Factors associated with inappropriateness of antibiotic prescriptions for acutely ill children presenting to ambulatory care in high-income countries: a systematic review and meta-analysis

BACKGROUND

Acutely ill children are at risk of unwarranted antibiotic prescribing. Data on the appropriateness of antibiotic prescriptions provide insights into potential tailored interventions to promote antibiotic stewardship.

OBJECTIVES

To examine factors associated with the inappropriateness of antibiotic prescriptions for acutely ill children presenting to ambulatory care in high-income countries.

METHODS

On 8 September 2022, we systematically searched articles published since 2002 in MEDLINE, Embase, CENTRAL, Web of Science, and grey literature databases. We included studies with acutely ill children presenting to ambulatory care settings in high-income countries reporting on the appropriateness of antibiotic prescriptions. The quality of the studies was evaluated using the Appraisal tool for Cross-Sectional Studies and the Newcastle-Ottawa Scale. Pooled ORs were calculated using random-effects models. Meta-regression, sensitivity and subgroup analysis were also performed.

RESULTS

We included 40 articles reporting on 30 different factors and their association with inappropriate antibiotic prescribing. 'Appropriateness' covered a wide range of definitions. The following factors were associated with increased inappropriate antibiotic prescribing: acute otitis media diagnosis [pooled OR (95% CI): 2.02 (0.54-7.48)], GP [pooled OR (95% CI) 1.38 (1.00-1.89)] and rural setting [pooled OR (95% CI) 1.47 (1.08-2.02)]. Older patient age and a respiratory tract infection diagnosis have a tendency to be positively associated with inappropriate antibiotic prescribing, but pooling of studies was not possible.

CONCLUSIONS

Prioritizing acute otitis media, GPs, rural areas, older children and respiratory tract infections within antimicrobial stewardship programmes plays a vital role in promoting responsible antibiotic prescribing. The implementation of a standardized definition of appropriateness is essential to evaluate such programmes.

A data-driven spike sorting feature map for resolving spike overlap in the feature space

Objective.Spike sorting is the process of extracting neuronal action potentials, or spikes, from an extracellular brain recording, and assigning each spike to its putative source neuron. Spike sorting is usually treated as a clustering problem. However, this clustering process is known to be affected by overlapping spikes. Existing methods for resolving spike overlap typically require an expensive post-processing of the clustering results. In this paper, we propose the design of a domain-specific feature map, which enables the resolution of spike overlap directly in the feature space.Approach.The proposed domain-specific feature map is based on a neural network architecture that is trained to simultaneously perform spike sorting and spike overlap resolution. Overlapping spikes clusters can be identified in the feature space through a linear relation with the single-neuron clusters for which the neurons contribute to the overlapping spikes. To aid the feature map training, a data augmentation procedure is presented that is based on biophysical simulations.Main results.We demonstrate the potential of our method on independent and realistic test data. We show that our novel approach for resolving spike overlap generalizes to unseen and realistic test data. Furthermore, the sorting performance of our method is shown to be similar to the state-of-the-art, but our method does not assume the availability of spike templates for resolving spike overlap.Significance.Resolving spike overlap directly in the feature space, results in an overall simplified spike sorting pipeline compared to the state-of-the-art. For the state-of-the-art, the overlapping spike snippets exhibit a large spread in the feature space and do not appear as concentrated clusters. This can lead to biased spike template estimates which affect the sorting performance of the state-of-the-art. In our proposed approach, overlapping spikes form concentrated clusters and spike overlap resolution does not depend on the availability of spike templates.

The PDGFRα-laminin B1-keratin 19 cascade drives tumor progression at the invasive front of human hepatocellular carcinoma

