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OBJECTIVEWe report the utility of whole-genome sequencing (WGS) conducted in a clinically relevant time frame (ie, sufficient for guiding management decision), in managing a Streptococcus pyogenes outbreak, and present a comparison of its performance with emm typing.SETTINGA 2,000-bed tertiary-care psychiatric hospital.METHODSActive surveillance was conducted to identify new cases of S. pyogenes. WGS guided targeted epidemiological investigations, and infection control measures were implemented. Single-nucleotide polymorphism (SNP)–based genome phylogeny, emm typing, and multilocus sequence typing (MLST) were performed. We compared the ability of WGS and emm typing to correctly identify person-to-person transmission and to guide the management of the outbreak.RESULTSThe study included 204 patients and 152 staff. We identified 35 patients and 2 staff members with S. pyogenes. WGS revealed polyclonal S. pyogenes infections with 3 genetically distinct phylogenetic clusters (C1–C3). Cluster C1 isolates were all emm type 4, sequence type 915 and had pairwise SNP differences of 0–5, which suggested recent person-to-person transmissions. Epidemiological investigation revealed that cluster C1 was mediated by dermal colonization and transmission of S. pyogenes in a male residential ward. Clusters C2 and C3 were genomically diverse, with pairwise SNP differences of 21–45 and 26–58, and emm 11 and mostly emm120, respectively. Clusters C2 and C3, which may have been considered person-to-person transmissions by emm typing, were shown by WGS to be unlikely by integrating pairwise SNP differences with epidemiology.CONCLUSIONSWGS had higher resolution than emm typing in identifying clusters with recent and ongoing person-to-person transmissions, which allowed implementation of targeted intervention to control the outbreak.Infect Control Hosp Epidemiol 2018;852–860

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • High-dose antipsychotic use in schizophrenia has been a topic of continuous debate since the introduction of the first antipsychotic in the 1950s. • There are reasons arguing for (such as pharmacokinetic reasons for the possible use of high antipsychotic doses in those with genetic polymorphisms associated with unusually high metabolic rates and the presence of inducers such as co-prescriptions of other medications and smoking) and against high-dose antipsychotic use (such as the pharmacokinetic understanding that Asians may need lower antipsychotic doses, the association of high antipsychotic doses with more frequent adverse effects, and receptor occupancy data from neuroimaging studies). • There is increasing awareness of the need for more practice-based research in order to highlight discrepancies between the empirical data and clinical practice. WHAT THIS STUDY ADDS • There was an overall significant decrease in the frequency of high-dose antipsychotic use from 17.9% in 2001 to 6.5% in 2004 within East Asia. • The association of high antipsychotic doses with demographic, psychopathological and treatment variables identified the clinical profile of schizophrenia patients who are at risk of receiving high antipsychotic doses. • These findings provide information and impetus for clinicians to constantly monitor the drug regimes and to foster rational, evidence-based prescribing practices. AIMS We aimed to examine the frequency of high-dose (defined as mean chlorpromazine mg equivalent doses above 1000) antipsychotic prescriptions in schizophrenia and their clinical correlates in the context of a comparison between studies in 2001 and 2004 within six East Asian countries and territories. METHODS Prescriptions of high-dose antipsychotic for a sample of 2136 patients with schizophrenia from six countries and territories (mainland China, Hong Kong, Korea, Japan, Taiwan and Singapore) were evaluated in 2004 and compared with data obtained for 2399 patients in 2001. RESULTS Overall, the comparison between 2001 and 2004 showed a significant decrease in high-dose antipsychotic use from 17.9 to 6.5% [odds ratio (OR) 0.32, 95% confidence interval (CI) 0.26, 0.39, P

Electrochemical discharge machining (ECDM) is found to be a potential process for the microdrilling of glass wafers. However, some degree of heat-affected zone resulting from the thermal energy during ECDM produces several inherent problems that might be major issues, such as over cut and taper hole. To improve the quality of the ECDM microhole, a flat sidewall–flat front tool electrode is designed to reduce taper phenomena due to the sidewall discharge. In addition, a pulse voltage is applied to improve the heat-affected zone in the rectified dc voltage. The experimental results show that the combination of flat sidewall–flat front tool and pulse voltage conspicuously increases the machining accuracy while retaining the machining rate. This experimental investigation provides a new method that overcomes the disadvantages of conventional ECDM.

In this study, an optimization algorithm is proposed for asymmetric s-shape acceleration/deceleration to achieve better contour accuracy for biaxial systems. The optimization is based on the method of genetic algorithm incorporated with the constraints made by the motion system. Numerical simulations of an XY table driven by linear motors following a simple cornering path verify the proposed algorithm.

In general, there are two types of acceleration/deceleration (Acc/Dec) motion planning architectures: Acc/Dec before interpolation (ADBI) and Acc/Dec after interpolation (ADAI). The ADBI approach will not generate command errors and the look-ahead function can be easily implemented. The ADAI approach can generate smooth velocity profiles even at sharp corners. In this paper, a novel Acc/Dec hybrid interpolation (ADHI) scheme is presented. The ADHI integrates the ADBI and ADAI techniques to deal with multiblocks of non-uniform rational B-spline (NURBS) curves. The feedrates for multi-blocks of NURBS curves are computed by utilizing the derived corner error equation. Simulations are performed to validate the ADHI approach. It is shown that the ADHI approach improves tracking and contour accuracies significantly compared to the hybrid multi-blocks look-ahead approach.

We test the hypothesis of increasing prevalence of low-dose antipsychotic use (300 mg/d chlorpromazine-equivalent) in East Asia and examine clinical correlates of conservative dosing. Rates of low-dose antipsychotic prescription were determined for 4535 patients with DSM-IV diagnosis of schizophrenia in six East Asian countries and territories, with comparisons analysed for 2004 vs. 2001. Between 2001 (n=2399 subjects) and 2004 (n=2136 subjects), prescription rates for low doses of antipsychotic drugs (APDs) increased from 24.8% to 44.0% (p0.001). Low doses were more likely among older patients (p=0.005), during first-lifetime hospitalizations (p0.001), and among patients with less prominent delusions, hallucinations or disorganized speech (all p0.05). Multivariate modelling indicated that low doses were strongly associated with older age, first admission, sampling year (20042001), less use of antipsychotic polytherapy (all p0.001) and depot antipsychotics (p=0.009). Conservative dosing of APDs was increasingly prevalent in East Asia. Our findings suggest characteristics of patients who may be particularly likely to require low antipsychotic doses.