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Ventilator bundles encompass practices that reduce the risk of ventilator complications, including ventilator-associated pneumonia. The impact of ventilator bundles on the risk of developing ventilator-associated events (VAEs) is unknown. We sought to determine whether decreased compliance to the ventilator bundle increases the risk for VAE development.
Nested case-control study.
This study was conducted at 6 adult intensive care units at an academic tertiary-care center in Tennessee.
In total, 273 patients with VAEs were randomly matched in a 1:4 ratio to controls by mechanical ventilation duration and ICU type.
Controls were selected from the primary study population at risk for a VAE after being mechanically ventilated for the same number of days as a specified case. Using conditional logistic regression analysis, overall cumulative compliance, and compliance with individual components of the bundle in the 3 and 7 days prior to VAE development (or the control match day) were examined.
Overall bundle compliance at 3 days (odds ratio [OR], 1.15; P=.34) and 7 days prior to VAE diagnosis (OR, 0.96; P=.83) were not associated with VAE development. This finding did not change when limiting the outcome to infection-related ventilator-associated complications (IVACs) and after adjusting for age and gender. In the examination of compliance with specific bundle components increased compliance with chlorhexidine oral care was associated with increased risk of VAE development in all analyses.
Ventilator bundle compliance was not associated with a reduced risk for VAEs. Higher compliance with chlorhexidine oral care was associated with a greater risk for VAE development.
From the bites and scratches of lovers and the threat of flogging that hangs over the comic slave, to murder, rape, dismemberment, and crucifixion, violence is everywhere in Latin literature. The contributors to this volume explore the manifold ways in which violence is constructed and represented in Latin poetry and prose from Plautus to Prudentius, examining the interrelations between violence, language, power, and gender, and the narrative, rhetorical, and ideological functions of such depictions across the generic spectrum. How does violence contribute to the pleasure of the text? Do depictions of violence always reinforce status-hierarchies, or can they provoke a reassessment of normative value-systems? Is the reader necessarily complicit with authorial constructions of violence? These are pressing questions both for ancient literature and for film and other modern media, and this volume will be of interest to scholars and students of cultural studies as well as of the ancient world.
A field experiment was conducted to quantify changes in soil aggregation and aggregate-associated soil organic carbon (SOC) concentration 1, 3, 5 and 10 years after abandoned, salinized land in the Manasi River Basin was reclaimed for cotton (Gossypium hirsutum L.). Results showed that reclamation significantly increased SOC concentrations and SOC stocks. Specifically, 10 years of cotton production increased SOC concentrations by 45% in the 0–60 cm depth and SOC stocks by 35%. The SOC concentrations and stocks decreased as soil depth increased. Reclamation time, season and soil depth had significant interaction effects on SOC. The SOC concentrations were significantly and positively correlated with available soil nitrogen and available soil phosphorus. Compared with abandoned farmland, macro-aggregate-associated (>250 µm) SOC concentrations in the 0–60 cm depth increased by 47% after 5 years of cotton production and by 53% after 10 years of cotton production. The contribution of macro-aggregate-associated SOC to total SOC in the 0–60 cm depth increased by 87% after 5 years of cotton production and by 69% after 10 years of cotton production. The findings indicate that soil aggregates were more stable after abandoned, salinized farmland was reclaimed for cotton production. Furthermore, cotton production can increase SOC concentrations and sequester C in this arid area.
This study evaluated whether exposure to maternal pre- or postnatal depression or anxiety symptoms predicted psychopathology in adolescent offspring. Growth mixture modeling was used to identify trajectories of pre- and postnatal depression and anxiety symptoms in 577 women of low socioeconomic status selected from a prenatal clinic. Logistic regression models indicated that maternal pre- and postnatal depression trajectory exposure was not associated with offspring major depression, anxiety, or conduct disorder, but exposure to the high depression trajectory was associated with lower anxiety symptoms in males. Exposure to medium and high pre- and postnatal anxiety was associated with the risk of conduct disorder among offspring. Male offspring exposed to medium and high pre- and postnatal anxiety had higher odds of conduct disorder than did males with low exposure levels. Females exposed to medium or high pre- and postnatal anxiety were less likely to meet conduct disorder criteria than were females with lower exposure. To the best of our knowledge, this is the first study to examine the effect of pre- and postnatal anxiety trajectories on the risk of conduct disorder in offspring. These results suggest new directions for investigating the etiology of conduct disorder with a novel target for intervention.
