Antibiotic Stewardship Improvement Initiative at a Veterans Health Administration Ambulatory Care Center.

Background: The negative impact of unnecessary antibiotic prescribing is well known and includes risks of antibiotic adverse effects, overgrowth of pathogenic organisms, unnecessary costs, and selection of antibiotic-resistant organisms in the populace at large. Acute viral respiratory infections are among the leading causes of inappropriate antibiotic usage. Methods: This study examined the effect on inappropriate antibiotic prescribing rates of educating clinicians regarding antibiotic stewardship and making a prepackaged kit (containing symptom relief and patient education) for clinicians to distribute to patients with viral upper respiratory tract infections vs writing a prescription for antibiotics. Results: Between December 1, 2018, and March 31, 2019, 357 viral illness support packs were distributed. Antibiotic prescriptions for the diagnostic codes pertaining to viral upper respiratory tract infections were tracked and compared to a similar period from December 1, 2017, to March 31, 2018. A 9% reduction in antibiotic prescriptions was observed (P = .02). Conclusions: The results of this project demonstrate that the combination of patient education and the ready availability of a nonantibiotic symptomatic treatment option can significantly decrease the unnecessary prescribing of antibiotics for viral illnesses.

Design of an aircraft generator with radial force control.

With the increasing electrical energy demands in aviation propulsion systems, the increase in the onboard generators' power density is inevitable. During the flight, forces coming from the gearbox or gyroscopic forces generated by flight manoeuvres like take-off and landing can act on the generators' bearings, which can lead to wear and fatigue in the bearings. Utilizing the radial force control concept in the electrical machine can relieve loads from the bearings that not only minimize the bearing losses but also increase bearing life. The objective of the MAGLEV project (Measurement and Analysis of Generator bearing Loads and Efficiency with Validation) is to study, demonstrate, and test a new class of high-speed generators with radial force control. In this paper, design steps of this type of generator and its test rig are presented and the measurement methodology used for radial force control is explained. The concept is developed in an electrical machine and is validated on a test rig by measuring required parameters like shaft displacement, vibrations and bearing temperature. Additionally, the friction moment of each generator's bearings is measured and validated in a separate test rig under comparable conditions to the bearing loads in the generator. Therefore, a novel approach to determine precisely the bearing friction in a radial load unit, rotatably supported by an additional needle bearing is used, which shows a good agreement with the calculated friction. Furthermore, new calculation methods for the operating behavior of cylindrical roller bearings with clearance are presented, which are utilized in the generator test rig.

Simpson grade: an opportunity to reassess the need for complete resection of meningiomas.

BACKGROUND: The relevance of the Simpson grading system as a predictor of meningioma progression or recurrence in modern neurosurgical practice has recently been called into question. The aim of our study was to compare the risk of progression/recurrence of tumours that had been treated with different Simpson grade resections in a contemporary population of benign (WHO grade I) meningioma patients. METHOD: One hundred eighty-three patients with histologically confirmed WHO grade I meningioma were retrospectively analysed. All patients underwent first-time craniotomy as their initial therapy between 2004 and 2012. Univariate analysis was performed using log-rank testing and Kaplan-Meier analysis for progression/recurrence-free survival. Multivariate analysis was performed using Cox proportional hazards regression modelling. RESULTS: The three-year progression/recurrence-free survival rates for patients receiving Simpson grade 1, 2 or 4 resections were 95 %, 87 % and 67 %, respectively. Simpson grade 4 resections progressed/recurred at a significantly greater rate than Simpson grade 1 resections (hazard ratio [HR] = 3.26, P = 0.04), whereas Simpson grade 2 resections did not progress/recur at a significantly greater rate than Simpson grade 1 resections (HR = 1.78, P = 0.29). Subtotal resections progressed/recurred at a significantly greater rate than gross-total resections (HR = 2.47, P = 0.03). CONCLUSIONS: Tumours that undergo subtotal resection are at a significantly greater risk of progression/recurrence than tumours that undergo gross-total resection. Gross-total resection should therefore be the aim of surgery. However, given modern access to follow-up imaging and stereotactic radiosurgery, these results should not be used to justify overly 'heroic' tumour resection.

Growing Bacillus subtilis tendrils sense and avoid each other.

Growing tendrils of aflagellate hag mutants of Bacillus subtilis were found to show an avoidance response when colonizing a semi-solid medium, suggesting a tip-to-tip communication mechanism between colonies. There may be a second sensing mechanism involved in shaping the morphology of tendrils. Tendril growth in B. subtilis was dependent on and possibly shaped by the release of surfactin, a biosurfactant. Transposon mutagenesis yielded two mutants with 'touching' tendrils, and each had a disrupted gspA gene that encodes a putative glycosyltransferase. Tendrils of gspA mutants, unlike the parental strain, were unresponsive to tendril tip growth by surfactin, suggesting disruption of intercellular signaling. Tendril sensing and avoidance could be physiologically relevant in habitats, such as plant roots, where some limiting nutrient might induce this type of multicellular behavior, promoting avoidance of previously explored areas by sibling colonies.

Humans appear no more sensitive than laboratory animals to the inhibition of red blood cell cholinesterase by dichlorvos.

Inhibition of red blood cell (RBC) cholinesterase is a consistent and sensitive indicator of exposure to dichlorvos (DDVP). Absent human data, default 10-fold adjustment factors for potential interspecies and intraspecies sensitivity differences would be used in developing a reference dose from the no observed effect levels for this endpoint obtained in toxicological assessments of laboratory animals. However, many studies of the cholinesterase-inhibiting effects associated with DDVP exposure have been conducted in humans, including healthy male volunteers, other healthy subpopulations, and diverse clinical subpopulations. Indeed, ample human data exist to permit a data-based assessment of potential interspecies sensitivity differences in RBC cholinesterase inhibition associated with DDVP exposure. In aggregate, these data demonstrate that the DDVP doses producing inhibition in humans are virtually identical to those eliciting the same levels of inhibition in laboratory rats, mice, monkeys, and dogs. Thus, healthy humans appear to be no more sensitive than laboratory animals to DDVP's effects on RBC cholinesterase, and an interspecies uncertainty factor of 1 is appropriate and scientifically warranted for use in DDVP risk assessments.