General Practitioner Antimicrobial Stewardship Programme Study (GAPS): protocol for a cluster randomised controlled trial

Background There is a strong link between antibiotic consumption and the rate of antibiotic resistance. In Australia, the vast majority of antibiotics are prescribed by general practitioners, and the most common indication is for acute respiratory infections. The aim of this study is to assess if implementing a package of integrated, multifaceted interventions reduces antibiotic prescribing for acute respiratory infections in general practice. Methods/design This is a cluster randomised trial comparing two parallel groups of general practitioners in 28 urban general practices in Queensland, Australia: 14 intervention and 14 control practices. The protocol was peer-reviewed by content experts who were nominated by the funding organization. This study evaluates an integrated, multifaceted evidence-based package of interventions implemented over a six month period. The included interventions, which have previously been demonstrated to be effective at reducing antibiotic prescribing for acute respiratory infections, are: delayed prescribing; patient decision aids; communication training; commitment to a practice prescribing policy for antibiotics; patient information leaflet; and near patient testing with C-reactive protein. In addition, two sub-studies are nested in the main study: (1) point prevalence estimation carriage of bacterial upper respiratory pathogens in practice staff and asymptomatic patients; (2) feasibility of direct measures of antibiotic resistance by nose/throat swabbing. The main outcome data are from Australia’s national health insurance scheme, Medicare, which will be accessed after the completion of the intervention phase. They include the number of antibiotic prescriptions and the number of patient visits per general practitioner for periods before and during the intervention. The incidence of antibiotic prescriptions will be modelled using the numbers of patients as the denominator and seasonal and other factors as explanatory variables. Results will compare the change in prescription rates before and during the intervention in the two groups of practices. Semi-structured interviews will be conducted with the general practitioners and practice staff (practice nurse and/or practice manager) from the intervention practices on conclusion of the intervention phase to assess the feasibility and uptake of the interventions. An economic evaluation will be conducted to estimate the costs of implementing the package, and its cost-effectiveness in terms of cost per unit reduction in prescribing. Discussion The results on the effectiveness, cost-effectiveness, acceptability and feasibility of this package of interventions will inform the policy for any national implementation.

Transposable elements in a marginal plant population

Background
How new forms arise in nature has engaged evolutionary biologists since Darwin's seminal treatise on the origin of species. Transposable elements (TEs) may be among the most important internal sources for intraspecific variability. Thus, we aimed to explore the temporal dynamics of several TEs in individual genotypes from a small, marginal population of Aegilops speltoides. A diploid cross-pollinated grass species, it is a wild relative of the various wheat species known for their large genome sizes contributed by an extraordinary number of TEs, particularly long terminal repeat (LTR) retrotransposons. The population is characterized by high heteromorphy and possesses a wide spectrum of chromosomal abnormalities including supernumerary chromosomes, heterozygosity for translocations, and variability in the chromosomal position or number of 45S and 5S ribosomal DNA (rDNA) sites. We propose that variability on the morphological and chromosomal levels may be linked to variability at the molecular level and particularly in TE proliferation.

Results
Significant temporal fluctuation in the copy number of TEs was detected when processes that take place in small, marginal populations were simulated. It is known that under critical external conditions, outcrossing plants very often transit to self-pollination. Thus, three morphologically different genotypes with chromosomal aberrations were taken from a wild population of Ae. speltoides, and the dynamics of the TE complex traced through three rounds of selfing. It was discovered that: (i) various families of TEs vary tremendously in copy number between individuals from the same population and the selfed progenies; (ii) the fluctuations in copy number are TE-family specific; (iii) there is a great difference in TE copy number expansion or contraction between gametophytes and sporophytes; and (iv) a small percentage of TEs that increase in copy number can actually insert at novel locations and could serve as a bona fide mutagen.

Conclusions
We hypothesize that TE dynamics could promote or intensify morphological and karyotypical changes, some of which may be potentially important for the process of microevolution, and allow species with plastic genomes to survive as new forms or even species in times of rapid climatic change.

Impulse-voltage breakdown characteristics of large gaps at low pressures

A study of the gap breakdown voltage characteristic at a low pressure of 7×10-5 Torr with a standard (1/50)-μsec impulse-voltage wave reveals an agreement with the criterion Vb=Cd0.5 suggested by Cranberg. Voltage-time-to-breakdown characteristics has also been determined. From these studies, it is concluded that impulse breakdown in vacuum is initiated by an electron current heating an anode spot and thereby liberating a clump which causes breakdown.

