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To evaluate the National Health Safety Network (NHSN) hospital-onset Clostridioides difficile infection (HO-CDI) standardized infection ratio (SIR) risk adjustment for general acute-care hospitals with large numbers of intensive care unit (ICU), oncology unit, and hematopoietic cell transplant (HCT) patients.
Retrospective cohort study.
Eight tertiary-care referral general hospitals in California.
We used FY 2016 data and the published 2015 rebaseline NHSN HO-CDI SIR. We compared facility-wide inpatient HO-CDI events and SIRs, with and without ICU data, oncology and/or HCT unit data, and ICU bed adjustment.
For these hospitals, the median unmodified HO-CDI SIR was 1.24 (interquartile range [IQR], 1.15–1.34); 7 hospitals qualified for the highest ICU bed adjustment; 1 hospital received the second highest ICU bed adjustment; and all had oncology-HCT units with no additional adjustment per the NHSN. Removal of ICU data and the ICU bed adjustment decreased HO-CDI events (median, −25%; IQR, −20% to −29%) but increased the SIR at all hospitals (median, 104%; IQR, 90%–105%). Removal of oncology-HCT unit data decreased HO-CDI events (median, −15%; IQR, −14% to −21%) and decreased the SIR at all hospitals (median, −8%; IQR, −4% to −11%).
For tertiary-care referral hospitals with specialized ICUs and a large number of ICU beds, the ICU bed adjustor functions as a global adjustment in the SIR calculation, accounting for the increased complexity of patients in ICUs and non-ICUs at these facilities. However, the SIR decrease with removal of oncology and HCT unit data, even with the ICU bed adjustment, suggests that an additional adjustment should be considered for oncology and HCT units within general hospitals, perhaps similar to what is done for ICU beds in the current SIR.
Neonatal aortic thrombosis is a rare occurrence but can be life-threatening. Most aortic thrombosis in neonates is related to umbilical artery catheters. A case of a neonate with a spontaneous aortic thrombosis is described here along with a comprehensive review of the literature for cases of neonatal aortic thrombosis not related to any intravascular device or procedure. The aetiologies of these spontaneous thromboses and the relevance of hypercoagulable disorders are discussed. The cases were analysed for odds of death by treatment method adjusted for era. The reference treatment method was thrombolysis and anticoagulation. No other treatment modality had significantly lower odds than the reference. Surgery alone had higher odds for death than the reference, but this may be confounded by severity of case. The management recommendations for clinicians encountering neonates with spontaneous neonatal aortic thrombosis are discussed.
Watermelon [Citrullus lanatus (Thunb.) Matsum & Nakai] grafting is commonly used for management of diseases caused by soilborne pathogens; however, little research exists describing the effect of grafting on the weed-competitive ability of watermelon. Field experiments determined the response in yield, fruit number, and fruit quality of grafted and nongrafted watermelon exposed to increasing densities of Palmer amaranth (Amaranthus palmeri S. Watson). Grafting treatments included ‘Exclamation’ triploid (seedless) watermelon grafted on two interspecific hybrid squash rootstocks ‘Carnivor’ and ‘Kazako’, with nongrafted Exclamation as the control. Weed treatments included A. palmeri at densities of 1, 2, 3, and 4 A. palmeri plants per watermelon planting hole (0.76-m row) and a weed-free control. Increasing A. palmeri densities caused significant reductions (P <0.05) in marketable watermelon yield and marketable fruit number. Watermelon yield reduction was described by a rectangular hyperbola model, and 4 A. palmeri plants planting hole−1 reduced marketable yield 41%, 38%, and 65% for Exclamation, Carnivor, and Kazako, respectively. Neither grafting treatment nor A. palmeri density had a biologically meaningful effect on soluble solids content or on the incidence of hollow heart in watermelon fruit. Amaranthus palmeri seed and biomass production was similar across weed population densities, but seed number per female A. palmeri decreased according to a two-parameter exponential decay equation. Thus, increasing weed population densities resulted in increased intraspecific competition among A. palmeri plants. While grafting may offer benefits for disease resistance, no benefits regarding weed-competitive ability were observed, and a consistent yield penalty was associated with grafting, even in weed-free treatments.
