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We studied the association between chlorhexidine gluconate (CHG) concentration on skin and resistant bacterial bioburden. CHG was almost always detected on the skin, and detection of methicillin-resistant Staphylococcus aureus, carbapenem-resistant Enterobacteriaceae, and vancomycin-resistant Enterococcus on skin sites was infrequent. However, we found no correlation between CHG concentration and bacterial bioburden.
The linear instability of a vortex ring with swirl with Gaussian distributions of azimuthal vorticity and velocity in its core is studied by direct numerical simulation. The numerical study is carried out in two steps: first, an axisymmetric simulation of the Navier–Stokes equations is performed to obtain the quasi-steady state that forms a base flow; then, the equations are linearized around this base flow and integrated for a sufficiently long time to obtain the characteristics of the most unstable mode. It is shown that the vortex rings are subjected to curvature instability as predicted analytically by Blanco-Rodríguez & Le Dizès (J. Fluid Mech., vol. 814, 2017, pp. 397–415). Both the structure and the growth rate of the unstable modes obtained numerically are in good agreement with the analytical results. However, a small overestimation (e.g. 22 % for a curvature instability mode) by the theory of the numerical growth rate is found for some instability modes. This is most likely due to evaluation of the critical layer damping which is performed for the waves on axisymmetric line vortices in the analysis. The actual position of the critical layer is affected by deformation of the core due to the curvature effect; as a result, the damping rate changes since it is sensitive to the position of the critical layer. Competition between the curvature and elliptic instabilities is also investigated. Without swirl, only the elliptic instability is observed in agreement with previous numerical and experimental results. In the presence of swirl, sharp bands of both curvature and elliptic instabilities are obtained for
is the vortex core radius and
the ring radius, while the elliptic instability dominates for
. New types of instability mode are also obtained: a special curvature mode composed of three waves is observed and spiral modes that do not seem to be related to any wave resonance. The curvature instability is also confirmed by direct numerical simulation of the full Navier–Stokes equations. Weakly nonlinear saturation and subsequent decay of the curvature instability are also observed.
Although executive and other cognitive deficits have been found in patients with borderline personality disorder (BPD), whether these have brain functional correlates has been little studied. This study aimed to examine patterns of task-related activation and de-activation during the performance of a working memory task in patients with the disorder.
Sixty-seven DSM-IV BPD patients and 67 healthy controls underwent fMRI during the performance of the n-back task. Linear models were used to obtain maps of within-group activations and areas of differential activation between the groups.
On corrected whole-brain analysis, there were no activation differences between the BPD patients and the healthy controls during the main 2-back v. baseline contrast, but reduced activation was seen in the precentral cortex bilaterally and the left inferior parietal cortex in the 2-back v. 1-back contrast. The patients showed failure of de-activation affecting the medial frontal cortex and the precuneus, plus in other areas. The changes did not appear to be attributable to previous history of depression, which was present in nearly half the sample.
In this study, there was some, though limited, evidence for lateral frontal hypoactivation in BPD during the performance of an executive task. BPD also appears to be associated with failure of de-activation in key regions of the default mode network.
One of the job resources most strongly associated with nurses’ well-being and motivation is social support. However, the psychosocial mechanisms that would explain this relationship have not been sufficiently researched. Thus, the main aim of this study was analyze whether this relationship could be mediated by two variables: role ambiguity and psychological flexibility. A total of 196 nurses from various Spanish hospitals and primary health care centers participated in this cross-sectional study. A multiple mediation analysis was run using the “PROCESS” macro script in SPSS 23.0. The results showed that co-worker support was related to higher levels of vigor and vitality through role ambiguity (Estimate = .158, 95% CI [.050, .298], and Estimate = .212, 95% CI [.076, .390], respectively). The same applied to supervisor support, (Estimate = .197, 95% CI [.059, .378], and Estimate = .212, 95% CI [.076, .390], respectively). Co-worker support was also related to higher levels of vigor and vitality through psychological flexibility, (Estimate = .132, 95% CI [.048, .271], and Estimate = .216, 95% CI [.086, .394], respectively). The same applied to supervisor support (Estimate = .092, 95% CI [.024, .208], and Estimate = .157, 95% CI [.035, .333], respectively). However, in the relationships between co-worker, supervisor support and exhaustion, only psychological flexibility played a mediating role. In conclusion, social support in nursing is a job resource that is associated with high levels of energy and motivation among nurses through the mediating role of certain job demands and personal resources.
