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Background: Electronic decision support systems could reduce the use of inappropriate or ineffective empirical antibiotics. We assessed the accuracy of an open-source machine-learning algorithm trained in predicting antibiotic resistance for three Gram-negative bacterial species isolated from patients' blood and urine within 48 h of hospital admission.Methods: This retrospective, observational study used routine clinical information collected between January 2010 and October 2016 in Birmingham, UK. Patients from whose blood or urine cultures Escherichia coli, Klebsiella pneumoniae or Pseudomonas aeruginosa was isolated were identified. Their demographic, microbiology and prescribing data were used to train an open-source machine-learning algorithm-XGBoost-in predicting resistance to co-amoxiclav and piperacillin/tazobactam. Multivariate analysis was performed to identify predictors of resistance and create a point-scoring tool. The performance of both methods was compared with that of the original prescribers.Results: There were 15 695 admissions. The AUC of the receiver operating characteristic curve for the point-scoring tools ranged from 0.61 to 0.67, and performed no better than medical staff in the selection of appropriate antibiotics. The machine-learning system performed statistically but marginally better (AUC 0.70) and could have reduced the use of unnecessary broad-spectrum antibiotics by as much as 40% among those given co-amoxiclav, piperacillin/tazobactam or carbapenems. A validation study is required.Conclusions: Machine-learning algorithms have the potential to help clinicians predict antimicrobial resistance in patients found to have a Gram-negative infection of blood or urine. Prospective studies are required to assess performance in an unselected patient cohort, understand the acceptability of such systems to clinicians and patients, and assess the impact on patient outcome. [ABSTRACT FROM AUTHOR]

Phantom studies and a prior patient study have shown up to 53% effective dose reduction when lumbar spine radiographs are acquired posteroanterior (PA) instead of anteroposterior (AP). Since November 2017, Taunton and Somerset NHS Foundation Trust has acquired all standing lumbar spine radiographs PA. The aim of this study was to locally evaluate dose and image quality in both projections and survey current UK practice. 80 outpatients having a standing lumbar spine radiograph (40 AP; 40 PA) had their dose–area product recorded at a constant KV and focus film distance. Effective dose was calculated using PCXMC software. Each blinded radiograph was scored against an optimal reference image using European Guidelines criteria. The data were analyzed using Mann–Whitney U tests and linear regression. Eighty radiologists nationally were sent an anonymous survey to establish their current practice. A lumbar spine radiograph acquired PA instead of AP reduced effective dose by 41% (p < 0.001) with no difference in image quality (p = 0.9). 21 radiologists completed our survey and only 1 NHS Trust is currently using PA. PA lumbar spine radiography reduces patient radiation exposure with no affect on image quality, acquisition time or cost. The majority of NHS Trusts nationally are still using AP and it is time to standardize to PA. This patient study provides further good evidence of how reduction in exposure to ionizing radiation can be achieved in lumbar spine radiography and more widespread adoption of PA protocol could improve patient safety. [ABSTRACT FROM AUTHOR]

Summary: Analysis of RNA sequencing (RNA-Seq) data have highlighted the fact that most genes undergo alternative splicing (AS) and that these patterns are tightly regulated. Many of these events are complex, resulting in numerous possible isoforms that quickly become difficult to visualize, interpret and experimentally validate. To address these challenges we developed MAJIQ-SPEL, a web-tool that takes as input local splicing variations (LSVs) quantified from RNA-Seq data and provides users with visualization and quantification of gene isoforms associated with those. Importantly, MAJIQ-SPEL is able to handle both classical (binary) and complex, non-binary, splicing variations. Using a matching primer design algorithm it also suggests to users possible primers for experimental validation by RT-PCR and displays those, along with the matching protein domains affected by the LSV, on UCSC Genome Browser for further downstream analysis. [ABSTRACT FROM AUTHOR]

