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To develop a fully automated algorithm using data from the Veterans’ Affairs (VA) electrical medical record (EMR) to identify deep-incisional surgical site infections (SSIs) after cardiac surgeries and total joint arthroplasties (TJAs) to be used for research studies.
Retrospective cohort study.
This study was conducted in 11 VA hospitals.
Patients who underwent coronary artery bypass grafting or valve replacement between January 1, 2010, and March 31, 2018 (cardiac cohort) and patients who underwent total hip arthroplasty or total knee arthroplasty between January 1, 2007, and March 31, 2018 (TJA cohort).
Relevant clinical information and administrative code data were extracted from the EMR. The outcomes of interest were mediastinitis, endocarditis, or deep-incisional or organ-space SSI within 30 days after surgery. Multiple logistic regression analysis with a repeated regular bootstrap procedure was used to select variables and to assign points in the models. Sensitivities, specificities, positive predictive values (PPVs) and negative predictive values were calculated with comparison to outcomes collected by the Veterans’ Affairs Surgical Quality Improvement Program (VASQIP).
Overall, 49 (0.5%) of the 13,341 cardiac surgeries were classified as mediastinitis or endocarditis, and 83 (0.6%) of the 12,992 TJAs were classified as deep-incisional or organ-space SSIs. With at least 60% sensitivity, the PPVs of the SSI detection algorithms after cardiac surgeries and TJAs were 52.5% and 62.0%, respectively.
Considering the low prevalence rate of SSIs, our algorithms were successful in identifying a majority of patients with a true SSI while simultaneously reducing false-positive cases. As a next step, validation of these algorithms in different hospital systems with EMR will be needed.
To investigate the central electrode artefact effect of different ion chambers in the verification phantom using the dose calculation algorithms Analytical Anisotropic Algorithm (AAA) and Acuros XB.
Materials and methods:
The dosimetric study was conducted using an in-house fabricated polymethyl methacrylate head phantom. The treatment planning system (TPS)-calculated doses in the phantom with detectors were compared against the dummy detector fillets using AAA and Acuros XB algorithm. The planned and measured doses were compared for the study.
The mean percentage variation in volumetric-modulated arc therapy plans using Acuros XB and the measurement in the head phantom are statistically significant (p-value = 0.001) for FC65 and CC13 chambers. In small volume chambers (A14SL and CC01), the measured and TPS-calculated dose shows a good agreement.
The study confirmed the CT set of the phantom with detectors (FC65 and CC13) give more artefacts/heterogeneity caused a significant variation in dose calculation using Acuros XB. Therefore, the study suggests a method of using phantom CT set with the dummy detector for mean dose calculation for the Acuros XB algorithm.
The eastern Arabian Sea is influenced by both the advection of upwelled water from the western Arabian Sea and winter convective mixing. Therefore, sediments collected from the eastern Arabian Sea can help to understand the long-term seasonal hydrographic changes. We used the planktonic foraminifera census and stable isotopic ratio (δ18O) from sediments drilled during the International Ocean Discovery Program Expedition 355 to reconstruct surface hydrographic changes in the eastern Arabian Sea during the last 350 kyr. The increased abundance of Globigerina bulloides suggests enhanced advection of upwelled water during the latter half of MIS7 and the beginning of MIS6, as a result of a strengthened summer monsoon. A large drop in upwelling and/or advection of upwelled water from the western Arabian Sea is inferred during the subsequent interval of MIS6, based on the rare presence of G. bulloides. The comparable relative abundance of Neogloboquadrina dutertrei, G. bulloides and Globigerinoides ruber suggests that during the early part of MIS5, hydrographic conditions were similar to today. The upwelling decreased and winter convection increased with the progress of the glacial interval. A good coherence between planktonic foraminiferal assemblage-based monsoon stacks from both the eastern and western Arabian Sea suggests a coeval response of the entire northern Arabian Sea to the glacial–interglacial changes. The glacial–interglacial difference in δ18Osw-ivc was at a maximum with 4–5 psu change in salinity during Termination 2 and 3, and a minimum during Termination 4. The significantly reduced regional contribution to the glacial–interglacial change in δ18Osw-ivc during Termination 4 suggests a lesser change in the monsoon.
