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Catheter-associated urinary tract infections in 592 hospitals immediately declined after federal value-based incentive program implementation, but this was fully attributable to a concurrent surveillance case definition revision. Post revision, more hospitals had favorable standardized infection ratios, likely leading to artificial inflation of their performance scores unrelated to changes in patient safety.
Three antidot arrays with FeNi alloy thickness of 20, 50 and 100 nm have been patterned using magnetron sputtering followed by the electron-beam lithography and lift-off technique. Ferromagnetic resonance technique was used to study dynamic properties of the antidot arrays. These results were compared with the measurements of continuous films with the same composition and thickness. Two distinct resonant fields have been observed for the bias field aligned with the edges of the square holes. Resonance peaks shifted towards each other and eventually merged when the in-plane bias field was rotated towards diagonal of the squares. This dependence has been explained in terms of magnetostatic energy associated with the square holes. The magnitude of this effect was decreasing for the arrays with the reduced thickness. The perpendicular and lateral quantized standing spin wave modes were detected in the reference films and the antidot arrays due to the perpendicular and lateral dimensional confinements.
The unboundedness of the sequence of Lebesgue constants (norms), at a point, of certain transforms implies, as is well known, that there exist (i) a continuous function whose transform fails to converge to the function at the point in question (the du Bois-Reymond singularity), and (ii) another such function whose transform, while converging everywhere to the function, does not do so uniformly in any neighbourhood of the stipulated point (the Lebesgue singularity). The converses also hold in our case.
Intermediate wheatgrass (Thinopyrum intermedium; IWG) is a perennial cereal crop undergoing development for grain production; however, grain yield declines of >75% are often observed after year 2 of the perennial stand and may be linked to soil nutrient depletion. Intercropping IWG with a perennial legume such as alfalfa (Medicago sativa) could benefit nutrient cycling while increasing agroecological diversity. Intermediate wheatgrass was established at five environmentally diverse sites in Minnesota, USA in (1) bi-culture with alfalfa, (2) non-fertilized monoculture and (3) monoculture fertilized annually in the spring with 80 kg N/ha. At northern sites where alfalfa growth was favoured, IWG grain yields were reduced in year 2 by growing IWG in bi-culture with alfalfa, relative to the monoculture systems. Across all sites IWG grain yield decreased by 90% in the non-fertilized monoculture, 80% in the fertilized monoculture and 65% in the bi-culture from year 2 to 4 and plant macronutrient concentrations decreased by 25–70%. In year 4, IWG grain yield was similar or greater in the bi-culture than the fertilized monoculture at three of the five sites and alfalfa biomass was correlated positively with grain yield, harvest index and nutrient uptake in the year 4 bi-culture. Chemical-nitrogen fertilization increased grain yields in year 2 but did not mitigate the decline in yields as stands aged. Intermediate wheatgrass in the bi-culture had similar yields and nutrient uptake and lower yield declines than the chemically fertilized stand at sites where alfalfa growth was maintained throughout the life of the stand.
In 2012, the Centers for Medicare and Medicaid Services expanded a 2008 program that eliminated additional Medicare payment for mediastinitis following coronary artery bypass graft (CABG) to include Medicaid. We aimed to evaluate the impact of this Medicaid program on mediastinitis rates reported by the National Healthcare Safety Network (NHSN) compared with the rates of a condition not targeted by the program, deep-space surgical site infection (SSI) after knee replacement.
Interrupted time series with comparison group.
We included surveillance data from nonfederal acute-care hospitals participating in the NHSN and reporting CABG or knee replacement outcomes from January 2009 through June 2017. We examined the Medicaid program’s impact on NHSN-reported infection rates, adjusting for secular trends. The data analysis used generalized estimating equations with robust sandwich variance estimators.
During the study period, 196 study hospitals reported 273,984 CABGs to the NHSN, resulting in 970 mediastinitis cases (0.35%), and 294 hospitals reported 555,395 knee replacements, with 1,751 resultant deep-space SSIs (0.32%). There was no significant change in incidence of either condition during the study. Mediastinitis models showed no effect of the 2012 Medicaid program on either secular trend during the postprogram versus preprogram periods (P=.70) or an immediate program effect (P=.83). Results were similar in sensitivity analyses when adjusting for hospital characteristics, restricting to hospitals with consistent NHSN reporting or incorporating a program implementation roll-in period. Knee replacement models also showed no program effect.
The 2012 Medicaid program to eliminate additional payments for mediastinitis following CABG had no impact on reported mediastinitis rates.
We present NLTE radiative transfer in hydrodynamic models representative of Mira-type variable stars. Calculations were carried out with the PANDORA code of the Bowen models using a snapshot approximation.