In cluster-randomized trials (CRT), groups rather than individuals are randomized to interventions. The aim of this study was to present critical design, implementation, and analysis issues to consider when planning a CRT in the healthcare setting and to synthesize characteristics of published CRT in the field of healthcare epidemiology.
A systematic review was conducted to identify CRT with infection control outcomes.
We identified the following 7 epidemiological principles: (1) identify design type and justify the use of CRT; (2) account for clustering when estimating sample size and report intraclass correlation coefficient (ICC)/coefficient of variation (CV); (3) obtain consent; (4) define level of inference; (5) consider matching and/or stratification; (6) minimize bias and/or contamination; and (7) account for clustering in the analysis. Among 44 included studies, the most common design was CRT with crossover (n = 15, 34%), followed by parallel CRT (n = 11, 25%) and stratified CRT (n = 7, 16%). Moreover, 22 studies (50%) offered justification for their use of CRT, and 20 studies (45%) demonstrated that they accounted for clustering at the design phase. Only 15 studies (34%) reported the ICC, CV, or design effect. Also, 15 studies (34%) obtained waivers of consent, and 7 (16%) sought consent at the cluster level. Only 17 studies (39%) matched or stratified at randomization, and 10 studies (23%) did not report efforts to mitigate bias and/or contamination. Finally, 29 studies (88%) accounted for clustering in their analyses.
We must continue to improve the design and reporting of CRT to better evaluate the effectiveness of infection control interventions in the healthcare setting.
Studies of psychological interventions for the prevention of depression have found significant effects in the short-term, but the long-term efficacy has yet to be determined. This study evaluated the 8-year effect of a randomized controlled trial for indicated prevention of depression in female caregivers.
A total of 173 non-professional female caregivers with subclinical depressive symptoms not meeting criteria for a major depressive episode (MDE) were randomized to either a brief problem-solving intervention (n = 89) or usual-care control group (n = 84). Blinded evaluators conducted an assessment at the 8-year follow-up. The primary outcome was Depression Status, defined by diagnoses of MDE since the 1-year follow-up using the Structured Clinical Interview for the Disorders of the DSM-5. The secondary outcome was current Depressive Symptom Severity. Regression analyses were conducted to evaluate the effect of the intervention on the outcomes.
There were no significant differences in the Depression Status between the problem-solving (30.3%) and control groups (26.2%) (adjusted OR 1.25, 95% CI −0.58 to 2.69). Depressive Symptom Severity, however, was significantly lower in the problem-solving group compared to the control group at this follow-up, amounting to a small effect size of Cohen's d = 0.39 (adjusted B = −3.32, p = 0.018).
This is the first study to assess such a long-term follow-up of intervention of indicated prevention of depression. Results seem to indicate that the protective effect of the intervention became smaller over time during follow-up. Future research should replicate these results.
Prevalence of multidrug-resistant microorganisms (MDROs) continues to increase, while infection control gaps in healthcare settings facilitate their transmission between patients. In this setting, 5 distinct yet interlinked pathways are responsible for transmission. The complete transmission process is still not well understood. Designing and conducting a single research study capable of investigating all 5 complex and multifaceted pathways of hospital transmission would be costly and logistically burdensome. Therefore, this scoping review aims to synthesize the highest-quality published literature describing each of the 5 individual potential transmission pathways of MDROs in the healthcare setting and their overall contribution to patient-to-patient transmission.
In 3 databases, we performed 2 separate systematic searches for original research published during the last decade. The first search focused on MDRO transmission via the HCW or the environment to identify publications studying 5 specific transmission pathways: (1) patient to HCW, (2) patient to environment, (3) HCW to patient, (4) environment to patient, and (5) environment to HCW. The second search focused on overall patient-to-patient transmission regardless of the transmission pathway. Both searches were limited to transmission of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus, multidrug-resistant A. baumannii, and carbapenem-resistant Enterobacteriaceae. After abstract screening of 5,026 manuscripts, researchers independently reviewed and rated the remaining papers using objective predefined criteria to identify the highest quality and most influential manuscripts.
High-quality manuscripts were identified for all 5 routes of transmission. Findings from these studies were consistent for all pathways; however, results describing the routes from the environment/HCW to a noncolonized patient were more limited and variable. Additionally, most research focused on MRSA, instead of other MDROs. The second search yielded 10 manuscripts (8 cohort studies) that demonstrated the overall contribution of patient-to-patient transmission in hospitals regardless of the transmission route. For MRSA, the reported cross-transmission was as high as 40%.
