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  • 1
    Publication Date: 2023-07-17
    Description: BACKGROUND: Influenza-like illness (ILI) is a common reason for paediatric consultations. Viral causes predominate, but antibiotics are used frequently. With regard to influenza, pneumococcal coinfections are considered major contributors to morbidity/mortality. METHODS: In the context of a perennial quality management (QM) programme at the Charit{\'e} Departments of Paediatrics and Microbiology in collaboration with the Robert Koch Institute, children aged 0-18 years presenting with signs and symptoms of ILI were followed from the time of initial presentation until hospital discharge (Charit{\'e} Influenza-Like Disease = ChILD Cohort). An independent QM team performed highly standardized clinical assessments using a disease severity score based on World Health Organization criteria for uncomplicated and complicated/progressive disease. Nasopharyngeal and pharyngeal samples were collected for viral reverse transcription polymerase chain reaction and bacterial culture/sensitivity and MaldiTOF analyses. The term 'detection' was used to denote any evidence of viral or bacterial pathogens in the (naso)pharyngeal cavity. With the ChILD Cohort data collected, a standard operating procedure (SOP) was created as a model system to reduce the inappropriate use of antibiotics in children with ILI. Monte Carlo simulations were performed to assess cost-effectiveness. RESULTS: Among 2,569 ChILD Cohort patients enrolled from 12/2010 to 04/2013 (55\% male, mean age 3.2 years, range 0-18, 19\% {\ensuremath{〉}}5 years), 411 patients showed laboratory-confirmed influenza, with bacterial co-detection in 35\%. Influenza and pneumococcus were detected simultaneously in 12/2,569 patients, with disease severity clearly below average. Pneumococcal vaccination rates were close to 90\%. Nonetheless, every fifth patient was already on antibiotics upon presentation; new antibiotic prescriptions were issued in an additional 20\%. Simulation of the model SOP in the same dataset revealed that the proposed decision model could have reduced the inappropriate use of antibiotics significantly (P{\ensuremath{〈}}0.01) with an incremental cost-effectiveness ratio of -99.55?. CONCLUSIONS: Physicians should be made aware that in times of pneumococcal vaccination the prevalence and severity of influenza infections complicated by pneumococci may decline. Microbiological testing in combination with standardized disease severity assessments and review of vaccination records could be cost-effective, as well as promoting stringent use of antibiotics and a personalized approach to managing children with ILI.
    Language: English
    Type: article , doc-type:article
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  • 2
    Electronic Resource
    Electronic Resource
    s.l. : American Chemical Society
    Analytical chemistry 67 (1995), S. 3676-3680 
    ISSN: 1520-6882
    Source: ACS Legacy Archives
    Topics: Chemistry and Pharmacology
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Experimental brain research 124 (1999), S. 489-502 
    ISSN: 1432-1106
    Keywords: Key words Regularity ; Lateral superior olive ; Chopper ; Lateral olivocochlear system
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Neurons in the lateral superior olivary nucleus (LSO) respond to acoustic stimuli with the ”chopper response”, a regular repetitive firing pattern with a short and precise latency. In the past, this pattern has been attributed to dendritic integration of synaptic inputs. We investigated a possible contribution of intrinsic membrane properties using intracellular recording techniques in a tissue slice preparation. We found two electrophysiological classes of neurons in the LSO. Chopper neurons responded to depolarizing current pulses with a single onset spike at short, precise latency close to threshold and with repetitive, regular, but accommodating discharges at greater current intensities. An emphasis of response onset and subsequent rate accommodation resulted from the activation of a voltage- and time-dependent sustained outward rectification in a range depolarized from rest. Responses to hyperpolarizing pulses were characterized by an inward rectification, which caused a depolarizing voltage sag in a range negative to –65 mV. Peristimulus time histograms were multimodal, and discharge regularity was evident in narrow unimodal interspike interval time histograms and low coefficients of variation. The accommodation time course was usually fit best by two exponentials with time constants of τ1=3–8 ms and τ2=32–97 ms. Delay neurons responded with a regular repetitive firing to depolarization by current pulses. However, repetitive spike discharge occurred with a prolonged, variable delay of 25–180 ms. High current intensities evoked an additional onset spike with short, precise latency. Activation of a transient outward conductance in the depolarized voltage range caused an early repolarization, which terminated as a depolarizing ramp, reaching spike threshold after the delay. Flat peristimulus time histograms characterized the repetitive discharge in spite of narrow unimodal interspike interval time histograms and low coefficients of variation. Intracellular neurobiotin injections revealed morphological differences between these classes. Chopper neurons were large and fusiform, with a bipolar dendritic distribution oriented perpendicular to the curvature of the LSO. Delay neurons were small and spherical, with highly branched tortuous dendritic arbours of bipolar origin and variable orientation. Chopper and delay neurons are probably LSO principal cells and lateral olivocochlear efferent neurons, respectively. Our findings suggest that the pattern of firing activity of LSO neurons to sound, in vivo, is determined to a large extent by intrinsic membrane properties. Somato-dendritic integration of synaptic inputs are fundamental to the encoding of interaural sound differences, but membrane non-linearities play an important role in determining postsynaptic response patterns.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Numerische Mathematik 60 (1991), S. 251-290 
    ISSN: 0945-3245
    Keywords: 65F10
    Source: Springer Online Journal Archives 1860-2000