Human hepatocellular carcinomas (HCCs) expressing the biliary/hepatic progenitor cell marker keratin 19 (K19) have been linked with a poor prognosis and exhibit an increase in platelet-derived growth factor receptor α (PDGFRα) and laminin beta 1 (LAMB1) expression. PDGFRα has been reported to induce de novo synthesis of LAMB1 protein in a Sjogren syndrome antigen B (La/SSB)-dependent manner in a murine metastasis model. However, the role of this cascade in human HCC remains unclear. This study focused on the functional role of the PDGFRα-La/SSB-LAMB1 pathway and its molecular link to K19 expression in human HCC. In surgical HCC specimens from a cohort of 136 patients, PDGFRα expression correlated with K19 expression, microvascular invasion and metastatic spread. In addition, PDGFRα expression in pre-operative needle biopsy specimens predicted poor overall survival during a 5-year follow-up period. Consecutive histological staining demonstrated that the signaling components of the PDGFRα-La/SSB-LAMB1 pathway were strongly expressed at the invasive front. K19-positive HCC cells displayed high levels of α2β1 integrin (ITG) receptor, both in vitro and in vivo. In vitro activation of PDGFRα signaling triggered the translocation of nuclear La/SSB into the cytoplasm, enhanced the protein synthesis of LAMB1 by activating its internal ribosome entry site, which in turn led to increased secretion of laminin-111. This effect was abrogated by the PDGFRα-specific inhibitor crenolanib. Importantly LAMB1 stimulated ITG-dependent focal adhesion kinase/Src proto-oncogene non-receptor tyrosine kinase signaling. It also promoted the ITG-specific downstream target Rho-associated coiled-coil containing protein kinase 2, induced K19 expression in an autocrine manner, invadopodia formation and cell invasion. Finally, we showed that the knockdown of LAMB1 or K19 in subcutaneous xenograft mouse models resulted in significant loss of cells invading the surrounding stromal tissue and reduced HepG2 colonization into lung and liver after tail vein injection. The PDGFRα-LAMB1 pathway supports tumor progression at the invasive front of human HCC through K19 expression.

A novel In-situ Enzymatic Cleaning Method for Reducing Membrane Fouling in Membrane Bioreactors (MBRs)

A novel in-situ enzymatic cleaning method was developed for fouling control in membrane bioreactors (MBRs). It is achieved by bringing the required enzymes near the membrane surface by pulling the enzymes to a magnetic membrane (MM) surface by means of magnetic forces, exactly where the cleaning is required. To achieve this, the enzyme was coupled to a magnetic nanoparticle (MNP) and the membrane it self was loaded with MNP. The magnetic activity was turned by means of an external permanent magnet. The effectiveness of concept was tested in a submerged membrane filtration using the model enzyme-substrate of Bacillus subitilis xylanase-arabinoxylan. The MM had almost similar properties compared to the unloaded ones, except for its well distributed MNPs. The enzyme was stable during coupling conditions and the presence of coupling could be detected using a high-performance anion-exchange chromatography (HPAEC) analysis and Fourier transform infrared spectroscopy (FTIR). The system facilitated an in-situ enzymatic cleaning and could be effectively applied for control fouling in membrane bioreactors (MBRs).

Predictive factors of speech understanding in adults with cochlear implants

OBJECTIVE

The aim of this study was to analyse the factors that influenced speech recognition scores in quiet conditions and speech reception threshold levels (SRT) in fixed noise conditions, after cochlear implant (CI) surgery in adults with postlinguistic deafness.

STUDY DESIGN

Combined retrospective and prospective study in a tertiary referral centre.

METHODS

We included 66 patients that received implants between 2002 and 2013. We retrospectively collected speech recognition scores and 14 demographic, audiological, and technical factors, including gender, age at implantation, aetiology, hearing loss progression, preoperative Pure Tone Average (PTA), hearing loss onset age and duration, duration and use of hearing aids (HAs); implantation in the best or worst ear; implantation on the right or left side; use of HA after implantation; and the duration and type of CI. We prospectively tested a subgroup of 21 patients for SRT in fixed noise.

RESULTS

The hearing loss duration significantly affected speech recognition scores in quiet conditions (H (4) = 10.567, p =0.032) and SRTs in fixed noise conditions (rs = 0.466, p = 0.033). The PTA of the better ear significantly affected only the SRT in fixed noise conditions (rs = 0.57 1, p = 0.007).

CONCLUSION

The duration of hearing loss and the PTA of the best ear had significant effects on the outcomes of speech recognition and SRT in quiet and fixed noise conditions, respectively. These findings are important for counselling CI candidates. Further studies in larger study populations are warranted.

