Does Telemedicine Affect Physician Decisions? Evidence from Antibiotic Prescriptions

Telemedicine has long been of interest to the U.S. general public. Yet, despite the advent of high-speed internet and mobile device technology, telemedicine did not reach its full potential until the COVID-19 pandemic spurred its unparalleled adoption. This sudden shift in the setting of healthcare delivery raises questions regarding possible changes in clinical decision-making. Using a unique set of patient-provider encounter data from the U.S. in 2020 and 2021, we examine the effect of telemedicine on antibiotic prescription errors for urinary tract infections. After accounting for potential endogeneity issues using provider fixed effects and an instrumental variable approach, we find a significantly lower likelihood of prescription errors with telemedicine relative to in-person encounters. We also find heterogeneous effects by a provider's patient volume and the patient-provider relationship

A review of basic soil constitutive models for geotechnical application

Solutions in soil constitutive modeling have been based upon Hooke’s law of linear elasticity for describing soil behaviour under working loading condition and Coulomb’s law of perfect plasticity for describing soil behaviour under collapse state because of its simplicity in applications. The combination and generalization of Hooke and Coulomb’s law is formulated in a plasticity framework and is known as Mohr-Coulomb model. However, it is well known that soils are not linearly elastic and perfectly platic for the entire range of loading. In fact, actual behaviour of soils is very complicated and it shows a great variety of behaviour when subjected to different conditions. Various constitutive models have been proposed by several researchers to describe various aspects of soil behaviour in details and also to apply such models in finite element modelling for geotechnical engineering applications. Recent published evolution of models used for soft soils and tunnels for the past 30 years was also presented. It must be emphasized here that no soil constitutive model available that can completely describe the complex behaviour of real soils under all conditions. This paper attempts to collaborate the efforts from various researchers and present the discussion on each models with advantages and limitations for the purpose of giving an overview comparison of various soil models for engineering applications

The composite picture of the charge carriers in La2-xSrxCuO4 (0.063 < x < 0.11) superconductors

Through far-infrared studies of La2-xSrxCuO4 single crystals for x = 0.063, 0.07, 0.09, and 0.11, we found that only ~ 0.2 % of the total holes participated in the nearly dissipationless normal state charge transport and superconductivity. We have also observed characteristic collective modes at w ~ 18 cm-1 and 22 cm-1 due to the bound carriers in an electronic lattice (EL) state and the free carriers are massively screened by the EL. Our findings lead us to propose a composite picture of the charge system where the free carriers are coupled to and riding on the EL. This unique composite system of charge carriers may provide further insights into the understanding of the cuprate physics.Comment: 10 pages, 4 figure

Simulation of the deflected cutting tool trajectory in complex surface milling

Since industry is rapidly developing, either locally or globally, manufacturers witness harder challenges due to the growing competitivity. This urges them to better consider the four factors linked to production and output: quality, quantity, cost and price, quality being of course the most important factor which constitutes their main concern. Efforts will be concentrated—in this research—on improving the quality and securing more accuracy for a machined surface in ball-end milling. Quality and precision are two essential criteria in industrial milling. However, milling errors and imperfections, duemainly to the cutting tool deflection, hinder the full achieving of these targets. Our task, all along this paper, consists in studying and realizing the simulation of the deflected cutting tool trajectory, by using the methods which are available. In a future stage, and in the frame of a deeper research, the simulation process will help to carry out the correction and the compensation of the errors resulting from the tool deflection. The corrected trajectory which is obtained by the method mirror will be sent to the machine. To achieve this goal, the next process consists—as a first step—in selecting a model of cutting forces for a ball-end mill. This allows to define—later on—the behavior of this tool, and the emergence of three methods namely the analytical model, the finite elements method, and the experimental method. It is possible to tackle the cutting forces simulation, all along the tool trajectory, while this latter is carrying out the sweeping of the part to be machined in milling and taking into consideration the cutting conditions, as well as the geography of the workpiece. A simulation of the deflected cutting tool trajectory dependent on the cutting forces has been realized

Significant Short-Term Shifts in the Microbiomes of Smokers With Periodontitis After Periodontal Therapy With Amoxicillin & Metronidazole as Revealed by 16S rDNA Amplicon Next Generation Sequencing

The aim of this follow-up study was, to compare the effects of mechanical periodontal therapy with or without adjunctive amoxicillin and metronidazole on the subgingival microbiome of smokers with periodontitis using 16S rDNA amplicon next generation sequencing. Fifty-four periodontitis patients that smoke received either non-surgical periodontal therapy with adjunctive amoxicillin and metronidazole (n = 27) or with placebos (n = 27). Subgingival plaque samples were taken before and two months after therapy. Bacterial genomic DNA was isolated and the V4 hypervariable region of the bacterial 16S rRNA genes was amplified. Up to 96 libraries were normalized and pooled for Illumina MiSeq paired-end sequencing with almost fully overlapping 250 base pairs reads. Exact ribosomal sequence variants (RSVs) were inferred with DADA2. Microbial diversity and changes on the genus and RSV level were analyzed with non-parametric tests and a negative binomial regression model, respectively. Before therapy, the demographic, clinical, and microbial parameters were not significantly different between the placebo and antibiotic groups. Two months after the therapy, clinical parameters improved and there was a significantly increased dissimilarity of microbiomes between the two groups. In the antibiotic group, there was a significant reduction of genera classified as Porphyromonas, Tannerella, and Treponema, and 22 other genera also decreased significantly, while Selenomonas, Capnocytophaga, Actinomycetes, and five other genera significantly increased. In the placebo group, however, there was not a significant decrease in periodontal pathogens after therapy and only five other genera decreased, while Veillonella and nine other genera increased. We conclude that in periodontitis patients who smoke, microbial shifts occurred two months after periodontal therapy with either antibiotics or placebo, but genera including periodontal pathogens decreased significantly only with adjunctive antibiotics

