Abstract
Objectives
We studied trends in antibiotic prescribing by primary care and assessed the associations between generated antibiotic selection pressure (ASP) and the prevalence of sentinel ...drug-resistant microorganisms (SDRMs).
Methods
The volume of antibiotic prescribing in primary and hospital care expressed in DDD/1000 inhabitants per day and the prevalences of SDRMs in European countries where GPs act as gatekeepers were obtained from the European Centre for Disease Control ESAC-NET. Associations were tested between (i) DDD and (ii) the Antibiotic Spectrum Index (ASI) as a proxy indicator for ASP, and the prevalences of three SDRMs: MRSA, MDR Escherichia coli and Streptococcus pneumoniae resistant to macrolides.
Results
Fourteen European countries were included. Italy, Poland and Spain had the highest prevalence of SDRMs and prescribed the highest volume of antibiotics in primary care (average 17 DDD per 1000 inhabitants per day), approximately twice that of countries with the lowest volumes. Moreover, the ASIs of these high antibiotic volume countries were approximately three times higher than those of the low-volume countries. Cumulative ASI showed the strongest association with a country’s prevalence of SDRMs. The cumulative ASI generated from primary care was about four to five times higher than the cumulative ASI generated by hospital care.
Conclusions
Prevalences of SDRMs are associated with the volume of antimicrobial prescribing and in particular broad-spectrum antibiotics in European countries where GPs act as gatekeepers. The impact of ASP generated from primary care on increasing antimicrobial resistance may be much larger than currently assumed.
A SiGe RF low-noise amplifier (LNA) with built-in tolerance to single-event transients is proposed. The LNA utilizes an inverse-mode SiGe HBT for the common-base transistor in a cascode core. This ...new cascode configuration exhibits reduced transient peaks and shorter transient durations compared to the conventional cascode one. The improved SET response was verified with through-wafer two-photon absorption pulsed-laser experiments and supported via mixed-mode TCAD simulations. In addition, analysis of the RF performance and the reliability issues associated with the inverse-mode operation further suggests this new cascode structure can be a strong contender for space-based applications. The LNA with the inverse-mode-based cascode core was fabricated in a 130 nm SiGe BiCMOS platform and has similar RF performance to the conventional schematic-based LNA, further validating the proposed approach.
Content-based image retrieval (CBIR) is a valuable computer vision technique which is increasingly being applied in the medical community for diagnosis support. However, traditional CBIR systems only ...deliver visual outputs, i.e., images having a similar appearance to the query, which is not directly interpretable by the physicians. Our objective is to provide a system for endomicroscopy video retrieval which delivers both visual and semantic outputs that are consistent with each other. In a previous study, we developed an adapted bag-of-visual-words method for endomicroscopy retrieval, called "Dense-Sift," that computes a visual signature for each video. In this paper, we present a novel approach to complement visual similarity learning with semantic knowledge extraction, in the field of in vivo endomicroscopy. We first leverage a semantic ground truth based on eight binary concepts, in order to transform these visual signatures into semantic signatures that reflect how much the presence of each semantic concept is expressed by the visual words describing the videos. Using cross-validation, we demonstrate that, in terms of semantic detection, our intuitive Fisher-based method transforming visual-word histograms into semantic estimations outperforms support vector machine (SVM) methods with statistical significance. In a second step, we propose to improve retrieval relevance by learning an adjusted similarity distance from a perceived similarity ground truth. As a result, our distance learning method allows to statistically improve the correlation with the perceived similarity. We also demonstrate that, in terms of perceived similarity, the recall performance of the semantic signatures is close to that of visual signatures and significantly better than those of several state-of-the-art CBIR methods. The semantic signatures are thus able to communicate high-level medical knowledge while being consistent with the low-level visual signatures and much shorter than them. In our resulting retrieval system, we decide to use visual signatures for perceived similarity learning and retrieval, and semantic signatures for the output of an additional information, expressed in the endoscopist own language, which provides a relevant semantic translation of the visual retrieval outputs.
Single-event transient (SET)-hardened SiGe HBT RF single-pole single-throw (SPST) switches were designed and fabricated for the first time. TCAD-based heavy-ion simulations and two-photon absorption ...(TPA) laser-induced beam experiments were used to optimize the switch core configuration for SET mitigation. Among different configurations, the reverse-connected series and shunt device core, where both emitter terminals are connected to the output, exhibits the smallest transient peaks and shortest durations at the output terminal of the switch. Based on this finding, the design considerations for maximizing the RF performance of SiGe HBT SPST RF switches are discussed. In addition, a comparison of the SET response and RF performance of CMOS (nFET) SPST and SiGe HBT SPST switches provides additional information on the trade-offs in the SET mitigation strategy and potential RF capabilities.