Speech-in-noise testing as a marker for noise-induced hearing loss and tinnitus

Speech-in-noise testing as a marker for noise-induced hearing loss and tinnitus. Noise-induced hearing loss and tinnitus are auditory complaints that often co-occur. Often, there is no immediate indication of changes in the pure tone audiogram. Patients can still have clinically normal hearing thresholds while clearly experiencing reduced speech comprehension. This might be explained by the process of neurodegeneration of the innervated dendrites of the auditory nerve fibres and secondary degeneration of spiral ganglion neurons. Subsequent maladaptive neuronal plasticity of the central auditory system can induce tinnitus. Standard hearing testing is no longer sufficient in these patients. Therefore more complex tasks, such as speech-in-noise tests, might be valuable extensions to the standard hearing tests. We carried out a prospective investigation of the influence of tinnitus upon speech comprehension in noise and the effectiveness of speech-in-noise testing, using the Flemish version of the digit triplet test (DTT). Thirty-seven patients with mild noise-induced hearing loss, tinnitus complaints and clinically normal pure tone thresholds completed the DTT and filled in two tinnitus enquiries. A statistically significant (p=0.026) correlation between the averaged high PTA, 2,z and the averaged SRT across ears on the DTT was found. There also seems to be a slight influence of tinnitus onset on the SRT score.

Solid-state investigation on a new dimorphic substituted N-salicylidene compound: insights into its thermochromic behaviour

The solid-state polymorphism behaviour of a new thermochromic mechanosynthesized compound derived from ortho-vanillin is investigated through SCXRD and ab initio prediction methods.

Auditory neuropathy/dyssynchrony revisited

Auditory neuropathy/dyssynchrony (AN/AD) is a relatively, recently described diagnostic term. It describes a disorder characterised by detectable otoacoustic emissions and/or cochlear microphonics, combined with abnormal or absent auditory brainstem responses and deficient speech understanding. Consequently, the patient's cognitive responses are inconsistent with a behavioural tone audiogram. This review describes the epidemiology, pathogenesis, diagnosis, and treatment of AN/AD. We have focused on the diagnostic pathway, because diagnosis is sometimes difficult, and recent research has provided important insights into the aetiopathology of the disease. The diagnostic tools for AN/AD currently used in our department will be demonstrated in a clinical case. It is very important to recognise AN/AD and provide patient counselling and support as early as possible, due to the potentially major influence of this disorder on a patient's social life and language acquisition.

Avalanches, breathers, and flow reversal in a continuous Lorenz-96 model

For the discrete model suggested by Lorenz in 1996, a one-dimensional long-wave approximation with nonlinear excitation and diffusion is derived. The model is energy conserving but non-Hamiltonian. In a low-order truncation, weak external forcing of the zonal mean flow induces avalanchelike breather solutions which cause reversal of the mean flow by a wave-mean flow interaction. The mechanism is an outburst-recharge process similar to avalanches in a sandpile model.

Evidence for a fluctuation theorem in an atmospheric circulation model

An investigation of the distribution of finite time trajectory divergence is performed on an atmospheric global circulation model. The distribution of the largest local Lyapunov exponent shows a significant probability for negative values over time spans up to 10 days. This effect is present for resolutions up to wave numbers ℓ=42 (≈250 km). The probability for a negative local largest Lyapunov exponent decreases over time, similarly to the predictions of the fluctuation theorem for entropy production. The model used is hydrostatic with variable numbers of vertical levels and different horizontal resolutions.

Newborn hearing screening and cochlear implantation: impact on spoken language development

OBJECTIVES

This study retrospectively evaluates the effect of newborn hearing screening on age at diagnosis, age at cochlear implantation and spoken language development in severely hearing-impaired children.

METHODS

Age at diagnosis, age at cochlear implantation and language development were evaluated in a group of early screened (n = 149) and a group of late screened (n = 139) severely hearing-impaired children. Language outcomes were quantified as language quotients (LQs) on the Reynell Developmental Language Scales and Schlichting Expressive Language Test at 1,2, and 3 years after cochlear implantation.

RESULTS

Early screened children were significantly younger than late screened children at the time of hearing loss diagnosis and cochlear implantation. Furthermore, early screening was associated with better receptive and expressive spoken language skills after cochlear implantation.

