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This study aimed to improve the quality of documentation on antibiotic therapy in the computerized medical records of inpatients. A prospective, uncontrolled, interrupted time series (ITS) study was conducted by repeated point prevalence survey (PPS) to audit the quality of documentation on antibiotic therapy in the medical records before and after a combined intervention strategy (implementation of guidelines, distribution of educational materials, educational outreach visits, group educational interactive sessions) from the antimicrobial stewardship team (AST) in the academic teaching hospital (CHU) of Liège, Belgium. The primary outcome measure was the documentation rate on three quality indicators in the computerized medical records: (1) indication for treatment, (2) antibiotics prescribed, and (3) duration or review date. Segmented regression analysis was used to analyze the ITS. The medical records of 2306 patients receiving antibiotics for an infection (1177 in the pre-intervention period and 1129 in the post-intervention period) were analyzed. A significant increase in mean percentages in the post-intervention period was observed as compared with the pre-intervention period for the three quality indicators (indication documented 83.4 ± 10.4 % vs. 90.3 ± 6.6 %, p  = 0.0013; antibiotics documented 87.9 ± 9.0 % vs. 95.6 ± 5.1 %, p  < 0.0001; and duration or review date documented 31.9 ± 15.4 % vs. 67.7 ± 15.2 %, p  < 0.0001). The study demonstrated the successful implementation of a combined intervention strategy from the AST. This strategy was associated with significant changes in the documentation rate in the computerized medical records for the three quality indicators.

The objective of new combustion concepts is to meet emission standards by improving fuel air mixing prior to ignition. Since there is no overlap between injection and ignition, combustion is governed mainly by chemical kinetics and it is challenging to control the phasing of ignition. Reactivity Controlled Compression Ignition (RCCI) combustion aims to control combustion phasing by altering the fuel ratios of the high- and low octane fuel and injection timings. In this study the dual fuel blend is prepared with gasoline and diesel fuels. The applied injection timings of the diesel are very early (90 to 60° CA bTDC). In the detailed reaction mechanism, n-heptane and iso-octane represent diesel and gasoline fuel, respectively. A multi-zone model approach is implemented to perform RCCI combustion simulation. Ignition characteristics are analyzed by using CA50 as the main parameter. In the experiments for the early direct injection (DI) timing advancing the injection time results in a later ignition. Qualitatively, the trend effect of the diesel injection timing and the effect of the ratio gasoline/diesel are captured accurately by the multi-zone model.

ObjectiveTo explore patient-related outcomes measures (PROMs) of piezocision-assisted orthodontic treatment compared to a conventional orthodontic treatment using customized appliance.Materials and methodsTwenty-four adult patients requiring orthodontic treatment for mild-to-moderate overcrowding in both jaws were randomly assigned to a test group, treated with a piezocision-assisted orthodontic treatment, or to a control group, where piezocision was not applied. The patient-related outcomes were recorded using a 0–10 visual analog scale (VAS). Daily analgesic consumption and pain level were also recorded following the placement of the orthodontic appliance in both groups and after the piezocision procedure in the test group. Moreover, levels of apprehension and satisfaction were also assessed in both groups.ResultsIn the piezocision group, over the 7-day period, paracetamol consumption was comparable after the placement of the orthodontic appliance and after the piezocision surgery. Pain levels after the orthodontic and the surgical procedure decreased with time (p < 0.0001) but remained globally higher after piezocision (p = 0.0056). Significantly, more patients of the piezocision group reported that they would undergo the treatment again (p = 0.033) and that they greatly appreciated the duration of treatment (p = 0.0008). However, the level of apprehension was significantly higher in the piezocision group compared to the test group (p = 0.012).ConclusionsAlthough, the degree of apprehension before the surgery and higher pain level in the piezocision group, PROMs emphasized similar pain killer consumption in both group and revealed high acceptance and satisfaction with piezocision approach.Clinical relevanceThe benefit of piezocision-assisted orthodontic treatment seems to be relevant from a patient perspective.Trial registrationNCT03406130

