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Background: Well-designed infection prevention programs include basic elements aimed at reducing the risk of transmission of infectious agents in healthcare settings. Although most acute-care facilities have robust infection prevention programs, data are sporadic and often lacking in other healthcare settings. Infection control assessment tools were developed by the CDC to assist health departments in assessing infection prevention preparedness across a wide spectrum of health care including acute care, long-term care, outpatient care, and hemodialysis. Methods: The North Carolina Division of Public Health collaborated with the North Carolina Statewide Program for Infection Control and Epidemiology (SPICE) to conduct a targeted number of on-site assessments for each healthcare setting. Three experienced infection preventionists recruited facilities, conducted on-site assessments, provided detailed assessment findings, and developed educational resources. Results: The goal of 250 assessments was exceeded, with 277 on-site assessments completed across 75% of North Carolina counties (Table 1). Compliance with key observations varied by domain and type of care setting (Table 2). Conclusions: Comprehensive on-site assessments of infection prevention programs are an effective way to identify gaps or breaches in infection prevention practices. Gaps identified in acute care primarily related to competency validation: however, gaps presenting a threat to patient safety (ie, reuse of single dose vials, noncompliance with sterilization and/or high-level disinfection processes) were identified in other care settings. Infection control assessment and response findings underscore the need for ongoing assessment, education, and collaboration among all healthcare settings.
Li[Lix/3Mn2x/3M1−x]O2 (M = Ni, Mn, Co) (HE-NMC) materials, which can be expressed as a combination of trigonal LiTMO2 (TM = transition metal) and monoclinic Li2MnO3 phases, are of great interest as high capacity cathodes for lithium-ion batteries. However, structural stability prevents their commercial adoption. To address this, Si doping was applied, resulting in improved stability. Raman and differential capacity analyses suggest that silicon doping improves the structural stability during electrochemical cycling. Furthermore, the doped material exhibits a 10% higher capacity relative to the control. The superior capacity likely results from the increased lattice parameters as determined by X-ray diffraction (XRD) and the lower resistance during the first cycle found by impedance and direct current resistance (DCR) measurements. Density functional theory (DFT) predictions suggest that the observed lattice expansion is an indication of increased oxygen vacancy concentration and may be due to the Si doping.
Mountain pine beetle (Dendroctonus ponderosae Hopkins; Coleoptera: Curculionidae) is a major disturbance agent in pine (Pinus Linnaeus; Pinaceae) ecosystems of western North America. Adaptation to local climates has resulted in primarily univoltine generation time across a thermally diverse latitudinal gradient. We hypothesised that voltinism patterns have been shaped by selection for slower developmental rates in southern populations inhabiting warmer climates. To investigate traits responsible for latitudinal differences we measured lifestage-specific development of southern mountain pine beetle eggs, larvae, and pupae across a range of temperatures. Developmental rate curves were fit using maximum posterior likelihood estimation with a Bayesian prior to improve fit stability. When compared to previously published data for a northern population, optimal development of southern individuals occurred at higher temperatures, with higher development thresholds, as compared with northern individuals. Observed developmental rates of the southern and northern populations were similar across studied lifestages at 20 °C, and southern lifestages were generally faster at temperature extremes (10 °C, 27 °C). At 25 °C southern fourth instars were significantly slower than northern fourth instars. Our results suggest that evolved traits in the fourth instar and remaining unstudied lifestage, teneral (i.e., preemergent) adult, likely influence latitudinal differences in mountain pine beetle generation time.
Does the addition of topical tranexamic acid to anterior nasal packing decrease bleeding in patients with epistaxis who are taking antiplatelet medications?
Zahed R, Jayazeri M, Naderi A, et al. Topical tranexamic acid compared with anterior nasal packing for treatment of epistaxis in patients taking antiplatelet drugs: randomized controlled trial. Acad Emerg Med 2018;25(3):261-6.
The primary outcome of this randomized controlled trial was the percentage of patients whose epistaxis had stopped at 10 minutes from the time of intervention. Secondary outcomes included the frequency of epistaxis recurrence at both 24 hours and 7 days, emergency department length of stay, and patient satisfaction.
To develop evidence-based materials which provide information and support for parents who are concerned about their baby’s excessive crying. As well as meeting these parents’ needs, the aim was to develop a package of materials suitable for use by the UK National Health Service (NHS).
