although diagnostic work-up was significantly more common (aURTD: university hospitals, 58%; private practices, 1%; FLUTD: university hospitals, 92%; private practices, 27%) and the use of critically important antibiotics significantly less common at the university hospitals (aURTD, 10%; FLUTD, 14%) compared to private practices (aURTD, 38%; FLUTD, 54%), the frequency of antibiotic treatment was not different between the university hospitals and private practices. CONCLUSIONS Our results indicate that overprescription of antibiotics in cats in Switzerland is common and accordance with guidelines is poor. The study highlights the need to promote antimicrobial stewardship in small animal medicine