This scoping review brings together evidence supporting all 5 possible transmission pathways and illustrates the complex nature of patient-to-patient transmission of MDROs in hospitals. Our findings also confirm that transmission of MDROs in hospitals occurs frequently, suggesting that ongoing efforts are necessary to strengthen infection prevention and control to prevent the spread of MDROs.
be a quadratic extension of totally real number fields. For any prime
, we construct a
-function interpolating the central values of the twisted triple product
-functions attached to a
-nearly ordinary family of unitary cuspidal automorphic representations of
. Furthermore, when
is a real quadratic number field and
is a split prime, we prove a
-adic Gross–Zagier formula relating the values of the
-function outside the range of interpolation to the syntomic Abel–Jacobi image of generalized Hirzebruch–Zagier cycles.
The present longitudinal study assessed whether changes in socio-economic status (SES) from infancy to adolescence were associated with plasma lipoprotein concentrations in adolescence, of which low HDL-cholesterol (HDL-C) and high LDL-cholesterol (LDL-C), TAG and total cholesterol (TC) concentrations are associated with higher cardiovascular risk.
SES, assessed using the modified Graffar Index, was calculated at 1, 5, 10 and 16 years. Principal components factor analysis with varimax rotation extracted two orthogonal SES factors, termed ‘environmental capital’ and ‘social capital’. Generalized linear models were used to analyse associations between environmental and social capital at 1 and 16 years and outcomes (HDL-C, LDL-C, TAG, TC) at 16 years, as well as changes in environmental and social capital from 1–5, 5–10, 10–16 and 1–16 years, and outcomes at 16 years.
We evaluated 665 participants from the Santiago Longitudinal Study enrolled at infancy in Fe-deficiency anaemia studies and examined every 5 years to age 16 years.
Social capital in infancy was associated with higher HDL-C in adolescence. Environmental capital in adolescence was associated with higher LDL-C and TC during adolescence. Changing environmental capital from 1–16 years was associated with higher LDL-C. Changing environmental capital from 1–5 and 1–16 years was associated with higher TC.
Improvements in environmental capital throughout childhood were associated with less healthy LDL-C and TC concentrations in adolescence. We found no evidence of associations between changing environmental capital and HDL-C or TAG, or changing social capital and HDL-C, LDL-C, TAG or TC.
We conducted two Facebook experiments (the first one during July 21–25, 2016, and the second during April 22–25, 2018) to determine what type of message related to injunctive norms is more effective in getting Hispanic women interested in learning about financial planning for retirement. We also explore how social media tools could be used in future interventions to promote retirement saving among Hispanic women. In both experiments, we found that a message centered on peer influence may be more successful than a message centered on familism in getting Hispanic women interested in learning more about financial planning for retirement. When we disaggregate our data by age and state, we find that click-through rates were higher among Hispanic women between 45 and 55 years old, and the largest numbers of impressions were among Hispanic women in California and Texas. When we disaggregate our data by device, we find that most study participants were reached through an Android smartphone.
To estimate the risk of transmission of antibiotic-resistant Gram-negative bacteria (RGNB) to gowns and gloves worn by healthcare personnel (HCP) when providing care to residents of community-based nursing facilities to identify the types of care and resident characteristics associated with transmission.
Prospective observational study.
Settings and participants
Residents and HCP from 13 community-based nursing facilities in Maryland and Michigan.
Perianal swabs were collected from residents and cultured to detect RGNB. HCP wore gowns and gloves during usual care activities, and at the end of each interaction, these were swabbed in a standardized manner. Transmission of RGNB from a colonized resident to gowns and gloves was estimated. Odds ratios (ORs) of transmission associated with type of care or resident characteristic were calculated.
We enrolled 403 residents and their HCP in this study. Overall, 19% of enrolled residents with a perianal swab (n=399) were colonized with at least 1 RGNB. RGNB transmission to either gloves or gowns occurred during 11% of the 584 interactions. Showering the resident, hygiene or toilet assistance, and wound dressing changes were associated with a high risk of transmission. Glucose monitoring and assistance with feeding or medication were associated with a low risk of transmission. Residents with a pressure ulcer were 3 times more likely to transmit RGNB than residents without one (OR, 3.3; 95% confidence interval [CI], 1.0–11.1).
Gown and glove use in community nursing facilities should be prioritized for certain residents and care interactions that are deemed a high risk for transmission.