A total of 45 strains of Vibrio cholerae O1 isolated from 10 different places in India where they were associated with cases of cholera between the years 2007 and 2008 were examined by molecular methods. With the help of phenotypic and genotypic tests the strains were confirmed to be O1 El Tor biotype strains with classical ctxB gene. Polymerase chain reaction (PCR) analysis by double – mismatch amplification mutation assay PCR showed 16 of these strains carried the ctxB-7 allele reported in Haitian strains. Sequencing of the ctxB gene in all the 45 strains revealed that in 16 strains the histidine at the 20th amino acid position had been replaced by asparagine and this single nucleotide polymorphism did not affect cholera toxin production as revealed by beads enzyme-linked immunosorbent assay. This study shows that the new ctxB gene sequence was circulating in different places in India. Seven representatives of these 45 strains analysed by pulsed – field gel electrophoresis showed four distinct Not I digested profiles showing that multiple clones were causing cholera in 2007 and 2008.
In this study, we present the case of a neonate with obstructed infracardiac total anomalous pulmonary venous connection with severe pulmonary hypertension and a patent ductus arteriosus with right-to-left shunting. The patient had an unusual finding of pandiastolic flow reversal in the upper descending thoracic aorta. He underwent emergency surgical re-routing of the pulmonary veins to the left atrium, and postoperative echocardiography showed disappearance of the descending aortic flow reversal. We hypothesise that in severely obstructed total anomalous pulmonary venous connection the left ventricular output may be extremely low, resulting in flow reversal in the descending aorta.
To report the International Nosocomial Infection Control Consortium surveillance data from 40 hospitals (20 cities) in India 2004–2013.
Surveillance using US National Healthcare Safety Network’s criteria and definitions, and International Nosocomial Infection Control Consortium methodology.
We collected data from 236,700 ICU patients for 970,713 bed-days
Pooled device-associated healthcare-associated infection rates for adult and pediatric ICUs were 5.1 central line–associated bloodstream infections (CLABSIs)/1,000 central line–days, 9.4 cases of ventilator-associated pneumonia (VAPs)/1,000 mechanical ventilator–days, and 2.1 catheter-associated urinary tract infections/1,000 urinary catheter–days
In neonatal ICUs (NICUs) pooled rates were 36.2 CLABSIs/1,000 central line–days and 1.9 VAPs/1,000 mechanical ventilator–days
Extra length of stay in adult and pediatric ICUs was 9.5 for CLABSI, 9.1 for VAP, and 10.0 for catheter-associated urinary tract infections. Extra length of stay in NICUs was 14.7 for CLABSI and 38.7 for VAP
Crude extra mortality was 16.3% for CLABSI, 22.7% for VAP, and 6.6% for catheter-associated urinary tract infections in adult and pediatric ICUs, and 1.2% for CLABSI and 8.3% for VAP in NICUs
Pooled device use ratios were 0.21 for mechanical ventilator, 0.39 for central line, and 0.53 for urinary catheter in adult and pediatric ICUs; and 0.07 for mechanical ventilator and 0.06 for central line in NICUs.
Despite a lower device use ratio in our ICUs, our device-associated healthcare-associated infection rates are higher than National Healthcare Safety Network, but lower than International Nosocomial Infection Control Consortium Report.
Infect. Control Hosp. Epidemiol. 2016;37(2):172–181
Photovoltaic (PV) systems are progressively used for decentralized electricity generation. To obtain the maximum yield from such systems, optimisation of all components is essential. In this contribution, we provide a comprehensive modelling and sizing of PV systems for any location. Three applications are here presented providing real time monitoring of PV potential, accurate prediction of yield taking into account thermodynamic temperature effects, optimization of modules orientation addressing the effects of shading and efficient sizing of inverter for a higher yield output. When combined, these models can accurately predict the real time performance of any PV system.
To determine the prognostic value of laryngoscopy in predicting the recovery of unilateral vocal fold paralysis.
A prospective study was carried out of all patients with unilateral vocal fold paralysis without a progressive lesion or arytenoid dislocation.
Among the 66 candidates, 15 recovered. Patients with interarytenoid paralysis (p < 0.001) or posterolateral tilt of the arytenoid (p = 0.028) had less chance of recovery. Among 51 patients who did not recover, 25.49 per cent regained phonatory function by compensatory movement of the normal side; the rest required an intervention. Intervention requirement was significantly less for those patients who had isolated glottic level compensation. The paralysed vocal fold was at the same level in 32.35 per cent of patients, higher in 38.23 per cent and lower in 29.42 per cent. In those in whom vocal folds were in the abducted position (46.67 per cent), the affected vocal fold was at a lower position on phonation. Inter-observer reliability assessment revealed excellent to good agreement for all criteria.
Interarytenoid paralysis and posterolateral tilt of the arytenoid were predictors of poor recovery.