Abstract
Background
Acute pancreatitis is the most common gastrointestinal cause of hospitalization in the United States. Amylase and lipase are commonly ordered together in the workup of suspected ...pancreatitis at our institution (a large academic medical center), despite meta-analyses and evidence-based guidelines that recommend the use of lipase alone. Lipase has more diagnostic accuracy, rises earlier, and stays elevated longer than amylase. Co-ordering amylase has not been shown to increase sensitivity or specificity. This study aims to explore how well amylase and lipase correlate in our patient population, and which marker more accurately detects acute pancreatitis when the results are discrepant.
Methods
The laboratory information system was queried for co-orders of amylase and lipase during a 2-month period (November 1, 2016, to December 31, 2016). The overall agreement and Cohen’s kappa were calculated. Discrepant results were separated from concordant results. Clinical data were extracted from the electronic medical record, including the rationale for ordering and relevant diagnosis code.
Results
There were 962 instances of amylase and lipase co-orders in the 2-month period. Of these, 138 had high amylase and lipase, and 694 had normal amylase and lipase concentrations. The overall agreement was 86.5% and Cohen’s kappa was 0.596 (moderate agreement) (P < .0001). There were 88 cases in which the lipase was elevated and the amylase was normal. Of these, 12 were acute pancreatitis and 76 were not. There were 42 cases in which the amylase was elevated and the lipase was normal; only one case out of 42 was acute pancreatitis. Further investigation into this case revealed that the patient was approximately 7 months status-post pancreas transplant. During this admission, he was diagnosed with “graft pancreatitis” and, while amylase remained elevated above the reference range for longer than lipase after treatment, both enzymes were increased at diagnosis (lipase 831 U/L 73-393 U/L and amylase 194 U/L 30-110 U/L). These data show that, had only lipase been ordered, no cases of acute pancreatitis would have been missed.
Conclusion
Amylase has been shown to be an inferior marker of acute pancreatitis compared to lipase, and many guidelines recommend the use of lipase alone. However, these tests are commonly co-ordered at our institution; in a given 2-month period, there were 962 co-order events. Of these, there were no cases of pancreatitis that would have been missed by ordering lipase alone. Our laboratory charges $50 per amylase assay; therefore $48,100 was spent on unnecessary amylase orders during the 2 months of this study. Lab test overutilization has been identified as an important problem; if addressed and curtailed, labs and hospitals can increase efficiency and cost savings.
The capability of inverse-mode (IM) silicon- germanium (SiGe) heterojunction bipolar transistors (HBTs) for the mitigation of single-event transients (SETs) under large-signal operation was ...investigated in an RF down-conversion single- balanced mixer using a through-wafer, two-photon absorption pulsed-laser beam experiment and TCAD heavy-ion simulations. The IM SiGe HBTs replace conventional forward-mode (FM) SiGe HBTs in the differential pair, which provides full current steering for frequency mixing operation. Under steady-state conditions, the IM SiGe HBT differential pair exhibits smaller transient peaks with shorter durations compared to the FM SiGe HBTs. In addition, under the injection of a local oscillator (LO) signal with large swing, the IM SiGe HBTs show faster recovery (50% reduction in the best case) from the impact of SETs. In the frequency domain, it is observed that IM SiGe HBTs produce less distortion at the output for an intermediate frequency below 1 GHz. Based on the performance comparison between FM and IM SiGe HBT down-conversion mixers, system design guidelines to compensate the noise figure degradation associated with using IM SiGe HBTs are discussed.
Land use science has traditionally used case-study approaches for in-depth investigation of land use change processes and impacts. Meta-studies synthesize findings across case-study evidence to ...identify general patterns. In this paper, we provide a review of meta-studies in land use science. Various meta-studies have been conducted, which synthesize deforestation and agricultural land use change processes, while other important changes, such as urbanization, wetland conversion, and grassland dynamics have hardly been addressed. Meta-studies of land use change impacts focus mostly on biodiversity and biogeochemical cycles, while meta-studies of socioeconomic consequences are rare. Land use change processes and land use change impacts are generally addressed in isolation, while only few studies considered trajectories of drivers through changes to their impacts and their potential feedbacks. We provide a conceptual framework for linking meta-studies of land use change processes and impacts for the analysis of coupled human-environmental systems. Moreover, we provide suggestions for combining meta-studies of different land use change processes to develop a more integrated theory of land use change, and for combining meta-studies of land use change impacts to identify tradeoffs between different impacts. Land use science can benefit from an improved conceptualization of land use change processes and their impacts, and from new methods that combine meta-study findings to advance our understanding of human-environmental systems.