The apparatus of Vogelgnathus simplicatus (Rhodes, Austin, and Druce, 1969) is reconstructed from discrete elements from a sample of limited diversity from the Limerick Province (Ireland). The apparatus is typical of the order Ozarkodinida and the P1 element was previously placed within Gnathodus. Here we assign it to Vogelgnathus by applying a multielemental concept rather than using P1 element morphology. The holotype and paratypes are re-illustrated and the species distribution revised based on published data. Vogelgnathus simplicatus ranges from the late Tournaisian to the early Viséan (Mississippian, Carboniferous), with common occurrences relating to the growth of Waulsortian bank complexes in a high-stand sea-level along the southern and western margins of the Laurussian landmass (Belgium, the British Isles, the Republic of Ireland, and USA). Vogelgnathus simplicatus appears to represent the rootstock from which deep-water and shallow-water Viséan species of Vogelgnathus evolved in the Mississippian.
The animal health and welfare status in European organic dairy production does not in all aspects meet the organic principles and consumers’ expectations and needs to be improved. To achieve this, tailored herd health planning, targeted to the specific situation of individual farms could be of use. The aim of this study was to apply herd health planning in a structured participatory approach, with impact matrix analysis, not previously used in this context, in European organic dairy farms and to assess changes in animal health and welfare. Herd health planning farm visits were conducted on 122 organic dairy farms in France, Germany and Sweden. The farmer, the herd veterinarian and/or an advisor took part in the farm discussions. The researcher served as facilitator. Baseline data on the animal health status of the individual farm, collected from national milk recording schemes, were presented as an input for the discussion. Thereafter a systematic impact matrix analysis was performed. This was to capture the complexity of individual farms with the aim to identify the farm-specific factors that could have a strong impact on animal health. The participants (i.e. farmer, veterinarian and advisor) jointly identified areas in need of improvement, taking the health status and the interconnected farm system components into account, and appropriate actions were jointly identified. The researcher took minutes during the discussions, and these were shared with the participants. No intervention was made by the researcher, and further actions were left with the participants. The number of actions per farm ranged from 0 to 22. The change in mortality, metabolic diseases, reproductive performance and udder health was assessed at two time points, and potential determinators of the change were evaluated with linear regression models. A significant association was seen between change in udder health, as measured by the somatic cell count, and country. At the first follow-up, a significant association was also found between change in the proportion of prolonged calving interval and the farmers’ desire to improve reproductive health as well as with an increase in herd size, but this was not seen at the second follow-up. The degree of implementation of the actions was good (median 67%, lower quartile 40%, upper quartile 83%). To conclude, the degree of implementation was quite high, improvement of animal health could not be linked to the herd health planning approach. However, the approach was highly appreciated by the participants and deserves further study.
In this survey we give very simple proofs of Kepler's Laws and other facts about central force fields using only Newton's second law, Newton's law of universal gravitation, basic notions of vector calculus, and an elementary double integral.
Hopefully, this article will help undergraduate students of mathematics and engineering who wish to understand these fundamental scientific discoveries.
In many textbooks (see, for instance, [1, 2, 3, 4, 5]), Kepler's Laws are obtained using conservation of energy and angular momentum, differential equations, mobile reference systems, or notions not so well-defined such as differentials or ‘infinitesimal elements’. Some of the arguments appear to be rather involved if one is not accustomed to them, whereas the proof of Kepler's Laws may actually be obtained from quite simple facts.
In this work, a data assimilation method is proposed following an optimise-then-discretise approach, and is applied in the context of computational haemodynamics. The methodology aims to make use of phase-contrast magnetic resonance imaging to perform optimal flow control in computational fluid dynamic simulations. Flow matching between observations and model predictions is performed in luminal regions, excluding near-wall areas, improving the near-wall flow reconstruction to enhance the estimation of related quantities such as wall shear stresses. The proposed approach remarkably improves the flow field at the aortic root and reveals a great potential for predicting clinically relevant haemodynamic phenomenology. This work presents model validation against an analytical solution using the standard 3-D Hagen–Poiseuille flow, and validation with real data involving the flow control problem in a glass replica of a human aorta imaged with a 3T magnetic resonance scanner. In vitro experiments consist of both a numerically generated reference flow solution, which is considered as the ground truth, as well as real flow MRI data obtained from phase-contrast flow acquisitions. The validation against the in vitro flow MRI experiments is performed for different flow regimes and model parameters including different mesh refinements.