We report on 475 measurements of depth to ice-cemented ground in four high-elevation valleys of the Quartermain Mountains, McMurdo Dry Valleys, Antarctica. These valleys have pervasive ice-cemented ground, and the depth to ice-cemented ground and the ice composition may be indicators of climate change. In University Valley, the measured depth to ice-cemented ground ranges from 0–98 cm. There is an overall trend of increasing depth to ice-cemented ground with distance from a small glacier at the head of the valley, with a slope of 32 cm depth per kilometre along the valley floor. For Farnell Valley, the depth to ice-cemented ground is roughly constant (c. 30 cm) in the upper and central parts of the valley, but increases sharply as the valley descends into Beacon Valley. The two valleys north of University Valley also have extensive ice-cemented ground, with depths of 20–40 cm, but exhibit no clear patterns of ice depth with location. For all valleys there is a tendency for the variability in depth to ice-cemented ground at a site to increase with increasing depth to ice. Snow recurrence, solar insolation, and surface albedo may all be factors that cause site to site variations in these valleys.
Tissue transplantation is an important adjunct to modern medical care and is used daily to save or improve patient lives. Tissue allografts include bone, tendon, corneas, heart valves and others. Increasing utilization may lead to tissue shortages, and tissue procurement organizations continue to explore ways to expand the cadaveric donor pool. Currently more than half of all deaths occur outside the acute care setting.
Many who suffer prehospital deaths might be eligible for non-organ tissue donation.
A retrospective review of electronic prehospital medical records was conducted from May 1, 2008 through December 31, 2009. All prehospital deaths were included irrespective of cause. Once identified, additional medical history was obtained from prehospital, inpatient, and emergency department records. Age, medical history, and time of death were compared to exclusion criteria for four tissue procurement organizations (MTF, LifeNet, LifeCell, EyeBank). After analysis, percentages of eligible donors were calculated.
Over 50,000 prehospital records were reviewed; 432 subjects died in the field and were eligible for analysis. Ages ranged from four to 103 years of age; the average was 68.3 (SD = 20.1) years. After exclusion for age, medical conditions, and time of death, 185 unique patients (42.8%) were eligible for donation to at least one of the four tissue procurement organizations (range 11.6%-34.3%).
After prehospital death, many individuals may be eligible for tissue donation. These findings suggest that future prospective studies exploring tissue donation after prehospital death are indicated. These studies should aim to clarify eligibility criteria, create protocols and infrastructure, and explore the ethical implications of expanding tissue donation to include this population.
ShiroffAM, GaleSC, MerlinMA, CrystalJS, LingerM, ShahAD, BeaumontE, LustigerE, TabakinE, GraciasVH. Enhancing the Tissue Donor Pool through Donation after Death in the Field. Prehosp Disaster Med. 2013;28(2):1-4.
We report the dry etch of GaSb(001) by inductively coupled plasma reactive ion etcher. Silicon Oxide, deposited by PECVD, was used as a mask. The oxide layer proved to be almost unaffected compared to the GaSb, when using chlorine compound gases as etchants (Cl2, BCl3, and SiCl4) as well as argon. This provides high selectivity for GaSb to the mask layer. The sample holder has no silicon that may contribute to the etching process. Etching using Cl2 + Ar showed increase in the etching rate as the chlorine ratio increases; however, the process led to grassy surface and chemical like reaction. The use of SiCl4+Cl2+Ar mixture with low chlorine ratio resulted in anisotropic etch with smooth sides. It has been found for this case that the increase of the chlorine ratio led to an increased etching rate as well. The repeat of previously reported result by Swaminathan et al. [Thin Solid Films 516 (2008) 8712.] yet with a sample holder not having silicon, proved the effect of Si-contribution in producing vertical profile etch with smooth surfaces.