Background: Indocyanine green (ICG) is a promising tracer for sentinel lymph node biopsy in early breast cancer. This randomized study was conducted to evaluate sentinel lymph node biopsy with ICG compared with blue dye as a tracer in woman with early breast cancer without any sign of lymph node invasion. Methods: Between January 2019 and November 2020, 240 consecutive women with early breast cancer were enrolled and randomized to sentinel lymph node biopsy using ICG or blue dye. The primary endpoint was the sentinel lymph node detection rate in both arms. Results: ICG was used in 121 patients and detected sentinel lymph nodes in all patients (detection rate, 100%; 95% CI: 96.9–100.0) while blue dye was used in 119 patients and detected sentinel lymph nodes in 116 patients (detection rate: 97.5%, 95% CI: 92.9–99.1). This analysis indicated the non-inferiority of ICG vs. blue dye tracer (90%CI: −1.9–6.9; p = 0.0009). Conclusion: ICG represents a new promising tracer to detect sentinel lymph nodes in early breast cancer with a detection rate similar to other conventional tracers, and is associated with easy learning and low cost. Our result suggest that this technique is a good alternative to avoid radioactive isotope manipulation.

To determine the source of a nosocomial outbreak of Legionella pneumophila serogroup 1 infection and the efficacy of control measures, clinical and environmental isolates were characterized by molecular subtyping and disease surveillance was conducted. The outbreak involved 32 cases (relative risk, 4.0; P < .001 vs. previous period). Water colonization with L. pneumophila serogroup 1 and patients' exposure to faucet use incriminated the water system as the environmental source. Monoclonal antibody typing showed that patient isolates belonged mainly to type Pontiac and water isolates mainly to type Bellingham (P < .001). By four genotypic techniques, outbreak-related isolates from patients and the water system were found to be clonally related and distinct from control strains (P < .001). Heat and UV light treatment of the water system showed a protective efficacy of 88% (95% confidence interval, 75%–94%). These findings indicate that phenotypic variation may interfere with monoclonal antibody typing of legionellae and that waterborne legionellosis can be controlled by physical disinfection.

Wild biotypes of cultivated sunflower (Helianthus annuus L.) are weeds in corn (Zea mays L.), soybean (Glycine max L.), and other crops in North America, and are commonly controlled by applying acetohydroxyacid synthase (AHAS)-inhibiting herbicides. Biotypes resistant to two classes of AHAS-inhibiting herbicides-imidazolinones (IMIs) or sulfonylureas (SUs)-have been discovered in wild sunflower populations (ANN-PUR and ANN-KAN) treated with imazethapyr or chlorsulfuron, respectively. The goals of the present study were to isolate AHAS genes from sunflower, identify mutations in AHAS genes conferring herbicide resistance in ANN-PUR and ANN-KAN, and develop tools for marker-assisted selection (MAS) of herbicide resistance genes in sunflower. Three AHAS genes (AHAS1, AHAS2, and AHAS3) were identified, cloned, and sequenced from herbicide-resistant (mutant) and -susceptible (wild type) genotypes. We identified 48 single-nucleotide polymorphisms (SNPs) in AHAS1, a single six-base pair insertion-deletion in AHAS2, and a single SNP in AHAS3. No DNA polymorphisms were found in AHAS2 among elite inbred lines. AHAS1 from imazethapyr-resistant inbreds harbored a C-to-T mutation in codon 205 (Arabidopsis thaliana codon nomenclature), conferring resistance to IMI herbicides, whereas AHAS1 from chlorsulfuron-resistant inbreds harbored a C-to-T mutation in codon 197, conferring resistance to SU herbicides. SNP and single-strand conformational polymorphism markers for AHAS1, AHAS2, and AHAS3 were developed and genetically mapped. AHAS1, AHAS2, and AHAS3 mapped to linkage groups 2 (AHAS3), 6 (AHAS2), and 9 (AHAS1). The C/T SNP in codon 205 of AHAS1 cosegregated with a partially dominant gene for resistance to IMI herbicides in two mutant x wild-type populations. The molecular breeding tools described herein create the basis for rapidly identifying new mutations in AHAS and performing MAS for herbicide resistance genes in sunflower.