Field experiments determined the critical period for weed control (CPWC) in grafted and nongrafted watermelon [Citrullus lanatus (Thumb.) Matsum. & Nakai] grown in plasticulture. Transplant types included ‘Exclamation’ seedless watermelon as the nongrafted control as well as Exclamation grafted onto two interspecific hybrid squash (ISH) rootstocks, ‘Carnivor’ and ‘Kazako’. To simulate weed emergence throughout the season, establishment treatments (EST) consisted of two seedlings each of common purslane (Portulaca oleracea L.), large crabgrass [Digitaria sanguinalis (L.) Scop.], and yellow nutsedge (Cyperus esculentus L.) transplanted in a 15 by 15 cm square centered on watermelon plants at 0, 2, 3, 4, and 6 wk after watermelon transplanting (WATr) and remained until the final watermelon harvest at 11 WATr. To simulate weed control at different times in the season, removal treatments (REM) consisted of two seedlings of the same weed species transplanted in a 15 by 15 cm square centered on watermelon plants on the same day of watermelon transplanting and allowed to remain until 2, 3, 4, 6, and 11 WATr, at which time they were removed. Season-long weedy and weed-free controls were included for both EST and REM studies in both years. For all transplant types, aboveground biomass of weeds decreased as weed establishment was delayed and increased as weed removal was delayed. The predicted CPWC for nongrafted Exclamation and Carnivor required only a single weed removal between 2.3 and 2.5 WATr and 1.9 and 2.6 WATr, respectively, while predicted CPWC for Kazako rootstock occurred from 0.3 to 2.6 WATr. Our study results suggest that weed control for this mixed population of weeds would be similar between nongrafted Exclamation and Exclamation grafted onto Carnivor. But the observed CPWC of Exclamation grafted onto Kazako suggests that CPWC may vary with specific rootstock–scion combinations.
Field studies were conducted to determine watermelon tolerance and yield response when treated with bicyclopyrone preplant (PREPLANT), POST, and POST-directed (POST-DIR). Treatments consisted of two rates of bicyclopyrone (37.5 and 50 g ai ha–1), fomesafen (175 g ai ha–1), S-metolachlor (802 g ai ha–1), and a nontreated check. Preplant treatments were applied to formed beds 1 d prior to transplanting and included bicyclopyrone (37.5 and 50 g ha–1) and fomesafen (175 g ha–1), and new polyethylene mulch was subsequently laid above treated beds. POST and POST-DIR treatments were applied 14 ± 1 d after watermelon transplanting and included bicyclopyrone (37.5 and 50 g ha–1) POST and POST-DIR, and S-metolachlor (802 g ai ha–1) POST-DIR. POST-DIR treatments were applied to row middles, ensuring that no herbicide contacted watermelon vines or polyethylene mulch. At 2 wk after transplanting (WAT), 15% foliar bleaching was observed in watermelon treated with bicyclopyrone (50 g ha–1) PRE. At 3 WAT, bicyclopyrone (37.5 and 50 g ha–1) POST caused 16% and 17% foliar bleaching and 8% and 9% crop stunting, respectively. At 4 WAT, initial injury had subsided and bicyclopyrone (37.5 and 50 g ha–1) POST caused 4% and 4% foliar bleaching and 4% and 8% crop stunting, respectively. No symptoms of bleaching or stunting were observed at 6- and 8-WAT ratings. Watermelon total yield, marketable yield, total fruit number, marketable fruit number, and average fruit size were unaffected by herbicide treatments. Therefore, registration of bicyclopyrone (37.5 and 50 g ha–1) PREPLANT, POST, and POST-DIR would offer watermelon producers a safe herbicide option and a novel mode of action for weed management.
Introduction: Tobacco use is common among people who have been in prison. The relationship between social stressors, risky health behaviours, and smoking cessation has not been studied in people recently released from prison. Studying this relationship could yield information that guides strategic and cost-effective tobacco cessation interventions for an under-resourced population.
Methods: One hundred and forty-three smokers were interviewed 7 to 21 days after they had been released from USA prisons. Independent variables included employment status, housing security, relationship problems, educational achievement, risky drinking behaviour, recent drug use, history of drug dependence, and depression. The primary outcome was ‘trying to quit smoking.’ Data were analysed using Pearson chi-square tests and single and multivariable logistic regression models.
Results: Of those who had to quit smoking due to tobacco-free prison policies, 98% reported relapsing on tobacco after release. Trying to quit smoking was associated with the absence of risky drinking behaviour in the past 30 days (adjusted odds ratio [AOR] 6.44, 95% confidence interval [CI] 2.02–20.48).
Conclusions: The absence of risky drinking behaviour is associated with trying to quit smoking among people recently released from prison. Further research may determine whether interventions addressing risky alcohol use can reduce smoking relapse.
