This population-based cohort study examines the appropriateness of antibiotic prescribing in South Carolina via aggregated pharmacy claims data matched with diagnosis codes from medical claims. Inappropriate antibiotic prescribing decreased from 30.2% in 2012 to 22.6% in 2017 (P < 0.001) and was more common in adults >40 years old.

Typically, the fuselage of a modern military aircraft is designed in such a way that the propulsion system is integrated into it. The main reasons are reduction of installation space and minimisation of radar signature. Those requirements can be achieved by using highly bent engine intakes, which are occluding a direct line of sight to the compressor system. Depending on their design, secondary flows and flow separation can be expected due to the strong curvature of the intake system. In this study, a serpentine intake in front of the Larzac 04 test engine is investigated experimentally and its performance compared with and without flow stabilising measures. In detail, a configuration with vortex generators was compared experimentally with a configuration of active flow control by injected air. In order to analyse and compare the efficiency of both systems, the dimensionless total pressure coefficient, the distortion coefficient (DC60) and detailed surface pressure distributions as well as the aerodynamic interface plane are evaluated. In addition, different throttle lines were recorded for surge line evaluation of the low pressure compressor of the Larzac engine and compared for each flow-stabilising measure investigated. It was found that the application of injecting air showed a larger improvement in surge margin and reduction in distortion coefficients compared to the passive flow control.

Internal and external rotation of the shoulder is often challenging to quantify in the clinic. Existing technologies, such as motion capture, can be expensive or require significant time to setup, collect data, and process and analyze the data. Other methods may rely on surveys or analog tools, which are subject to interpretation. The current study evaluates a novel, engineered, wearable sensor system for improved internal and external shoulder rotation monitoring, and applies it in healthy individuals. Using the design principles of the Japanese art of kirigami (folding and cutting of paper to design 3D shapes), the sensor platform conforms to the shape of the shoulder with four on-board strain gauges to measure movement. Our objective was to examine how well this kirigami-inspired shoulder patch could identify differences in shoulder kinematics between internal and external rotation as individuals moved their humerus through movement patterns defined by Codman’s paradox. Seventeen participants donned the sensor while the strain gauges measured skin deformation patterns during the participants’ movement. One-dimensional statistical parametric mapping explored differences in strain voltage between the rotations. The sensor detected distinct differences between the internal and external shoulder rotation movements. Three of the four strain gauges detected significant temporal differences between internal and external rotation (all p < .047), particularly for the strain gauges placed distal or posterior to the acromion. These results are clinically significant, as they suggest a new class of wearable sensors conforming to the shoulder can measure differences in skin surface deformation corresponding to the underlying humerus rotation.

Minimally invasive surgery (MIS) has been an essential tool in the surgical sector for many years due to its crucial advantages compared to open surgery. To overcome remaining limitations, teleoperated MIS experienced a strong emergence. However, the widespread usage of such systems is hindered by the enormous financial hurdle. The use of standard components and conventional tools for teleoperated MIS can facilitate integration into existing hospital workflows and can be a cost-efficient and versatile approach for research purposes. To compensate for the lack of haptic feedback, some teleoperation setups inherit a sensor system allowing them to record interaction forces and display them at the user interface. In research and in commercially available systems, different positions for the sensor can be found. In this paper, mechanical interfaces for the guidance and actuation of non-wristed and wristed standard instruments are presented. Furthermore, a method for the extracorporeal measurement of interaction forces is presented, characterized, and discussed. The overall mean relative error of the magnitude of the interaction force is 9.4%, while the overall mean absolute error of the force vector is 14.4$^{\circ }$, both below the respective human differential perception threshold. The presented measurement method is a simple, yet sufficiently accurate approach to measure interaction forces in surgical telemanipulation.

Understanding individual differences in neural responses to stressful environments is an important avenue of research throughout development. These differences may be especially critical during adolescence, which is characterized by opportunities for healthy development and increased susceptibility to the development of psychopathology. While the neural correlates of the psychosocial stress response have been investigated in adults, these links have not been explored during development. Using a new task, the Minnesota Imaging Stress Test in Children (MISTiC), differences in activation are found in fusiform gyrus, superior frontal gyrus, insula, and anterior cingulate cortex when comparing a stressful math task to a nonstressful math task. The MISTiC task successfully elicits cortisol responses in a similar proportion of adolescents as in behavioral studies while collecting brain imaging data. Cortisol responders and nonresponders did not differ in their perceived stress level or behavioral performance during the task despite differences in neuroendocrine function. Future research will be able to leverage the MISTiC task for many purposes, including probing associations between individual differences in stress responses with environmental conditions, personality differences, and the development of psychopathology.

Background: For the rising number of people living with dementia, cost-effective community-based interventions to support psychosocial care are needed. The FindMyApps program helps people with dementia and their caregivers learn to use tablet computers and find user-friendly apps that facilitate self-management and engagement in meaningful activities. This definitive trial builds on previous feasibility pilot trials of FindMyApps and further evaluates cost-effectiveness.