Modeling of passive piles - an overview

Piles subjected to lateral loading from the moving soils is known as passive piles. These passive load induces forces and bending moment in piles that can lead to serviceability problems or even failure of the piles itself. This area of research is not recent and there were countless works that has been documented for the last three decades. In this paper, a review was conducted based on existing literatures and then classified to address four topics, namely; pile subjected to horizontal soil movement, pile-supported embankment, piles for slope stabilization, piles adjacent to deep excavation and failures of piles in open excavation. In addition, this paper intends to present a general overview on the state-of the-art research for passive piles. Based on the summary, passive piles in open excavation may indeed proved to be another recent and significant area of research that should be emphasized, as this will have invaluable contribution to the deep foundation industry

Gene expression drives the evolution of dominance.

Dominance is a fundamental concept in molecular genetics and has implications for understanding patterns of genetic variation, evolution, and complex traits. However, despite its importance, the degree of dominance in natural populations is poorly quantified. Here, we leverage multiple mating systems in natural populations of Arabidopsis to co-estimate the distribution of fitness effects and dominance coefficients of new amino acid changing mutations. We find that more deleterious mutations are more likely to be recessive than less deleterious mutations. Further, this pattern holds across gene categories, but varies with the connectivity and expression patterns of genes. Our work argues that dominance arises as a consequence of the functional importance of genes and their optimal expression levels

Pocket depth and bleeding on probing and their associations with dental, lifestyle, socioeconomic and blood variables: a cross-sectional, multicenter feasibility study of the German National Cohort

Background: To investigate the periodontal disease status in a multi-center cross-sectional study in Germany. Associations of dental, socio-economic, blood and biomedical variables with periodontal outcome parameters were evaluated. Methods: From 4 different centers N = 311 persons were included, drawn randomly from the registration offices. Maximal pocket depth (PD) was used as primary indicator for periodontitis. It was classified as: no/mild ≤3 mm, moderate 4-5 mm, severe ≥6 mm. Associations between socioeconomic (household income, education), lifestyle, and biomedical factors and PD or bleeding on probing (BOP) per site (“Yes”/”No”) was analyzed with logistic regression analysis. Results: Mean age of subjects was 46.4 (range 20–77) years. A significantly higher risk of deeper pockets for smokers (OR = 2.4, current vs. never smoker) or persons with higher BMI (OR = 1.6, BMI increase by 5) was found. Severity of periodontitis was significantly associated with caries lesions (p = 0.01), bridges (p < .0001), crowns (p < .0001), leukocytes (p = 0.04), HbA1c (p &lt; .0001) and MCV (p = 0.04). PD was positively correlated with BOP. No significant associations with BOP were found in regression analysis. Conclusions: Earlier findings for BMI and smoking with severity of PD were confirmed. Dental variables might be influenced by potential confounding factors e.g. dental hygiene. For blood parameters interactions with unknown systemic diseases may exist

a cross-sectional, multicenter feasibility study of the German National Cohort

Background To investigate the periodontal disease status in a multi-center cross-sectional study in Germany. Associations of dental, socio-economic, blood and biomedical variables with periodontal outcome parameters were evaluated. Methods From 4 different centers N = 311 persons were included, drawn randomly from the registration offices. Maximal pocket depth (PD) was used as primary indicator for periodontitis. It was classified as: no/mild ≤3 mm, moderate 4-5 mm, severe ≥6 mm. Associations between socioeconomic (household income, education), lifestyle, and biomedical factors and PD or bleeding on probing (BOP) per site (“Yes”/”No”) was analyzed with logistic regression analysis. Results Mean age of subjects was 46.4 (range 20–77) years. A significantly higher risk of deeper pockets for smokers (OR = 2.4, current vs. never smoker) or persons with higher BMI (OR = 1.6, BMI increase by 5) was found. Severity of periodontitis was significantly associated with caries lesions (p = 0.01), bridges (p < .0001), crowns (p < .0001), leukocytes (p = 0.04), HbA1c (p < .0001) and MCV (p = 0.04). PD was positively correlated with BOP. No significant associations with BOP were found in regression analysis. Conclusions Earlier findings for BMI and smoking with severity of PD were confirmed. Dental variables might be influenced by potential confounding factors e.g. dental hygiene. For blood parameters interactions with unknown systemic diseases may exist