Parents report that around 20% of infants in Western countries cry excessively without an apparent reason during the first four months of age. Traditionally, research has focused on the crying and its causes. However, evidence is growing that how parents evaluate and respond to the crying needs to receive equal attention. This focus encompasses parental resources, vulnerabilities, well-being and mental health. At present, the UK NHS lacks a set of routine provisions to support parents who are concerned about their baby’s excessive crying. The rationales, methods and findings from a study developing materials for this purpose are reported.
Following a literature review, 20 parents whose babies previously cried excessively took part in focus groups or interviews. They provided reports on their experiences and the supports they would have liked when their baby was crying excessively. In addition, they identified their preferred delivery methods and devices for accessing information and rated four example support packages identified by the literature review.
During the period their baby cried excessively, most parents visited a health service professional and most considered these direct contacts to have provided helpful information and support. Websites were similarly popular. Telephones and tablets were the preferred means of accessing online information. Groups to meet other parents were considered an important additional resource by all the parents. Three package elements – a Surviving Crying website, a printed version of the website and a programme of Cognitive Behaviour Therapy-based support sessions delivered to parents by a qualified practitioner, were developed for further evaluation.
Eslicarbazepine is a novel anti-epileptic agent indicated for the treatment of partial-onset seizures. We present the case of an 18 year old female that presented to the Emergency Department four hours after a reported intentional ingestion of an estimated 5600 mg of eslicarbazepine. Although initially hemodynamically stable and neurologically normal, shortly after arrival she developed confusion, rigidity and clonus, followed by recurrent seizures, hypoxemia and cardiac arrest which responded to cardiopulmonary resuscitation and wide complex tachycardia requiring defibrillation. Treatment for refractory seizures included benzodiazepines and eventual intubation and sedation with propofol. Cardiac toxicity responded to sodium bicarbonate. In addition, empiric hemodialysis was performed. In this case report, we discuss the successful management of the first reported overdose of eslicarbazepine using supportive care and hemodialysis.
Belize contains important habitat for Antillean manatees (Trichechus manatus manatus) and provides refuge for the highest known population density of this subspecies. As these animals face impending threats, knowledge of their dietary habits can be used to interpret resource utilization. The contents of 13 mouth, six digestive tract (stomach, duodenum and colon) and 124 faecal samples were microscopically examined using a modified point technique detection protocol to identify key plant species consumed by manatees at two important aggregation sites in Belize: Southern Lagoon and the Drowned Cayes. Overall, 15 different items were identified in samples from manatees in Belize. Five species of seagrasses (Halodule wrightii, Thalassia testudinum, Ruppia maritima, Syringodium filiforme and Halophila sp.) made up the highest percentage of items. The red mangrove (Rhizophora mangle) was also identified as an important food item. Algae (Ulva sp., Chara sp., Lyngbya sp.) and invertebrates (sponges and diatoms) were also consumed. Variation in the percentage of seagrasses, other vascular plants and algae consumption was analysed as a 4-factor analysis of variance (ANOVA) with main effects and interactions for locality, sex, size classification and season. While sex and season did not influence diet composition, differences for locality and size classification were observed. These results suggest that analysis of diet composition of Antillean manatees may help to determine critical habitat and use of associated food resources which, in turn, can be used to aid conservation efforts in Belize.
The borderline between the periods commonly termed "medieval" and "Renaissance", or "medieval" and "early modern", is one of the most hotly, energetically and productively contested faultlines in literary history studies. The essays presented in this volume both build upon and respond to the work of Professor Helen Cooper, a scholar who has long been committed to exploring the complex connectionsand interactions between medieval and Renaissance literature. The contributors re-examine a range of ideas, authors and genres addressed in her work, including pastoral, chivalric romance, early English drama, and the writings of Chaucer, Langland, Spenser and Shakespeare. As a whole, the volume aims to stimulate active debates on the ways in which Renaissance writers used, adapted, and remembered aspects of the medieval.
Andrew King is Lecturer in Medieval and Renaissance Literature at University College, Cork; Matthew Woodcock is Senior Lecturer in Medieval and Renaissance Literature at the University of East Anglia.
Contributors: Joyce Boro, Aisling Byrne, Nandini Das, Mary C. Flannery, Alexandra Gillespie, Andrew King, Megan G. Leitch, R.W. Maslen, Jason Powell,Helen Vincent, James Wade, Matthew Woodcock