The usual systems of assay using techniques of chromosome substitution demonstrated in Drosophila and wheat are not applicable to barley (Hordeum vulgare). Chromosomal material for assay may, however, be substituted from one variety into another by using translocations to mark and restrict crossing over in the chromosomes to be transferred. This paper describes the isolation and assay of lines derived in this way.
Seven substitution lines derived from the donor variety Maris Badger and the recipient variety Mars have been scored for quantitative characters in two field trials.
The results indicate that variation in flowering time and other associated characters is largely determined by genes on chromosome 2 and that chromosome 4 is involved in the control of plant height.
The feasibility of the technique as a method of assaying the contributions of chromosomes to qualitative characters by substitution in a diploid is discussed.
Theory and models of crop yield loss from weed competition have led to decision models to help growers choose cost-effective weed management. These models are available for multiple-species weed communities in a single season of several crops. Growers also rely on crop rotation for weed control, yet theory and models of weed population dynamics have not led to similar tools for planning of crop rotations for cost-effective weed management. Obstacles have been the complexity of modeling the dynamics of multiple populations of weed species compared to a single species and lack of data. We developed a method to use limited, readily observed data to simulate population dynamics and crop yield loss of multiple-species weed communities in response to crop rotation, tillage system, and specific weed management tactics. Our method is based on the general theory of density dependence of plant productivity and extensive use of rectangular hyperbolic equations for describing crop yield loss as a function of weed density. Only two density-independent parameters are required for each species to represent differences in seed bank mortality, emergence, and maximum seed production. One equation is used to model crop yield loss and density-dependent weed seed production as a function of crop and weed density, relative time of weed and crop emergence, and differences among species in competitive ability. The model has been parameterized for six crops and 15 weeds, and limited evaluation indicates predictions are accurate enough to highlight potential weed problems and solutions when comparing alternative crop rotations for a field. The model has been incorporated into a decision support tool for whole-farm management so growers in the Central Great Plains of the United States can compare alternative crop rotations and how their choice influences farm income, herbicide use, and control of weeds in their fields.
Harold Pinter is one of the premier dramatists of the twentieth century; he also is a master screenwriter. In spite of the fact that he has written twenty-four filmscripts and in the 1980s and 1990s his artistic attention was focused almost exclusively on his screenwriting, relatively little critical attention has been paid to this large segment of his canon. Since his first scripted film, The Servant, appeared in 1962, he has had numerous cinematic successes, in terms of both popular acceptance and critical acclaim, and he has won several prestigious awards for his work. Besides being entered in major festivals, Pinter's films have been listed among the year's ten best consistently, and he received both the British Screenwriters Guild Award and the New York Film Critics Best Writing Award for The Servant (1963), the Berlin Film Festival Silver Bear and an Edinburgh Festival Certificate of Merit for The Caretaker (1963), the British Film Academy Award for The Pumpkin Eater (1964), the Cannes Film Festival Special Jury Prize and a National Board of Review Award for Accident (1967), the Cannes Film Festival Golden Palm for Best Film and the British Academy Award for The Go-Between (1970), and a National Board of Review Best English-Language Film Award for The Last Tycoon (1976). His more recent films, The French Lieutenant's Woman (1981), Betrayal (1982), Turtle Diary (1986), The Handmaid's Tale (1990) and The Trial (1993) have received equal praise from reviewers. As a matter of fact, critics claim that Pinter's distinctive style and unmistakable writing ability have been responsible for the best work done by several of his directors (as I documented in Butter's Going Up well over twenty years ago).