CONCLUSION

The results of this retrospective study indicate that the newborn hearing screening program in Flanders and The Netherlands resulted in earlier intervention in deaf children, which beneficially influenced spoken language development.

Molecular identification of hybrids of the invasive gibel carp Carassius auratus gibelio and crucian carp Carassius carassius in Swedish waters

Both mitochondrial DNA sequence and two nuclear microsatellite markers were used to confirm the identity of the first record of Carassius auratus gibelio in the western (Swedish) Baltic Sea region. A total of 49 fishes were analysed, where 22 were from three Swedish sites connected to the Baltic Sea. The D-loop mitochondrial DNA sequences showed that 16 of 22 Swedish fishes were related to C. a. gibelio. The phylogenetic analysis of these sequences showed that these fish are probably not native, but represent different lineages of C. a. gibelio from China, Japan and Russia. All except three of these 16 fishes had microsatellite alleles suggesting hybridization with Carassius carassius. These findings suggest that a cryptic invasion of C. a. gibelio might be in progress.

Functional benefit of the bone-anchored hearing aid with different auditory profiles: objective and subjective measures

OBJECTIVES

To examine sentence recognition and self-report outcomes in hearing-impaired persons with different auditory profiles and who were fitted unilaterally with a bone-anchored hearing aid.

STUDY-DESIGN

Prospective cohort study.

SETTING

Tertiary referral unit.

PATIENTS

Data were collected of six patients with single-sided deafness (SSD), seven with a mild to severe hearing loss at the bone-anchored hearing aid side and (near-)normal hearing at the other side and six with a severe bilateral hearing loss.

MAIN OUTCOME MEASUREMENTS

Sound field thresholds, and sentence recognition in noise (presented from different angles) with bone-anchored hearing aid, without bone-anchored hearing aid and with bone-anchored hearing aid and other ear occluded. In addition, the Speech, Spatial and Qualities of hearing scale and the Abbreviated Profile of Hearing Aid Benefit questionnaire were administered as self-report measures.

RESULTS

Patients with single-sided deafness listened mainly with their non-bone-anchored hearing aid ear, although the bone-anchored hearing aid lifted the head shadow effect. Patients with mild to severe hearing loss at the bone-anchored hearing aid side and (near-)normal hearing at the other side performed significantly differently in aided and unaided conditions and even regained limited binaural sensitivity with the device. The latter was also true for the patients with severe bilateral hearing loss. However, their hearing loss at the non-bone-anchored hearing aid side was too great to contribute to hearing and they listened predominantly with their bone-anchored hearing aid. Self-report outcomes provided useful information on hearing disability, although this information was not significantly differently for the 3 groups of patients.

CONCLUSIONS

The bone-anchored hearing aid enhanced performance in different hearing configurations, albeit to different extents.

Study on the applicability of instrumental measures for black-box evaluation of static feedback control in hearing aids

Presented is a report on black-box evaluation of feedback control systems for commercial hearing aids. The aim of the study is to examine the ability of existing instrumental measures to quantify the performance of the feedback control system in black-box settings and on realistic signals, when more than one element of the signal processing chain may be active (compression, noise suppression, microphone directionality, etc.). The evaluation is carried out on 6 different hearing aids and for 10 measures. Thereby it is possible to see which measure is best suited to measuring which specific characteristic of the feedback control system, and serves as a beginning for conducting perceptual tests. The study uses static (but variable) feedback paths and is based on signals recorded from the in-ear microphone of an artificial head, on which the hearing instruments are mounted.

A review on the monoacylglycerol lipase: at the interface between fat and endocannabinoid signalling

Together with anandamide, 2-arachidonoylglycerol (2-AG) constitutes one of the main representatives of a family of endogenous lipids known as endocannabinoids. These act by binding to CB(1) and CB(2) cannabinoid receptors, the molecular target of the psychoactive compound Delta(9)-THC, both in the periphery and in the central nervous system, where they behave as retrograde messengers to modulate synaptic transmission. These last years, evidence has accumulated to demonstrate the lead role played by the monoacylglycerol lipase (MAGL) in the regulation of 2-arachidonoylglycerol (2-AG) levels. Considering the numerous physiological functions played by this endocannabinoid, MAGL is now considered a promising target for therapeutics, as inhibitors of this enzyme could reveal useful for the treatment of pain and inflammatory disorders, as well as in cancer research, among others. Here we review the milestones that punctuated MAGL history, from its discovery to recent advances in the field of inhibitors development. An emphasis is given on the recent elucidation of the tridimensional structure of the enzyme, which could offer new opportunities for rational drug design.