Approximate VB-MO schemes for excitation gaps in Hubbard models

The excitation gaps in the singlet and triplet manifolds for finite Hubbard models in one, two and three dimensions have been obtained using different approximate configuration interaction (CI) schemes, as a function of the correlation strength, by using valence bond (VB) functions constructed over the molecular orbital (MO) basis. These are compared with numerically exact results and it is found that the scheme in which all particle hole excitations below a given threshold are included is the method of choice. The excitation energies are well reproduced, in trend as well as magnitude, particularly when the threshold equals the bandwidth of the corresponding noninteracting system.

Band gaps in diamond-graphite hybrids

The HOMO-LUMO gaps have been estimated in a graphite-like sp(2) carbon network with a progressive increase in the fraction of sp(3) carbons, taking into account several possible structural alternatives for each composition. The gap is shown to increase exponentially with the fraction of sp(3) carbons. Accordingly, the gap in a diamond-like sp(3) network decreases with the increase in the fraction of sp(2) carbons.

Localized data gathering paradigms for small and marginal farm lands in Semi-Arid region – Issues and Concerns

In this work we explore the application of wireless sensor technologies for the benefit of small and marginal farmers in semi-arid regions. The focus in this paper is to discuss the merits and demerits of data gathering & relay paradigms that collect localized data over a wide area. The data gathered includes soil moisture, temperature, pressure, rain data and humidity. The challenge to technology intervention comes mainly due to two reasons: (a) Farmers in general are interested in crop yield specific to their piece of land. This is because soil texture can vary rapidly over small regions. (b) Due to a high run-off, the soil moisture retention can vary from region to region depending on the topology of the farm. Both these reasons alter the needs drastically. Additionally, small and marginal farms can be sandwiched between rich farm lands. The village has very little access to grid power. Power cuts can extend up to 12 hours in a day and upto 3 or 4 days during some months in the year. In this paper, we discuss 3 technology paradigms for data relaying. These include Wi-Fi (Wireless Fidelity), GPRS (General Packet Radio Service) and DTN (Delay and Disruption Tolerant Network) technologies. We detail the merits and demerits of each of these solutions and provide our final recommendations. The project site is a village called Chennakesavapura in the state of Karnataka, India.

Large rapidity gaps survival probabilities at LHC

We calculate the probability of large rapidity gaps in high energy hadronic collisions using a model based on QCD mini-jets and soft gluon emission down into the infrared region. Comparing with other models we find a remarkable agreement among most predictions.

Prebreakdown current measurements in vacuum gaps stressed by alternating voltages

A method has been suggested for the measurement of prebreakdown currents under a.c. conditions. Measurements were made using hemispherical stainless steel electrodes and currents from 10~3 A down to 10~7 A have been measured.

Ultrahigh-temperature metamorphism from an unusual corundum plus orthopyroxene intergrowth bearing Al-Mg granulite from the Southern Marginal Zone, Limpopo Complex, South Africa

The Southern Marginal Zone of the Limpopo Complex is composed of granite-greenstone cratonic rocks reworked by a Neoarchean high-grade tectono-metamorphic event. Petrographic and mineral chemical characterization of an Al-Mg granulite from this zone is presented here. The granulite has a gneissic fabric with distinct Al-rich and Si-rich layers, with the former preserving the unusual lamellar (random and regular subparallel) intergrowths of corundum and symplectic intergrowth of spinel with orthopyroxene. The Al-rich layer preserves mineral assemblages such as rutile with orthopyroxene + sillimanite +/- A quartz, Al-rich orthopyroxene (similar to 11 wt%), spinel + quartz, and corundum in possible equilibrium with quartz, while the Si-rich layer preserves antiperthites and orthopyroxene + sillimanite +/- A quartz, all considered diagnostic of ultrahigh-temperature metamorphism. Application of Al-in-opx thermometry, ternary feldspar thermometry and construction of suitable pressure-temperature phase diagrams, compositional and model proportion isopleth results indicate P-T conditions as high as similar to 1,050-1,100 A degrees C, and similar to 10-12 kbars for the Al-Mg granulite. Our report of ultrahigh-temperature conditions is significant considering that the very high temperature was reached during decompression of an otherwise high-pressure granulite complex (clockwise P-T path), whereas most other ultrahigh-temperature granulites are linked to magma underplating at the base of the crust (counterclockwise P-T path).