Carrier-density distributions generated via two-photon absorption from pulsed laser excitation are simulated using nonlinear-optical beam propagation software. These simulated carrier-density ...distributions are used to calculate depth profiles of the integrated collected charge using a rectangular-parallel-piped approach for two silicon diodes of different structure. Using a set of proposed correlation metrics, the resulting simulated charge collection profiles are found to exhibit good agreement with measured transient charge-collection data for most, but not all of the metrics. The physical phenomena underlying the correlation metrics are discussed in detail. The remaining discrepancies that exist between the simulated and experimental results are addressed and their potential causes are detailed.
To support the challenging task of early epithelial cancer diagnosis from in vivo endomicroscopy, we propose a content-based video retrieval method that uses an expert-annotated database. We adjust ...the standard Bag-of-Visual-Words method to handle endomicroscopic image retrieval. The proper level of invariance is ensured by a local dense multi-scale description. To remove outliers, retrieval is followed by a geometrical approach that captures a statistical description of the spatial relationships between the local features. Video retrieval is performed using the coarse registration results of video-mosaicing to account for spatial overlap between images taken at different times. Retrieval evaluation consists of a simple nearest neighbors classification with leave-one-patient-out cross-validation. Results of binary and multi-class classification show that our method outperforms, with statistical significance, several state-of-the art methods.
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► Content-based video retrieval is applied to endomicroscopy for diagnosis support. ► Adjusted Bag-of-Visual-Words method is combined with video-mosaicing technique. ► Retrieval is objectively evaluated using leave-one-patient-out kNN classification. ► Binary classification evaluates retrieval with accuracy 94.2%. ► The method outperforms state-of-the-art in terms of multi-class classification.
To support the challenging task of early epithelial cancer diagnosis from
in vivo endomicroscopy, we propose a content-based video retrieval method that uses an expert-annotated database. Motivated by the recent successes of non-medical content-based image retrieval, we first adjust the standard Bag-of-Visual-Words method to handle single endomicroscopic images. A local dense multi-scale description is proposed to keep the proper level of invariance, in our case to translations, in-plane rotations and affine transformations of the intensities. Since single images may have an insufficient field-of-view to make a robust diagnosis, we introduce a video-mosaicing technique that provides large field-of-view mosaic images. To remove outliers, retrieval is followed by a geometrical approach that captures a statistical description of the spatial relationships between the local features. Building on image retrieval, we then focus on efficient video retrieval. Our approach avoids the time-consuming parts of the video-mosaicing by relying on coarse registration results only to account for spatial overlap between images taken at different times. To evaluate the retrieval, we perform a simple nearest neighbors classification with leave-one-patient-out cross-validation. From the results of binary and multi-class classification, we show that our approach outperforms, with statistical significance, several state-of-the art methods. We obtain a binary classification accuracy of 94.2%, which is quite close to clinical expectations.
Our aim was to assess the impact of cigarette smoking on the risk of the tumors classified by the International Agency for Research on Cancer as causally associated with smoking, referred to as ...tobacco-related cancers (TRC).
The study population included 441,211 participants (133,018 men and 308,193 women) from the European Prospective Investigation Into Cancer and Nutrition. We investigated 14,563 participants who developed a TRC during an average follow-up of 11 years. The impact of smoking cigarettes on cancer risk was assessed by the population attributable fraction (AF(p)), calculated using the adjusted hazard ratios and 95% CI for current and former smokers, plus either the prevalence of smoking among cancer cases or estimates from surveys in representative samples of the population in each country.
The proportion of all TRC attributable to cigarette smoking was 34.9% (95% CI, 32.5 to 37.4) using the smoking prevalence among cases and 36.2% (95% CI, 33.7 to 38.6) using the smoking prevalence from the population. The AF(p) were above 80% for cancers of the lung and larynx, between 20% and 50% for most respiratory and digestive cancers and tumors from the lower urinary tract, and below 20% for the remaining TRC.
Using data on cancer incidence for 2008 and our AF(p) estimates, about 270,000 new cancer diagnoses per year can be considered attributable to cigarette smoking in the eight European countries with available data for both men and women (Italy, Spain, United Kingdom, the Netherlands, Greece, Germany, Sweden, Denmark).
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