Aims and objectives This study used a 'Lean' technique, the 'waste walk' to evaluate the activities of clinical pharmacists with reference to the seven wastes described in 'Lean' including 'defects', 'unnecessary motion', 'overproduction', 'transport of products or material', 'unnecessary waiting', 'unnecessary inventory' and 'inappropriate processing'. The objectives of the study were to categorise the activities of ward-based clinical pharmacists into waste and non-waste, provide detail around what constitutes waste activity and quantify the proportion of time attributed to each category. Setting This study was carried out in a district general hospital in the North West of England. Method Staff were observed using work-sampling techniques, to categorise activity into waste and non-waste, with waste activities being allocated to each of the seven wastes described earlier and subdivided into recurrent themes. Key findings Twenty different pharmacists were observed for 1 h on two separate occasions. Of 1440 observations, 342 (23.8%) were categorised as waste with 'defects' and 'unnecessary motion' accounting for the largest proportions of waste activity. Conclusion Observation of clinical pharmacists' activities has identified that a significant proportion of their time could be categorised as 'waste'. There are practical steps that could be implemented in order to ensure their time is used as productively as possible. Given the challenges facing the UK National Health Service, the adoption of 'Lean' techniques provides an opportunity to improve quality and productivity while reducing costs. [ABSTRACT FROM AUTHOR]

We evaluated the accuracy of an Accutrend lactate meter and a Reichert® Vet 360 temperature compensated refractometer for determining red swamp crayfish Procambarus clarkii (Girard, 1852) hemolymph lactate and protein concentrations, with results compared to measurements obtained from spectrophotometric analyses. Results from the lactate meter (R² = 0.926) and refractometer (R² = 0.830) both demonstrated strong relationships with spectrophotometer measurements, indicating that these instruments provide rapid, reliable, and economical methods for determining crayfish hemolymph lactate and protein concentrations. Both meters can provide on-site information to commercial crayfish fanners and processors to assess crayfish health and stress levels, and can also provide important biomonitoring data to field biologists as they evaluate the success of water management activities designed to reduce hypoxia and improve habitat conditions for aquatic biota. [ABSTRACT FROM AUTHOR]

Objectives Medication history-taking is recognised as a potential source of medication errors and is the subject of the first National Patient Safety Agency/National Institute for Health and Clinical Excellence Patient Safety Guidance. Medication lists are suggested as a way of improving medicines reconciliation, but, anecdotally, can falsely reassure prescribers that they have an accurate list of medicines if used in isolation. Methods Patients in possession of a medicines list on admission to hospital were approached as part of routine care. Data were collated regarding medication-history discrepancies, their source and whether a prescription amendment was made. Key findings One hundred and twenty patients were reviewed and the median time for pharmacists to complete medicines reconciliation was 15 min. Eighty-three patients (69.2%) had only one medication list, 31 (26%) had two, five (4%) had three and one patient (0.8%) had four lists. In total, 447 discrepancies were identified of which 49 (11.0%) were initiated by the patient, including 32 (65.3%) to adjust a dosage regimen or not to comply with a dosing regime. For the 279 (62.4%) discrepancies attributable to secondary care staff, 119 (42.6%) prescribed medicines were omitted unintentionally. For the 119 (26.6%) discrepancies attributable to the primary care medicines lists, 48 (40.3%) related to inadequate or inaccurate information regarding medicine doses, frequency, strength or form. Each patient required a mean of 1.6 amendments to their prescription despite bringing a list of medicines with them. Conclusions Medication lists should be interpreted with caution and assessed in combination with other sources of information, particularly the patient or their carer. Strategies to improve medicines reconciliation on admission to hospital are still needed and a single electronic patient record encompassing primary and secondary care medication records would be a positive step forward. [ABSTRACT FROM AUTHOR]

Extensive reading has for many years been seen as an important and motivating means of improving general language proficiency in a second language. This article argues that while extensive reading per se is an important medium for long-term second language acquisition, extensive reading schemes may not be the most effective means of promoting acquisition. This argument springs from the disappointing results ofthe implementation of the Hong Kong Extensive Reading Scheme in English, which are described in the article. The article presents the view that extensive reading is too important an activity to be confined within the hermetic bounds ofa scheme. Instead, it is argued, extensive reading should be incorporated fully in the language curriculum as a vital component of a task-based approach to second language learning. [ABSTRACT FROM AUTHOR]

Discusses the effects of a pharmacist-initiated educational intervention on patient knowledge about the appropriate use of antibiotics in the U.S. Concern that antibiotic resistance can result in increased morbidity, mortality and health care costs; Association of antibiotic resistance with the inappropriate prescribing of antibiotics in the ambulatory care setting; Percentage of antibiotic prescriptions accounted to prescriptions for antibiotics to treat acute upper respiratory tract infections.