We analyzed birth order differences in means and variances of height and body mass index (BMI) in monozygotic (MZ) and dizygotic (DZ) twins from infancy to old age. The data were derived from the international CODATwins database. The total number of height and BMI measures from 0.5 to 79.5 years of age was 397,466. As expected, first-born twins had greater birth weight than second-born twins. With respect to height, first-born twins were slightly taller than second-born twins in childhood. After adjusting the results for birth weight, the birth order differences decreased and were no longer statistically significant. First-born twins had greater BMI than the second-born twins over childhood and adolescence. After adjusting the results for birth weight, birth order was still associated with BMI until 12 years of age. No interaction effect between birth order and zygosity was found. Only limited evidence was found that birth order influenced variances of height or BMI. The results were similar among boys and girls and also in MZ and DZ twins. Overall, the differences in height and BMI between first- and second-born twins were modest even in early childhood, while adjustment for birth weight reduced the birth order differences but did not remove them for BMI.
It is unclear which pediatric disaster triage (PDT) strategy yields the best accuracy or best patient outcomes.
We conducted a cross-sectional analysis on a sample of emergency medical services providers from a prospective cohort study comparing the accuracy and triage outcomes for 2 PDT strategies (Smart and JumpSTART) and clinical decision-making (CDM) with no algorithm. Participants were divided into cohorts by triage strategy. We presented 10-victim, multi-modal disaster simulations. A Delphi method determined patients’ expected triage levels. We compared triage accuracy overall and for each triage level (RED/Immediate, YELLOW/Delayed, GREEN/Ambulatory, BLACK/Deceased).
There were 273 participants (71 JumpSTART, 122 Smart, and 81 CDM). There was no significant difference between Smart triage and CDM. When JumpSTART triage was used, there was greater accuracy than with either Smart (P<0.001; OR [odds ratio]: 2.03; interquartile range [IQR]: 1.30, 3.17) or CDM (P=0.02; OR: 1.76; IQR: 1.10, 2.82). JumpSTART outperformed Smart for RED patients (P=0.05; OR: 1.48; IQR: 1.01,2.17), and outperformed both Smart (P<0.001; OR: 3.22; IQR: 1.78,5.88) and CDM (P<0.001; OR: 2.86; IQR: 1.53,5.26) for YELLOW patients. Furthermore, JumpSTART outperformed CDM for BLACK patients (P=0.01; OR: 5.55; IQR: 1.47, 20.0).
Our simulation-based comparison suggested that JumpSTART triage outperforms both Smart and CDM. JumpSTART outperformed Smart for RED patients and CDM for BLACK patients. For YELLOW patients, JumpSTART yielded more accurate triage results than did Smart triage or CDM. (Disaster Med Public Health Preparedness. 2016;10:253–260)
We present the design, fabrication, and measurement of a 2-way modified Wilkinson divider constructed in a coplanar geometry exhibiting ultra wideband isolation, transmission, and port matching in the millimeter-wave frequency range. The proposed divider replaces the lumped resistor in the conventional Wilkinson divider with two quarter-wave length transmission lines, a phase inverter, and two 2Z0 resistors. Except for the three ports that are coplanar waveguides (CPWs), the main body of the divider uses coplanar striplines (CPS). The phase inverter is realized using a simple airbridge-based crossover which is compatible with a modern monolithic microwave integrated circuit process. The divider has a ring-like configuration fabricated on a 620 µm thick semi-insulating GaAs wafer using electron beam lithography (EBL) technology. Three-dimensional (3D) full-wave electromagnetic simulations have been carried out to optimize the design and investigate the possible effect of fabrication tolerance on the performance of the crossover and the divider. Two dividers working at center frequencies of 25 and 80 GHz have been designed, fabricated, and tested. They all show consistent performance in terms of bandwidth, isolation, and port matching. Experimental and simulation results are in excellent agreement.
Significant new opportunities for astrophysics and cosmology have been identified at low radio frequencies. The Murchison Widefield Array is the first telescope in the southern hemisphere designed specifically to explore the low-frequency astronomical sky between 80 and 300 MHz with arcminute angular resolution and high survey efficiency. The telescope will enable new advances along four key science themes, including searching for redshifted 21-cm emission from the EoR in the early Universe; Galactic and extragalactic all-sky southern hemisphere surveys; time-domain astrophysics; and solar, heliospheric, and ionospheric science and space weather. The Murchison Widefield Array is located in Western Australia at the site of the planned Square Kilometre Array (SKA) low-band telescope and is the only low-frequency SKA precursor facility. In this paper, we review the performance properties of the Murchison Widefield Array and describe its primary scientific objectives.