The density and utility of the molecular genetic linkage map of cultivated sunflower (Helianthus annuus L.) has been greatly increased by the development and mapping of several hundred simple sequence repeat (SSR) markers. Of 1089 public SSR markers described thus far, 408 have been mapped in a recombinant inbred line (RIL) mapping population (RHA280 × RHA801). The goal of the present research was to increase the density of the sunflower map by constructing a new RIL map (PHA × PHB) based on SSRs, adding loci for newly developed SSR markers to the RHA280 × RHA801 RIL map, and integrating the restriction fragment length polymorphism (RFLP) and SSR maps of sunflower. The latter was accomplished by adding 120 SSR marker loci to a backbone of 80 RFLP marker loci on the HA370 × HA372 F2 map. The map spanned 1275.4 centimorgans (cM) and had a mean density of 6.3 cM per locus. The PHA × PHB SSR map was constructed from 264 SSR marker loci, spanned 1199.4 cM, and had a mean density of 4.5 cM per locus. The RHA280 × RHA801 map was constructed by adding 118 new SSR and insertion–deletion (INDEL) marker loci to 459 previously mapped SSR marker loci. The 577‐locus map spanned 1423.0 cM and had a mean density of 2.5 cM per locus. The three maps were constructed from 1044 DNA marker loci (701 unique SSR and 89 unique RFLP or INDEL marker loci) and supply a dense genome‐wide framework of sequence‐based DNA markers for molecular breeding and genomics research in sunflower.

Brucellosis is a worldwide zoonosis. Brucella melitensis infection occurs primarily after consumption of unpasteurized dairy products. We describe a patient with AIDS who developed B. melitensis osteitis after undergoing craniotomy.

Over the last ten years, the concept of pillaring has frequently been applied on layered double hydroxides (LDHs). Due to the variety of possible anionic pillaring species and the adjustable layer charge density, LDHs offer good perspectives with regard to the creation of porous adsorbents and catalysts. But despite these possibilities, their porosity properties can still not compete with those of industrially applicable materials like zeolites. In this study, theoretical calculations based on geometrical models and performed on both Fe(CN)6-MgAl-LDHs (A) and [PV2W10 O40]-ZnAl-LDHs (B) were reported. Properties such as the micropore volume and the interpillar distance were calculated, and compared to experimental data. For a M(II)/M(III) ratio in the layers of 3, the theoretical maximum micropore volumes were 0.3843 cm3/g (A) and 0.1497 cm3/g (B), respectively. By implementing parameters like the stack size, pillars on the outside of the stacks and the possibility of collapse, the model was adjusted in order to create a realistic picture of the microstructure of pillared LDHs. This led to a better understanding of the limiting factors, and gave an explanation for the relatively low micropore volumes of pillared LDHs. For the Fe(CN)6-MgAl-LDHs, small interpillar distances were responsible for the partial inaccessibility of the interlayer regions by N2. This effect was the most pronounced for high charge density LDHs. The situation for the [PV2W10O40]-ZnAl-LDHs is more complex. Probably due to an incomplete pillaring process, the theoretical maximum values are not reached.

To enhance the adsorption selectivity of pillared clays an attempt is made to modify the initial pore size by a controlled deposition of carbon. Cracking of hydrocarbons in the pores of the pillared clay results in coke deposits which can alter the pore size.Based on the evaluation of the amount of coke, the coke density, the decrease in micropore volume, changes in the micropore size distribution and the acidity it was possible to distinguish between pore-blocking, pore-filling and pore-narrowing effects.The modification mechanisms strongly depend on the initial porous structure, the acidity (Brönsted/Lewis), the cracking conditions (static or flow) and the hydrocarbons used.The carbon deposition results in a decrease in pore volume due to pore-filling (Ti-PILC) and pore-blocking (Al-PILC) without achieving a controlled pore-narrowing but some indications for pore-entrance narrowing were found.