The Utility of Trouble: Maximizing the Value of Our Human Services Dollars

Outlines recommendations to standardize service delivery areas and consolidate area offices of the state's seven largest human services agencies, as well as to close antiquated institutions. Projects benefits such as improved accessibility and savings

The potential negative impact of antibiotic pack on antibiotic stewardship in primary care in Switzerland: a modelling study.

BACKGROUND: In Switzerland, oral antibiotics are dispensed in packs rather than by exact pill-count. We investigated whether available packs support compliance with recommended primary care treatment regimens for common infections in children and adults. METHODS: Hospital-based guidelines for oral community -based treatment of acute otitis media, sinusitis, tonsillopharyngitis, community-acquired pneumonia and afebrile urinary tract infection were identified in 2017 in an iterative process by contacting hospital pharmacists and infectious diseases specialists. Furthermore, newly available national guidelines published in 2019 were reviewed. Available pack sizes for recommended solid, dispersible and liquid antibiotic formulations were retrieved from the Swiss pharmaceutical register and compared with recommended regimens to determine optimal (no leftovers) and adequate (optimal +/- one dose) matches. RESULTS: A large variety of recommended regimens were identified. For adults, optimal and adequate packs were available for 25/70 (36%) and 8/70 (11%) regimens, respectively. Pack-regimen matching was better for WHO Watch (optimal: 15/24, 63%) than Access antibiotics (optimal: 7/39, 18%). For the four paediatric weight-examples and 42 regimens involving child-appropriate formulations, optimal and adequate packs were available for only 14/168 (8%) and 27/168 (16%), respectively. Matching was better for older children with higher body and for longer treatment courses > 7 days. CONCLUSIONS: Fixed antibiotic packs often do not match recommended treatment regimens, especially for children, potentially resulting in longer than necessary treatments and leftover doses in the community. As part of national stewardship, a move to an exact pill-count system, including for child-appropriate solid formulations, should be considered

Impfungen gegen Pneumokokken und Influenza: Wie groß ist die Evidenz?

Zusammenfassung: Durch Pneumokokken verursachte Infektionen und die Influenza können bei Kindern und älteren Personen sowie bei chronisch Kranken und Immunosupprimierten zu schweren, komplizierten Verläufen führen. Bei der alternden Bevölkerung in westlichen Ländern sind sie wichtige Ursachen für erhöhte Morbidität und Letalität. Weltweit unterstreicht die Antibiotikaresistenzentwicklung die Notwendigkeit der effektiven Impfung. Der 23-valente Polysaccharidimpfstoff gegen Pneumokokken wird kontrovers diskutiert. Neue Metaanalysen zeigten keine/wenig Wirksamkeit der Impfung in Bezug auf invasive Pneumokokkenerkrankungen oder Gesamtletalität. Jedoch dokumentierte eine neue Studie bei Pflegeheimbewohnern eine signifikante Reduktion von Pneumonie und Tod durch Pneumokokkenerkrankungen nach Impfungen. Der 7-valente Konjugatimpfstoff ist bei Kindern und bei Immunosupprimierten deutlich immunogener und effizienter und ist im schweizerischen Impfplan für Kinder integriert. In Deutschland wurde er bereits durch den 13-valenten Konjugatimpfstoff ersetzt. Influenzaimpfungen sind gut immunogen. Dies wird durch Adjuvanzien bei einer älteren Bevölkerung erhöht. Aufgrund der pandemischen Influenza H1N1 2009 wurden die Impfempfehlungen und die Zusammensetzung der Impfstoffe durch die WHO für den Herbst/Winter 2010/2011 entsprechend angepasst. Die Influenzaimpfung bietet zwar keinen guten Schutz gegen die Ansteckung, jedoch einen guten Schutz gegen Komplikationen der Influenz