Background: To introduce the “uniform cortex sign” (UCS) and evaluate its performance as a diagnostic test for the presence of diffuse cortical injury (DCI). Methods: The study was approved by our institutional review board. Three experienced neuroradiologists were given a tutorial on the UCS. They were subsequently presented with 14 cases (7 control patients and 7 DCI patients with the UCS) in random order and asked to determine whether the UCS was present. Each case consisted of selected DWI, T2-weighted, and FLAIR images from unenhanced 1.5T MRI examinations. A consensus result for each case was determined by unanimity or majority rule. Results: All control patients were correctly identified as normal by all neuroradiologists (7/7). The UCS was correctly identified in 86% of DCI patients (6/7). UCS interrater agreement was high (multirater κ=0.81). Conclusions: This small study shows that the UCS can identify DCI, especially in patients with hypoxic-ischemic encephalopathy. The UCS can be subtle, hence the reader must be vigilant for this finding. The accuracy of the UCS may depend on the extent of cortical injury and time between injury and MRI. Also, a UCS may be reversible, as in our case of viral meningoencephalitis.
Background: In vitro models have suggested that stents affect atherosclerotic plaques symmetrically because of their outward radial forces. We evaluated the effects of stents on carotid plaque and the arterial wall using carotid ultrasound in carotid stenting patients to see whether these effects were borne out in vivo. Methods: From a carotid stent database, 30 consecutive patients were selected. All had carotid Doppler ultrasound performed pre- and poststenting. The diameters of the lumen at the level of stenotic plaque pre- and poststenting, the dorsal and ventral plaque thickness, and of the outer arterial wall diameter were measured. Plaque thickness was measured at the level of maximal stenosis. Nonparametric tests were used to determine whether the stent effect and luminal enlargement were based on wall remodeling or on total arterial expansion. Results: The patients were followed for an average of 22 months. Eighteen patients were male, with an average age of 70 years. A total of 87% of patients were symptomatic ipsilateral to the side of stenosis. Nine patients had angioplasty intraprocedurally. The luminal diameter increased poststenting in the region of severe stenosis. Plaque thickness, both ventrally and dorsally, decreased poststenting, with no significant difference between the ventral and dorsal plaque effects. The outer arterial wall diameters did not change. The measured lumen in the stent increased over time poststenting. Conclusions: Self-expanding nitinol stents alter the baseline ventral and dorsal plaque to a significant degree and do not significantly affect the native arterial wall and the overall arterial diameter.
A digital radar system comprising multiple microprocessors, for use with 50 MHz radar units modified from the Scott Polar Research Institute Mark IV design, is described. The major features of the system include coherent integration of radar traces, storage of data in raw digitized form without demodulation, real-time play-back of digitized information, and high system performance resulting in good spatial sampling with integration even in airborne operations. Unfocused synthetic beam shaping also results from the integration of echoes, thus reducing clutter or incoherent scattering from the sides of the beam pattern along the profiling track.
Examples of data collected during the austral summer of 1985–86 in the Antarctic on ice stream B, in both ground and airborne programs, illustrate both the flexibility in data presentation and features present in the records.
Adult ventilator-associated event (VAE) definitions include ventilator-associated conditions (VAC) and subcategories for infection-related ventilator-associated complications (IVAC) and possible ventilator-associated pneumonia (PVAP). We explored these definitions for children.
Pediatric, cardiac, or neonatal intensive care units (ICUs) in 6 US hospitals
Patients ≤18 years old ventilated for ≥1 day
We identified patients with pediatric VAC based on previously proposed criteria. We applied adult temperature, white blood cell count, antibiotic, and culture criteria for IVAC and PVAP to these patients. We matched pediatric VAC patients with controls and evaluated associations with adverse outcomes using Cox proportional hazards models.
In total, 233 pediatric VACs (12,167 ventilation episodes) were identified. In the cardiac ICU (CICU), 62.5% of VACs met adult IVAC criteria; in the pediatric ICU (PICU), 54.2% of VACs met adult IVAC criteria; and in the neonatal ICU (NICU), 20.2% of VACs met adult IVAC criteria. Most patients had abnormal white blood cell counts and temperatures; we therefore recommend simplifying surveillance by focusing on “pediatric VAC with antimicrobial use” (pediatric AVAC). Pediatric AVAC with a positive respiratory diagnostic test (“pediatric PVAP”) occurred in 8.9% of VACs in the CICU, 13.3% of VACs in the PICU, and 4.3% of VACs in the NICU. Hospital mortality was increased, and hospital and ICU length of stay and duration of ventilation were prolonged among all pediatric VAE subsets compared with controls.
We propose pediatric AVAC for surveillance related to antimicrobial use, with pediatric PVAP as a subset of AVAC. Studies on generalizability and responsiveness of these metrics to quality improvement initiatives are needed, as are studies to determine whether lower pediatric VAE rates are associated with improvements in other outcomes.
High purity UO2 powder samples were subjected to accelerated aging under controlled conditions with relative humidity ranging from 34% to 98%. Characterization of the chemical speciation of the products was accomplished using X-ray photoelectron spectroscopy (XPS). A shift to higher uranium oxidation states was found to be directly correlated to increased relative humidity exposure. Additionally, the relative abundance of O2-, OH-, and H2O was found to vary with exposure time. Thus, it is expected that uranium oxide materials exposed to high relative humidity conditions during processing and storage would display a similar increase in average uranium valence.