    Topics: Mathematics
    Notes: Summary The success of the cyclic Richardson iteration depends on the proper ordering of the acceleration parameters. We give a rigorous error analysis to show that, with the proper ordering, the relative error in the iterative method, when properly terminated, is not larger than the error incurred in stable direct methods such as Cholesky factorization. For both the computed approximation $$\tilde u$$ tou=L −1f satisfies $$\left\| {u - \tilde u} \right\|$$ ≦ cond (L)‖u‖2−t and this bound is attainable. We also show that the residual norm $$\left\| {f - L\tilde u} \right\|$$ is bounded by ‖L‖ cond $$(L)\left\| {\tilde u} \right\|2^{ - t} $$ . This bound is attainable for a small cycle lengthN. Our analysis suggests that for a larger cycle lengthN the residuals are bounded by $$\sqrt {cond(L)} \left\| L \right\|\left\| {\tilde u} \right\|2^{ - t} $$ . We construct a theoretical example in which this bound is attainable. However we observed in all numerical tests that ultimately the residual norms were of order $$\left\| L \right\|\left\| {\tilde u} \right\|2^{ - t} $$ . We explain why in practice even the factor $$\sqrt {cond(L)} $$ is never encountered. Therefore the residual stopping criterion for the Richardson iteration appears to be very reliable and the method itself appears to be stable.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    College Park, Md. : American Institute of Physics (AIP)
    The Journal of Chemical Physics 113 (2000), S. 10333-10343 
    ISSN: 1089-7690
    Source: AIP Digital Archive
    Topics: Physics , Chemistry and Pharmacology
    Notes: The dissociative adsorption of oxygen on the stepped Pt(533) surface has been investigated using supersonic molecular beams by measuring the initial dissociative sticking probability S0 as a function of incident kinetic energy Ei, angle Φ, surface temperature TS, and S as a function of coverage aitch-theta. By comparison with dynamical data available on the Pt(111) surface we have been able to establish that step sites dominate the dissociative adsorption process. S0(Ei) for oxygen on Pt(533) at TS=200 in the energy range 52 meV–1.4 eV shows a similar functional dependence to results on Pt(111), however, the magnitude of S0 on Pt(533) is significantly greater at all energies. The measurement of S0(Φ), scattering in a plane perpendicular to the step direction at Ei=1.18 eV at TS=350 K, reveals a strong and asymmetric angular dependence which contains contributions associated with activated adsorption and dissociation of the chemisorbed precursor on the (111) terraces, and a second contribution associated with activated dissociation through a similar channel at the step sites. The latter exhibits a maximum in S0(Φ) at 35°, near the angle corresponding to the normal of the (100) step plane. S0(TS) at Ei=1.18 eV and Φ=0° reveals a much smaller temperature dependence in the range 150〉TS(K)〉800 on Pt(533) than on Pt(111). At Ei=1.18 eV and Φ=0° ca. 15%–25% of dissociation takes place through molecules impinging directly at step sites. The remaining fraction dissociate through activated adsorption of the chemisorbed species on the (111) terrace and subsequent partition between desorption, and dissociation at step sites. Dissociation of the chemisorbed precursor on the (111) terrace appears highly activated, a result which is consistent with theory. The rapid decrease in S0(Ei) observed below 0.15 eV on Pt(533), observed also on Pt(111), is consistent with a trapping mechanism where the need to dissipate energy limits the probability of adsorption, and subsequent dissociation, of the physisorbed precursor. Kinetic modelling of this partition on Pt(533), between the conversion of the physisorbed precursor to the chemisorbed species, and desorption yields ΔE=120 meV and vd/vpc=80. We conclude that the effective barrier to conversion of the physisorbed to chemisorbed species on Pt(533) is effectively zero. We conclude that defects will tend to dominate this conversion process on the close packed surface. In addition to this channel, at Ei=0.05 meV ca. 50% of molecules dissociate through the same channel operating at higher energy on Pt(533). © 2000 American Institute of Physics.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 0009-8981
    Keywords: Ca antigen ; Malignant breast disease
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Amsterdam : Elsevier
    Molecular and Cellular Probes 4 (1990), S. 375-383 
    ISSN: 0890-8508
    Keywords: DNA/RNA hybridization ; antibiotics ; growth ; oligonucleotide probes ; regulation
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Biology , Medicine
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    [s.l.] : Nature Publishing Group
    Nature 427 (2004), S. 677-677 
    ISSN: 1476-4687
    Source: Nature Archives 1869 - 2009
    Topics: Biology , Chemistry and Pharmacology , Medicine , Natural Sciences in General , Physics
    Notes: [Auszug] Sir Cezary Wójcik, in Correspondence (“Eastern Europe; progress stifled the old guard” 〈weblink url="http://www.nature.com/cgi-taf/DynaPage.taf?file=/nature/journal/v427/n6971/full/427196b_fs.html"〉Nature 427, 196; 2004), expresses a view of ...
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1476-4687
    Source: Nature Archives 1869 - 2009
    Topics: Biology , Chemistry and Pharmacology , Medicine , Natural Sciences in General , Physics
    Notes: [Auszug] MicroRNAs (miRNAs) are small (∼ 22-nucleotide) RNAs that in lower organisms serve important regulatory roles in development and gene expression, typically by forming imperfect duplexes with target messenger RNAs. miRNAs have also been described in mammalian cells and in infections with ...
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1476-4687
    Source: Nature Archives 1869 - 2009
    Topics: Biology , Chemistry and Pharmacology , Medicine , Natural Sciences in General , Physics
    Notes: [Auszug] Carbon nanotubes combine a range of properties that make them well suited for use as probe tips in applications such as atomic force microscopy (AFM). Their high aspect ratio, for example, opens up the possibility of probing the deep crevices that occur in microelectronic circuits, and the ...
    Type of Medium: Electronic Resource
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