31,602 research outputs found

    Reducing inappropriate antibiotics prescribing: The role of online commentary on physical examination findings

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    Objective: This study investigates the relationship of ‘online commentary’(contemporaneous physician comments about physical examination [PE] findings) with (i) parent questioning of the treatment recommendation and (ii) inappropriate antibiotic prescribing. Methods: A nested cross-sectional study of 522 encounters motivated by upper respiratory symptoms in 27 California pediatric practices (38 pediatricians). Physicians completed a post-visit survey regarding physical examination findings, diagnosis, treatment, and whether they perceived the parent as expecting an antibiotic. Taped encounters were coded for ‘problem’ online commentary (PE findings discussed as significant or clearly abnormal) and ‘no problem’ online commentary (PE findings discussed reassuringly as normal or insignificant). Results: Online commentary during the PE occurred in 73% of visits with viral diagnoses (n = 261). Compared to similar cases with ‘no problem’ online commentary, ‘problem’ comments were associated with a 13% greater probability of parents uestioning a non-antibiotic treatment plan (95% CI 0-26%, p = .05,) and a 27% (95% CI: 2-52%, p < .05) greater probability of an inappropriate antibiotic prescription. Conclusion: With viral illnesses, problematic online comments are associated with more pediatrician-parent conflict over non-antibiotic treatment recommendations. This may increase inappropriate antibiotic prescribing. Practice implications: In viral cases, physicians should consider avoiding the use of problematic online commentary

    Community Structure in Time-Dependent, Multiscale, and Multiplex Networks

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    Network science is an interdisciplinary endeavor, with methods and applications drawn from across the natural, social, and information sciences. A prominent problem in network science is the algorithmic detection of tightly-connected groups of nodes known as communities. We developed a generalized framework of network quality functions that allowed us to study the community structure of arbitrary multislice networks, which are combinations of individual networks coupled through links that connect each node in one network slice to itself in other slices. This framework allows one to study community structure in a very general setting encompassing networks that evolve over time, have multiple types of links (multiplexity), and have multiple scales.Comment: 31 pages, 3 figures, 1 table. Includes main text and supporting material. This is the accepted version of the manuscript (the definitive version appeared in Science), with typographical corrections included her

    Ecological Modeling of Aedes aegypti (L.) Pupal Production in Rural Kamphaeng Phet, Thailand

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    Background - Aedes aegypti (L.) is the primary vector of dengue, the most important arboviral infection globally. Until an effective vaccine is licensed and rigorously administered, Ae. aegypti control remains the principal tool in preventing and curtailing dengue transmission. Accurate predictions of vector populations are required to assess control methods and develop effective population reduction strategies. Ae. aegypti develops primarily in artificial water holding containers. Release recapture studies indicate that most adult Ae. aegypti do not disperse over long distances. We expect, therefore, that containers in an area of high development site density are more likely to be oviposition sites and to be more frequently used as oviposition sites than containers that are relatively isolated from other development sites. After accounting for individual container characteristics, containers more frequently used as oviposition sites are likely to produce adult mosquitoes consistently and at a higher rate. To this point, most studies of Ae. aegypti populations ignore the spatial density of larval development sites. Methodology - Pupal surveys were carried out from 2004 to 2007 in rural Kamphaeng Phet, Thailand. In total, 84,840 samples of water holding containers were used to estimate model parameters. Regression modeling was used to assess the effect of larval development site density, access to piped water, and seasonal variation on container productivity. A varying-coefficients model was employed to account for the large differences in productivity between container types. A two-part modeling structure, called a hurdle model, accounts for the large number of zeroes and overdispersion present in pupal population counts. Findings - The number of suitable larval development sites and their density in the environment were the primary determinants of the distribution and abundance of Ae. aegypti pupae. The productivity of most container types increased significantly as habitat density increased. An ecological approach, accounting for development site density, is appropriate for predicting Ae. aegypti population levels and developing efficient vector control program