Nosokomiale Harnwegsinfektionen des Erwachsenen

Zusammenfassung: Die Harnwegsinfektion ist die häufigste Infektion des Erwachsenen im Spital. Sie ist meistens mit dem Tragen von Harnwegskathetern assoziiert. Entscheidend sind daher die richtige Indikationsstellung für die Kathetereinlage, die frühzeitige Wiederentfernung des Katheters sowie die korrekte Diagnosestellung zur Vermeidung unnötiger antibiotischer Behandlungen. Die therapeutischen Überlegungen sollten die Komorbiditäten und potenzielle Behinderungen des Urinabflusses mit einschließen. In der Behandlung stehen Chinolone, Breitspektrumpenizilline und Cephalosporine der 3.Generation im Vordergrund. Bei den ökonomischen Überlegungen sollte v.a. der höhere Preis von i.v.-Antibiotika im Vergleich zu per os mit einfließe

Finite-Volume Energy Spectrum, Fractionalized Strings, and Low-Energy Effective Field Theory for the Quantum Dimer Model on the Square Lattice

We present detailed analytic calculations of finite-volume energy spectra, mean field theory, as well as a systematic low-energy effective field theory for the square lattice quantum dimer model. The analytic considerations explain why a string connecting two external static charges in the confining columnar phase fractionalizes into eight distinct strands with electric flux $\frac{1}{4}$. An emergent approximate spontaneously broken $SO(2)$ symmetry gives rise to a pseudo-Goldstone boson. Remarkably, this soft phonon-like excitation, which is massless at the Rokhsar-Kivelson (RK) point, exists far beyond this point. The Goldstone physics is captured by a systematic low-energy effective field theory. We determine its low-energy parameters by matching the analytic effective field theory with exact diagonalization results and Monte Carlo data. This confirms that the model exists in the columnar (and not in a plaquette or mixed) phase all the way to the RK point.Comment: 35 pages, 16 figure

Positive Effect of Increased AFLP Diversity Among Parental Plants on Yield of Polycross Progenies in Perennial Ryegrass (\u3cem\u3eLolium Perenne\u3c/em\u3e L.)

In outbreeding forage crops such as perennial ryegrass (Lolium perenne L.), genetic diversity among parental plants may greatly influence the success of a cultivar through mechanisms such as heterosis and inbreeding depression. The aim of this study was to evaluate the use of amplified fragment length polymorphism (AFLP) markers to select polycross parents with contrasting levels of genetic diversity and to analyse genetic diversity and agronomic performance of first and second generation synthetic progenies (Syn1, Syn2)

Irreversible reorganization in a supercooled liquid originates from localised soft modes

The transition of a fluid to a rigid glass upon cooling is a common route of transformation from liquid to solid that embodies the most poorly understood features of both phases1,2,3. From the liquid perspective, the puzzle is to understand stress relaxation in the disordered state. From the perspective of solids, the challenge is to extend our description of structure and its mechanical consequences to materials without long range order. Using computer simulations, we show that the localized low frequency normal modes of a configuration in a supercooled liquid are causally correlated to the irreversible structural reorganization of the particles within that configuration. We also demonstrate that the spatial distribution of these soft local modes can persist in spite of significant particle reorganization. The consequence of these two results is that it is now feasible to construct a theory of relaxation length scales in glass-forming liquids without recourse to dynamics and to explicitly relate molecular properties to their collective relaxation.Comment: Published online: 20 July 2008 | doi:10.1038/nphys1025 Available from http://www.nature.com/nphys/journal/v4/n9/abs/nphys1025.htm

Genetic and Phenotypic Diversity of Swiss Red Clover Landraces

Mattenklee landraces are persistent and locally adapted Swiss red clover populations. About 100 populations are preserved and may represent a significant yet poorly characterised genetic resource for temperate regions. Genetic characterisation is important in order to improve cultivars, manage genetic resources and to maintain or restore biodiversity. The objectives of this study were to analyse genetic diversity, investigate potential ancestry and to elucidate the congruence of phenotypic and genetic structure of Mattenklee landraces