Design, synthesis and biological evaluation of a sulfonylcyanoguanidine as thromboxane A2 receptor antagonist and thromboxane synthase inhibitor

The synthesis and the structure of N-isopropyl-N′-[2-(3′-methylphenylamino)-5-nitrobenzenesulfonyl] urea (14) was drawn from two thromboxane A2 receptor antagonists structurally related to torasemide. Compound 14 showed an IC50 value of 22 nm for the thromboxane A2 (TXA2) receptor of human washed platelets. Compound 14 prevented platelet aggregation induced by arachidonic acid (0.6 mm) and U-46619 (1 μm) with an IC50 value of 0.45 and 0.15 μm, respectively. Moreover, 14 relaxed the rat isolated aorta and guinea-pig trachea precontracted by U-46619, a TXA2 agonist. Its efficacy (IC50) was 20.4 and 5.47 nm, respectively. Finally, 14 (1 μm) completely inhibited TXA2 synthase of human platelets. The pKa value and the crystallographic data of 14 were determined and used to propose an interaction model between the TXA2 antagonists related to torasemide and their receptor.

Structure-based drug design targeting biosynthesis of isoprenoids: a crystallographic state of the art of the involved enzymes

Biosynthesis of the universal terpenoid precursors, isopentenyl diphosphate (IPP) and dimethylallyl diphosphate (DMAPP), from three acetyl CoA moieties through mevalonate was studied extensively in the 1950s. For several decades, the mevalonate paradigm reigned supreme and a mevalonate origin was attributed to a growing number of natural products, in many cases erroneously. Besides this biosynthetic pathway, the existence of a second one leading to IPP and DMAPP through 1-deoxy-D-xylulose 5-phosphate and 2C-methyl-D-erythritol 4-phosphate was discovered more recently in plants and some eubacteria. This pathway is widely distributed in the bacterial kingdom including major human pathogens, such as Mycobacterium tuberculosis or Helicobacter pylori and is also essential in the malaria vector Plasmodium falciparum. During the last few years, the genes, enzymes, intermediates and mechanisms of the biosynthetic route have been elucidated by a combination of methods including comparative genomics, enzymology, advanced NMR technology and crystallography. The present crystallographic review of enzymes involved in isoprenoid biosynthesis will be useful for understanding the various catalytic mechanisms and could potentially help for structure-based drug design.

A MBP-FAAH fusion protein as a tool to produce human and rat fatty acid amide hydrolase: expression and pharmacological comparison

Fatty acid amide hydrolase (FAAH), a membrane-anchored enzyme responsible for the termination of endocannabinoid signalling, is an attractive target for treating conditions such as pain and anxiety. Inhibitors of the enzyme, optimized using rodent FAAH, are known but their pharmacology and medicinal chemistry properties on the human FAAH are missing. Therefore recombinant human enzyme would represent a powerful tool to evaluate new drug candidates. However, the production of high amounts of enzyme is hampered by the known refractiveness of FAAH to overexpression. Here, we report the successful overexpression of rat and human FAAH as a fusion to the E. coli maltose-binding protein, retaining catalytic properties of native FAAH. Several known FAAH inhibitors were tested and differences in their potencies toward the human and rat FAAH were found, underscoring the importance of using a human FAAH in the development of inhibitors.

Compact wavelength router based on a Silicon-on-insulator arrayed waveguide grating pigtailed to a fiber array

We demonstrate a compact, fiber-pigtailed, 4-by-4 wavelength router in Silicon-on-insulator photonic wires, fabricated using CMOS processing methods. The core is an AWG with a 250GHz channel spacing and 1THz free spectral range, on a 425x155 microm(2) footprint. The insertion loss of the AWG was reduced to 3.5dB by applying a two-step processing technique. The crosstalk is -12dB. The device was pigtailed using vertical fiber couplers and an eight-fiber array connector.