The ATDC gene was cloned using functional complementation and complements the radiosensitivity of ataxia telangiectasia (AT) group D cells. Although a number of transcripts have been detected, only a 3.0 kb cDNA found in a HeLa cell cDNA library has been cloned. Since AT group D cells express only a 2.4 kb transcript, efforts were made to clone and sequence this transcript. Using a biotinylated oligonucleotide probe, mRNA preparations were enriched in ATDC-related sequences. After this enrichment, 2.4 kb clones were obtained from the resulting library. The 2.4 kb transcript appears to be untranslated, since no protein from this transcript has been detected in AT group D cells, and this transcript is probably non-functional, since a splicing variation has positioned part of intron 1 near the first methionine codon in exon 1, eliminating most of exon 1 and important functional regions from this transcript. This transcript now has a stop codon located 33 bp in front of the first methionine, which would stop translation after the eleventh amino acid. As a result of these changes, the AT group D cell line (AT5BI) expresses no functional ATDC protein. [ABSTRACT FROM PUBLISHER]

The article presents information about several books related to economics. "Psychological Economics: Development, Tensions, Prospects," edited by Peter E. Earlisa collection of 15 chapters written by twelve academics in university economics departments, one professor of marketing and an economic psychologist. Some chapters are speculative, others more of a review. But the book is top-and-tailed by very useful and well written chapters by the editor. In the book "Economics: Between Predictive Science and Moral Philosophy," by James M. Buchanan, the essays are arranged in five sections devoted to methodological issues, individual choice, collective choice, morality and contractarianism, and the fiscal implications of the constitutional approach. A substantial minority of the papers are usefully reprinted from relatively inaccessible sources, but the majority are already easily available with the value of his collection limited to their convenient juxtapositioning. The book "Production, Distribution and Value: A Marxian Approach," by Robert Dixon presents and elaborates a simple model of income distribution with two commodities and two types of income.

The article focuses on the work of artist Juan Gris and his relationship as painter with the poets close to him. According to the author, in an artist's theorising is to be found important insights into his pictorial concerns, so far as he is conscious of them, but the fact remains that how an artist works and what he produces never fits altogether comfortably with the theories, and in Gris's case it is established that the work did not follow the theories but vice versa. It is also suggested that Gris enjoyed reading and he took particular pleasure in poetry.

The article presents information on Juan Gris' paintings. After some time during 1914-1918 War, his work is seen as the product of a synthetic process, which begins with the manipulation of colored abstract shapes and ends with their adjustments. For Gris, 1915 was the worst year of the war, but his work continued as vigorously and as confidently as before. One of the problem in few of the paintings made by Gris is legibility. Of all the still-lives painted by Gris in early 1917, " Le Damier," has most convincingly the look of a work begun in abstraction.

Purpose. A case of bupropion-induced constipation is reported. Summary. A 38-year-old man went to a clinic with a chief complaint of depression. He was prescribed extended-release bupropion 150 mg orally daily. Three weeks later, the patient returned to the clinic for a follow-up visit regarding his depression. He reported that his depression symptoms improved, but he complained of constipation and inflamed hemorrhoids from straining with defecation. He used docusate sodium, fiber supplements, and Preparation H (Wyeth) products with some relief. The bupropion was continued for his depression. Recommendations were given to the patient to increase fluids, maintain fiber intake, and add exercise. One week later, the patient complained of rectal pain and minimal bleeding. Prescriptions were given to the patient for hydrocortisone suppositories and 2.5% cream to be used twice daily. Three days later, the patient returned to the clinic complaining of increased pain and no relief from the hydrocortisone suppositories and cream. The rectal examination showed 3- and 5-cm hemorrhoids, one of which was thrombotic. The patient was instructed to continue hydrocortisone products, increase fluids, and continue docusate. Hemorrhoidectomy surgery was eventually performed, as well as a fissurectomy. The patient discontinued bupropion on his own due to the constipation approximately one week before the surgery. The constipation resolved after discontinuation of bupropion. Conclusion. Extended-release bupropion was the probable cause of severe constipation in a man with multiple medical problems. [ABSTRACT FROM AUTHOR]