Method: This is a protocol for a non-blinded randomized controlled trial (RCT) with two arms (intervention and usual care). 150 dyads (person with dementia and their carer) will be recruited. Participants must be resident in the community, with a diagnosis of Mild Cognitive Impairment or mild dementia (Mini Mental-State Examination 17-26, or Global Deterioration Scale 3-4. Dyads will be randomly assigned in equal proportions to receive either the FindMyApps intervention (experimental arm) or usual care (control arm). Primary outcomes measured at 3 months will be: patient self-management and social participation; caregiver sense of competence. Data will be collected through questionnaires filled in by the researcher (patient outcomes) or participants themselves (carer outcomes). In addition to a main effect analysis, a cost-effectiveness analysis will take place. In line with Medical Research Council (MRC) guidance for the evaluation of complex interventions, a process analysis will be undertaken, to identify factors that may influence trial outcomes. Semi-structured interviews and remotely collected data regarding use of the FindMyApps app will support the process analysis.

Result: Results of this study are expected in 2022. The study will be adequately powered to detect at least a moderate effect size of the intervention with respect to the primary outcomes.

Conclusion: This study will investigate the effectiveness and cost-effectiveness of the FindMyApps intervention. The results of the study will provide strong evidence to support or oppose scaling up implementation of the intervention. This is also an example of how the MRC framework for the evaluation of complex interventions can be implemented in practice. In a field which is often criticized for a lack of high quality evidence, randomized controlled trials should be applied more frequently designed for the robust and transparent evaluation of digital tools and technologies.

Background: As with other specialties, Royal College of Physicians and Surgeons of Canada (RCPSC) trainees in Neurosurgery have anecdotally had challenges securing full-time employment. This study presents the employment status, research pursuits, and fellowship choices of neurosurgery trainees in Canadian programs. Methods: RCPSC neurosurgery trainees (n = 143) who began their residency training between 1998 and 2008 were included in this study. Associations between year of residency completion, research pursuits, and fellowship choice with career outcomes were determined by Fisher’s exact test (p < 0.05, statistical significance). Results: In 2015, 60% and 26% of neurosurgery trainees had permanent positions in Canada and the USA, respectively. Underemployment, defined as locum and clinical associate positions, pursuit of multiple unrelated fellowships, unemployment, and career change to non-surgical career, was 12% in 2015. The proportion of neurosurgery trainees who had been underemployed at some point within 5 years since residency completion was 20%. Pursuit of in-folded research (MSc, PhD, or non-degree research greater than 1 year) was significantly associated with obtaining full employment (94% vs. 73%, p = 0.011). However, fellowship training was not significantly associated with obtaining full employment (78% vs. 75%, p = 1.000). Conclusions: Underemployment in neurosurgery has become a significant issue in Canada for various reasons. Pursuit of in-folded research, but not fellowship training, was associated with obtaining full employment.

Cr micas identified as chrome phengites occur in association with other Cr-rich minerals in a peculiar schist which lies along a complex shear zone within the pre-Caledonian Erris Complex. The schist generally has a chaotic internal structure but locally there is a crude planar mineralogical zoning with a serpentinebearing zone structurally above a Cr mica zone. Chemical analyses indicate that the schist is a tectonic derivative of a mixture of rock with a pronounced metasomatic character.

Soil incorporated into the tuber zone of purple nutsedge (Cyperus rotundus L.) at 1 to 9 kg/ha, O,O-diisopropyl phosphorodithioate S-ester with N-(2-mercaptoethyl)benzenesulfonamide (bensulide) inhibited the growth of roots on plants developing from these tubers. The inhibitory effect was temporary and occurred only when bensulide was in intimate contact with the tubers and developing plants. When tubers were removed from bensulide-treated soil, washed, and replanted in untreated soil, root growth was normal. The production of shoots from tubers planted in bensulide-treated soil apparently was not affected, but shoot-growth was retarded when root growth was suppressed. When bensulide was incorporated into the upper 5-cm layer of soil, the shoots of nutsedge plants developing from tubers located below this layer grew through the treated soil with no adverse effect; the roots of these plants developed from basal bulbs below the layer of treated soil and were normal. Leaching bensulide-treated soil with 37.6 hectare-cm of water did not move enough bensulide into the soil to cause inhibitory growth effects on purple nutsedge.

We have developed an easy-to-use, mouse-driven program for the interactive fitting of interstellar absorption lines in high-resolution astronomical spectra. The program, Xvoigt, gives values for the column density and velocity dispersion of the absorbing clouds. It runs under the popular X Window system available on most workstations, and offers significant enhancements over existing profile-fitting software. Xvoigt can be an important adjunct to automatic programs for fitting absorption lines in low to moderate signal-to-noise QSO or other spectra, and is ideal for demonstrating the details and difficulties of absorption line analysis.

Inferring the causes for change in the fossil record has been a persistent problem in evolutionary biology. Three independent lines of evidence indicate that a lineage of the fossil stickleback fish Gasterosteus doryssus experienced directional natural selection for reduction of armor. Nonetheless, application to this lineage of three methods to infer natural selection in the fossil record could not exclude random process as the cause for armor change. Excluding stabilizing selection and genetic drift as the mechanisms for biostratigraphic patterns in the fossil record when directional natural selection was the actual cause is very difficult. Biostratigraphic sequences with extremely fine temporal resolution among samples and other favorable properties must be used to infer directional selection in the fossil record.

A recent editorial claimed that the 2014 National Institute for Health and Care Excellence (NICE) guideline on psychosis and schizophrenia, unlike its equivalent 2013 Scottish Intercollegiate Guidelines Network (SIGN) guideline, is biased towards psychosocial treatments and against drug treatments. In this paper we underline that the NICE and SIGN guidelines recommend similar interventions, but that the NICE guideline has more rigorous methodology. Our analysis suggests that the authors of the editorial appear to have succumbed to bias themselves.