    Classification and analysis of emission-line galaxies using mean field independent component analysis

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    We present an analysis of the optical spectra of narrow emission-line galaxies, based on mean field independent component analysis (MFICA). Samples of galaxies were drawn from the Sloan Digital Sky Survey (SDSS) and used to generate compact sets of `continuum' and `emission-line' component spectra. These components can be linearly combined to reconstruct the observed spectra of a wider sample of galaxies. Only 10 components - five continuum and five emission line - are required to produce accurate reconstructions of essentially all narrow emission-line galaxies; the median absolute deviations of the reconstructed emission-line fluxes, given the signal-to-noise ratio (S/N) of the observed spectra, are 1.2-1.8 sigma for the strong lines. After applying the MFICA components to a large sample of SDSS galaxies we identify the regions of parameter space that correspond to pure star formation and pure active galactic nucleus (AGN) emission-line spectra, and produce high S/N reconstructions of these spectra. The physical properties of the pure star formation and pure AGN spectra are investigated by means of a series of photoionization models, exploiting the faint emission lines that can be measured in the reconstructions. We are able to recreate the emission line strengths of the most extreme AGN case by assuming the central engine illuminates a large number of individual clouds with radial distance and density distributions, f(r) ~ r^gamma and g(n) ~ n^beta, respectively. The best fit is obtained with gamma = -0.75 and beta = -1.4. From the reconstructed star formation spectra we are able to estimate the starburst ages. These preliminary investigations serve to demonstrate the success of the MFICA-based technique in identifying distinct emission sources, and its potential as a tool for the detailed analysis of the physical properties of galaxies in large-scale surveys.Comment: MNRAS accepted. 29 pages, 24 figures, 3 table

    Interpreting the Ionization Sequence in AGN Emission-Line Spectra

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    We investigate the physical cause of the great range in the ionization level seen in the spectra of narrow lined active galactic nuclei (AGN). Mean field independent component analysis identifies examples of individual SDSS galaxies whose spectra are not dominated by emission due to star formation (SF), which we designate as AGN. We assembled high S/N ratio composite spectra of a sequence of these AGN defined by the ionization level of their narrow-line regions (NLR), extending down to very low-ionization cases. We used a local optimally emitting cloud (LOC) model to fit emission-line ratios in this AGN sequence. These included the weak lines that can be measured only in the co-added spectra, providing consistency checks on strong line diagnostics. After integrating over a wide range of radii and densities our models indicate that the radial extent of the NLR is the major parameter in determining the position of high to moderate ionization AGN along our sequence, providing a physical interpretation for their systematic variation. Higher ionization AGN contain optimally emitting clouds that are more concentrated towards the central continuum source than in lower ionization AGN. Our LOC models indicate that for the objects that lie on our AGN sequence, the ionizing luminosity is anticorrelated with the NLR ionization level, and hence anticorrelated with the radial concentration and physical extent of the NLR. A possible interpretation that deserves further exploration is that the ionization sequence might be an age sequence where low ionization objects are older and have systematically cleared out their central regions by radiation pressure. We consider that our AGN sequence instead represents a mixing curve of SF and AGN spectra, but argue that while many galaxies do have this type of composite spectra, our AGN sequence appears to be a special set of objects with negligible SF excitation.Comment: 57 pages; 18 figures, accepted by MNRA

    Leech Parasitism of the Gulf Coast Box Turtle, Terrapene carolina major (Testudines:Emydidae) in Mississippi, USA

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    Ten leeches were collected from a Gulf Coast box turtle, Terrapene carolina major, found crossing a road in Gulfport, Harrison County, Mississippi, USA. Eight of the leeches were identified as Placobdella multilineata and 2 were identified as Helobdella europaea. This represents the second vouchered report of leeches from a box turtle. Helobdella europaea is reported for the first time associated with a turtle and for the second time from the New World
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