We report a stable CdS/Sb2S3/SnSe heterojunction thin film solar cell deposited on SnO2:F (FTO) – coated glass substrates. Thermal evaporation at 10-5 Torr with substrate temperature of 400 °C was used to deposit Sb2S3 and SnSe thin films of 450 nm and 160 nm, respectively. Thin film Sb2S3 has an optical band gap (Eg) of 1.48 eV and photoconductivity (σp) of 4x10-7 Ω-1 cm-1 and thin film SnSe has an Eg of 1.28 eV and σp of 2 Ω-1 cm-1. The chemically deposited CdS thin film heated at 400 °C shows an Eg of 2.34 eV and σp of 0.1 Ω-1 cm-1. Stabilized solar cell structures with these thin films, FTO/CdS/Sb2S3/SnSe/C-Ag, showed open circuit voltage (Voc) of 0.60 V, short circuit current density (Jsc) of 5.51 mA/cm2 and power conversion efficiency (η) of 0.96% with a fill factor FF of 0.29. In the absence of the SnSe layer, Jsc decreases to 4.77 mA/cm2.
The thyroid gland is removed en bloc during laryngectomy. There are no objective criteria for deciding the extent of thyroid gland resection in primary hypopharyngeal cancer cases. The present study aimed to determine the incidence of thyroid gland involvement in hypopharyngeal cancer and identify the various predictors of this involvement.
This paper reports a retrospective analysis of 358 patients with hypopharyngeal cancer, who underwent total laryngectomy with partial or total pharyngectomy at Tata Memorial Hospital, Mumbai between 2004 and 2010.
The mean age of this population was 61 years. The pyriform sinus was the most common hypopharyngeal subsite involved (in 89 per cent of cases). Most patients underwent hemi-thyroidectomy as part of their surgery. The thyroid gland was involved in only 13 per cent of cases.
Thyroid gland involvement is not common in hypopharyngeal cancer. Cases that involved the post-cricoid area, subglottic extension, extralaryngeal spread or prior tracheostomy were associated with a higher risk of thyroid gland involvement. Ipsilateral thyroidectomy is sufficient in most patients undergoing surgery (laryngectomy with partial or total pharyngectomy) for hypopharyngeal cancers.
Chemically deposited thin film stack of SnSe-ZnSe-Cu2-xSe was heated in nitrogen with Se vapor at 350-400 oC to produce Cu2ZnSnSe4 (CZTSe) thin films. For this, a thin film of SnSe with 180 nm thickness was deposited at 26 °C from a chemical bath containing tin(II) chloride, triethanolamine, sodium hydroxide, sodium selenosulfate, and a small quantity of polyvinylpyrrolidone. Thin films of ZnSe and Cu2-xSe were subsequently deposited on this SnSe film, also from chemical bath. The CZTSe thin film produced this way shows X-ray diffraction pattern matching that of Cu2ZnSnSe4 (kesterite/stannite) and have a Zn-rich composition. The film has an optical band gap of 0.9-1.0 eV and p-type electrical conductivity, 0.2-0.06 Ω-1 cm-1.
Thin films of AgSbS2 (150 nm) are prepared (75 min at 40 °C) via chemical deposition using a solution mixture containing SbCl3, Na2S2O3 and AgNO3. As-deposited films are amorphous. When they are heated in nitrogen at 180-320 °C, crystalline cubic-AgSbS2 films are formed. They show an optical band gap 1.89 eV and photoconductivity 1.8x10-5 Ω-1cm-1. Silver antimony sulfide-selenide film, AgSb(SxSe1-x)2, is produced from the initial amorphous film when it is heated in presence of Se-vapor. XRD analysis confirms the formation of solid solution AgSbS1.25Se0.75 or AgSbSe2 depending on the extent of Se-vapor available during heating. SnO2:F/CdS/AgSbS2/C solar cell shows Voc 610 mV, Jsc 0.88 mA/cm2,FF 0.53 and η 0.28%. In SnO2:F/CdS/Sb2S3/AgSb(SxSe1-x)2/C solar cell, Voc is 582 mV, Jsc 0.99 mA/cm2, FF 0.51 and η 0.29%.