Differential Scanning Calorimetry in Life Science: Thermodynamics, Stability, Molecular Recognition and Application in Drug Design

All biological phenomena depend on molecular recognition, which is either intermolecular like in ligand binding to a macromolecule or intramolecular like in protein folding. As a result, understanding the relationship between the structure of proteins and the energetics of their stability and binding with others (bio)molecules is a very interesting point in biochemistry and biotechnology. It is essential to the engineering of stable proteins and to the structure-based design of pharmaceutical ligands. The parameter generally used to characterize the stability of a system (the folded and unfolded state of the protein for example) is the equilibrium constant (K) or the free energy (deltaG(o)), which is the sum of enthalpic (deltaH(o)) and entropic (deltaS(o)) terms. These parameters are temperature dependent through the heat capacity change (deltaCp). The thermodynamic parameters deltaH(o) and deltaCp can be derived from spectroscopic experiments, using the van't Hoff method, or measured directly using calorimetry. Along with isothermal titration calorimetry (ITC), differential scanning calorimetry (DSC) is a powerful method, less described than ITC, for measuring directly the thermodynamic parameters which characterize biomolecules. In this article, we summarize the principal thermodynamics parameters, describe the DSC approach and review some systems to which it has been applied. DSC is much used for the study of the stability and the folding of biomolecules, but it can also be applied in order to understand biomolecular interactions and can thus be an interesting technique in the process of drug design.

Ultralow-loss 3-dB photonic crystal waveguide splitter

A photonic crystal waveguide splitter that exhibits ultralow-loss 3-dB splitting for TE-polarized light is fabricated in silicon-on-insulator material by use of deep UV lithography. The high performance is achieved by use of a Y junction, which is designed to ensure single-mode operation, and low-loss 60 degrees bends. Zero-loss 3-dB output is experimentally obtained in the range 1560-1585 nm. Results from three-dimensional finite-difference time-domain modeling with no adjustable parameters are found to be in excellent agreement with the experimental results.

Crystal structure of the C67A mutant of isopentenyl diphosphate isomerase complexed with a mechanism-based irreversible inhibitor

Isopentenyl diphosphate:dimethylallyl diphosphate (IPP:DMAPP) isomerase is a key enzyme in the biosynthesis of isoprenoids. The mechanism of the isomerization reaction involves protonation of the unactivated carbon-carbon double bond in the substrate. Analysis of the 1.97 A crystal structure of the inactive C67A mutant of E. coli isopentenyl diphosphate:dimethylallyl diphosphate isomerase complexed with the mechanism-based inactivator 3,4-epoxy-3-methyl-1-butyl diphosphate is in agreement with an isomerization mechanism involving Glu 116, Tyr 104, and Cys 67. In particular, the results are consistent with a mechanism where Glu116 is involved in the protonation step and Cys67 in the elimination step.

Crystallography of membrane proteins, major targets in drug design

Protein crystallography has the potential to accelerate drug discovery greatly. High-resolution structures of membrane proteins of pharmaceutical interest open new perspectives in drug design. Recent structural data obtained for cyclooxygenases, monoamine oxidase, squalene cyclase, rhodopsine, porins, aquaporins, and ABC transporters are presented and briefly discussed.

Crystal structure of Enterobacter cloacae 908R class C ?-lactamase bound to iodo-acetamido-phenyl boronic acid, a transition-state analogue

The structures of the class C beta-lactamase from Enterobacter cloacae 908R alone and in complex with a boronic acid transition-state analogue were determined by X-ray crystallography at 2.1 and 2.3 A, respectively. The structure of the enzyme resembles those of other class C beta-lactamases. The structure of the complex with the transition-state analogue, iodo-acetamido-phenyl boronic acid, shows that the inhibitor is covalently bound to the active-site serine (Ser64). Binding of the inhibitor within the active site is compared with previously determined structures of complexes with other class C enzymes. The structure of the boronic acid adduct indicates ways to improve the affinity of this class of inhibitors. This structure of 908R class C beta-lactamase in complex with a transition-state analogue provides further insights into the mechanism of action of these hydrolases.