Seismic hazard analysis of Lucknow considering local and active seismic gaps

The Himalayas are one of very active seismic regions in the world where devastating earthquakes of 1803 Bihar-Nepal, 1897 Shillong, 1905 Kangra, 1934 Bihar-Nepal, 1950 Assam and 2011 Sikkim were reported. Several researchers highlighted central seismic gap based on the stress accumulation in central part of Himalaya and the non-occurrence of earthquake between 1905 Kangra and 1934 Bihar-Nepal. The region has potential of producing great seismic event in the near future. As a result of this seismic gap, all regions which fall adjacent to the active Himalayan region are under high possible seismic hazard due to future earthquakes in the Himalayan region. In this study, the study area of the Lucknow urban centre which lies within 350 km from the central seismic gap has been considered for detailed assessment of seismic hazard. The city of Lucknow also lies close to Lucknow-Faizabad fault having a seismic gap of 350 years. Considering the possible seismic gap in the Himalayan region and also the seismic gap in Lucknow-Faizabad fault, the seismic hazard of Lucknow has been studied based on deterministic and the probabilistic seismic hazard analysis. Results obtained show that the northern and western parts of Lucknow are found to have a peak ground acceleration of 0.11-0.13 g, which is 1.6- to 2.0-fold higher than the seismic hazard compared to the other parts of Lucknow.

Pulsed rf magnetron sputtered alumina thin films

Alumina thin films were deposited on titanium (Ti) and fused quartz by both direct and reactive pulsed rf magnetron sputtering techniques. X-ray diffraction, field emission scanning electron microscopy, energy dispersive X-ray spectroscopy and atomic force microscopy were utilized to study the phases and surface morphology of the films. The as-deposited alumina thin films were amorphous. However, after annealing at 500 degrees C in vacuum, the crystalline peaks corresponding to the Theta (0), Delta (8) and Chi ()) alumina phases were obtained. The optical transmittance and reflectance as well as IR emittanc,e data were also evaluated for the thin films. The transmittance, e.g., (similar to 90%) of the bare quartz substrate was not changed even when the alumina thin films were deposited for an hour. However, further increase in deposition time (e.g., 7 h) of the alumina thin films showed only a marginal decrease (e.g., similar to 5%) in average transmittance of the bare quartz substrate. The direct and indirect optical band gaps and extinction coefficient of the alumina films were estimated from the transmittance spectra. The IR emittance of the Ti substrate (e.g., similar to 16%) was almost constant after depositing alumina thin films for an hour. Further increase in deposition time showed only a marginal increase (e.g., similar to 9%) in IR emittance value. Therefore, it is proposed that the alumina films developed in the present work can act as a protective cover for the Ti substrate while retaining the thermo-optical properties of the same. The nanohardness and Young's modulus of the alumina thin films were evaluated by the novel nanoindentation technique. The nanohardness was measured as similar to 6 GPa. Further, Young's modulus was evaluated as similar to 116 GPa. The magnitudes of the nanomechanical properties of the thin films were a little smaller than those reported in the literature. This was linked to the lack of crystalline phases in the as-deposited alumina thin films. (C) 2014 Elsevier Ltd and Techna Group S.r.l. All rights reserved.

A NOTE ON SMALL GAPS BETWEEN NONZERO FOURIER COEFFICIENTS OF CUSP FORMS

It is shown that there are infinitely many primitive cusp forms f of weight 2 with the property that for all X large enough, every interval (X, X + cX(1/4)), where c > 0 depends only on the form, contains an integer n such that the n-th Fourier coefficient of f is nonzero.

Simultaneous tunability of the electronic and phononic gaps in SnS2 under normal compressive strain

Controlled variation of the electronic properties of. two-dimensional (2D) materials by applying strain has emerged as a promising way to design materials for customized applications. Using density functional theory (DFT) calculations, we show that while the electronic structure and indirect band gap of SnS2 do not change significantly with the number of layers, they can be reversibly tuned by applying biaxial tensile (BT), biaxial compressive (BC), and normal compressive (NC) strains. Mono to multilayered SnS2 exhibit a reversible semiconductor to metal (S-M) transition with applied strain. For bilayer (2L) SnS2, the S-Mtransition occurs at the strain values of 17%,-26%, and -24% under BT, BC, and NC strains, respectively. Due to weaker interlayer coupling, the critical strain value required to achieve the S-Mtransition in SnS2 under NC strain is much higher than for MoS2. From a stability viewpoint, SnS2 becomes unstable at very low strain values on applying BC (-6.5%) and BT strains (4.9%), while it is stable even up to the transition point (-24%) in the case of NC strain. In addition to the reversible tuning of the electronic properties of SnS2, we also show tunability in the phononic band gap of SnS2, which increases with applied NC strain. This gap increases three times faster than for MoS2. This simultaneous tunability of SnS2 at the electronic and phononic levels with strain, makes it a potential candidate in field effect transistors (FETs) and sensors as well as frequency filter applications.