Pregnancy is a special condition where many metabolic changes may occur because of increased requirement of essential micronutrients such as iron and iodine. Foetal thyroid starts producing its own thyroid hormones after 12 weeks of gestation. Therefore, the first trimester is very crucial for meeting thyroid hormone requirements of the mother and foetus. Iodine deficiency and iron deficiency may affect mental and physical growth of the foetus. Hence, it is very important to establish a programme on the screening of pregnant women for thyroid dysfunction tests along with established iron status assessment. Thus, the study was aimed to screen the pregnant women for iodine deficiency disorders and iron deficiency during early gestation, situational analysis on thyroid insufficiency and iron deficiency in pregnant women (gestational age <15 weeks) in urban Vadodara, Gujarat. n = 256 healthy pregnant women with uncomplicated singleton pregnancy were selected. The thyroid hormone was estimated by RIA, UIE using simple microplate technique and haemoglobin (Hb) concentration by acid hematin method. Median thyrotropin (TSH), free thyroxine (FT4), total thyroxine (TT4) and UIE concentrations were 1.88 μIU/ml, 0.83 ng/dl, 10.24 μg/dl and 297.14 mcg/l, respectively. There was a significant correlation between TSH, FT4 and month of gestation. Mean Hb concentration was 9.27 ± 1.09 g/dl. The prevalence of iodine insufficiency (based on UI) was 16.79% and iron deficiency was 91%. Screening programme for iodine deficiency during early gestation should be implemented along with the existing programme of haemoglobin estimation at first prenatal visit. This would help prevent damage to the developing brain and growth of the foetus and also to trace at-risk pregnant women.
New variants of Vibrio cholerae O1 have appeared in different time-frames in various endemic regions, especially in Asia and Africa. Sixty-nine strains of V. cholerae O1 isolated in Zambia between 1996 and 2004 were investigated by various genotypic techniques to determine the lineage of virulence signatures and clonality. All strains were positive for Vibrio seventh pandemic Islands (VSP)-I and VSP-II and repeat toxin (RTX) gene clusters attesting their El Tor lineage. Interestingly, strains isolated in recent times (2003–2004) were identified as an altered variant (El Tor biotype that harbours El Tor type rstR but produce classical ctxB) that replaced completely the progenitor El Tor strains prevalent in 1996–1997. Recent altered variant strains differed from prototype El Tor strains isolated earlier in that these strains lacked two ORFs, VC0493 and VC0498, in the VSP-II region. PFGE analysis revealed two major clonal lineages in the strains; cluster A represented the strains isolated before 2003 and cluster B the altered strains isolated in 2003–2004. Cluster A was closely related to prototype El Tor reference strain isolated in Bangladesh in 1971. Cluster B was found to be matched with Bangladeshi altered strains but was different from the hybrid strains isolated from Mozambique and Bangladesh. This report provides important information on the genesis of altered strains of V. cholerae O1 isolated in Zambia and emphasizes the need for further studies to follow the trends of evolutionary changes.
Ecological changes observed in cloud forests in the Monteverde area, northern Costa Rica, including disappearance of anuran populations and expansion of bird and bat ranges to higher elevations, have been linked to an increasing trend in dry-season mist-free days. Prior studies suggest that this trend may be influenced by both large-scale processes of climate change and regional-scale changes in land cover. Preliminary investigations exploring the impact of land use on cloud formation indicated that drying and warming of boundary layer air in response to lowland deforestation leads to increased cloud base heights. In the present study, numerical model experiments utilizing realistic land-use scenarios and atmospheric conditions are used to further explore the impact of land-use change on orographic cloud formation. The Regional Atmospheric Modeling System (RAMS) was used to simulate orographic cloud formation during the time period of 1–14 March 2003 in the Monteverde region for pristine, current, and future land-use scenarios. The simulations were initiated from the same atmospheric conditions and subject to similar lateral boundary conditions. Comparisons against observations showed that RAMS was capable of realistically simulating the nature of orographic cloud formation and boundary-layer thermodynamics. Numerical simulations indicated that deforestation in the lowlands and adjacent pre-montane areas results in an increase in average cloud base height and a consequent decrease in the areal extent of montane forests immersed in clouds. In the current and future land-use scenarios, warmer and drier air is found over the lowlands and pre-montane areas. […]
Acute diarrhoea remains a major public health challenge in developing countries. We examined the role of a probiotic in the prevention of acute diarrhoea to discover if there was an effect directed towards a specific aetiology. A double-blind, randomized, controlled field trial involving 3758 children aged 1–5 years was conducted in an urban slum community in Kolkata, India. Participants were given either a probiotic drink containing Lactobacillus casei strain Shirota or a nutrient drink daily for 12 weeks. They were followed up for another 12 weeks. The primary outcome of this study was the occurrence of first episodes of diarrhoea. We assessed this during 12 weeks of intake of study agent and also for 12 weeks of follow-up. There were 608 subjects with diarrhoea in the probiotic group and 674 subjects in the nutrient group during the study period of 24 weeks. The level of protective efficacy for the probiotic was 14% (95% confidence interval 4–23, P<0·01 in adjusted model). The reduced occurrence of acute diarrhoea in the probiotic group compared to nutrient group was not associated with any specific aetiology. No adverse event was observed in children of either probiotic or nutrient groups. The study suggests that daily intake of a probiotic drink can play a role in prevention of acute diarrhoea in young children in a community setting of a developing country.