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No standardized surveillance criteria exist for surgical site infection after breast tissue expander (BTE) access. This report provides a framework for defining postaccess BTE infections and identifies contributing factors to infection during the expansion period. Implementing infection prevention guidelines for BTE access may reduce postaccess BTE infections.
To sustainably improve cleaning of high-touch surfaces (HTSs) in acute-care hospitals using a multimodal approach to education, reduction of barriers to cleaning, and culture change for environmental services workers.
The study was conducted in 2 academic acute-care hospitals, 2 community hospitals, and an academic pediatric and women’s hospital.
Frontline environmental services workers.
A 5-module educational program, using principles of adult learning theory, was developed and presented to environmental services workers. Audience response system (ARS), videos, demonstrations, role playing, and graphics were used to illustrate concepts of and the rationale for infection prevention strategies. Topics included hand hygiene, isolation precautions, personal protective equipment (PPE), cleaning protocols, and strategies to overcome barriers. Program evaluation included ARS questions, written evaluations, and objective assessments of occupied patient room cleaning. Changes in hospital-onset C. difficile infection (CDI) and methicillin-resistant S. aureus (MRSA) bacteremia were evaluated.
On average, 357 environmental service workers participated in each module. Most (93%) rated the presentations as ‘excellent’ or ‘very good’ and agreed that they were useful (95%), reported that they were more comfortable donning/doffing PPE (91%) and performing hand hygiene (96%) and better understood the importance of disinfecting HTSs (96%) after the program. The frequency of cleaning individual HTSs in occupied rooms increased from 26% to 62% (P < .001) following the intervention. Improvement was sustained 1-year post intervention (P < .001). A significant decrease in CDI was associated with the program.
A novel program that addressed environmental services workers’ knowledge gaps, challenges, and barriers was well received and appeared to result in learning, behavior change, and sustained improvements in cleaning.
Background: Meningiomas are the most commonly occurring benign intracranial tumors. When presenting with peritumoral brain edema (PTBE), surgical treatment can lead to patient morbidity. This retrospective case series aims to describe the conservative medical management of moderate to large meningiomas with large PTBE. Methods: Patients with suspected meningiomas greater than 2.0cm and edema index greater than 2.0 were identified by screening 3345 MRI scans between 2012-2017. Imaging analysis included MR imaging features of suspected meningiomas and clinical data was gathered from the electronic patient record (patient age, sex, patient symptoms, follow-up duration, and follow-up symptoms). Results: We report on 31 patients who received conservative medical management. Presenting complaints included headache, seizure, weakness; many presented asymptomatically. The average follow-up time was 3.96 years. At the final follow-up appointment, 19 (61%) patients were asymptomatic. Among symptomatic patients, seizures were the most common complaint. There was no mortality reported in our cohort and the average tumor progression was 7.04cm3/year. Conclusions: In this retrospective report of meningioma patients with high edema index, we found that most patients remained asymptomatic or had stable symptoms after at least 1-yr follow up after medical treatment. This study provides insight around the surgical decision-making for meningiomas with large spread of edema.
We introduce CRYSTAL, a multi-agent AI system for crystal-structure phase mapping. CRYSTAL is the first system that can automatically generate a portfolio of physically meaningful phase diagrams for expert-user exploration and selection. CRYSTAL outperforms previous methods to solve the example Pd-Rh-Ta phase diagram, enabling the discovery of a mixed-intermetallic methanol oxidation electrocatalyst. The integration of multiple data-knowledge sources and learning and reasoning algorithms, combined with the exploitation of problem decompositions, relaxations, and parallelism, empowers AI to supersede human scientific data interpretation capabilities and enable otherwise inaccessible scientific discovery in materials science and beyond.
Background: Brain tumors present unique challenges to patient and family quality of life (QOL). Cognitive dysfunction is common and functionally limiting, with no established treatments. These studies evaluate feasibility and preliminary efficacy of behavioral interventions developed for neuro-oncology patients. Study 1: A randomized controlled trial (N=25 primary brain tumor patients) compared an adapted version of Goal Management Training (GMT, a neuroscience-based integration of mindfulness and strategy training) and a newly-designed supportive psychoeducational intervention (Brain Health Program, BHP) to standard of care. Each intervention comprised 8 individual sessions and at-home practice between sessions. GMT patients’ executive functions improved immediately (p=.077, d=1.13), with maintenance at 4-month follow-up (p=.046, d=1.09). Both intervention groups reported improvements in everyday cognitive functioning immediately (p=.049; d’s GMT=0.43, BHP=0.79) and at follow-up (p=.001; d’s GMT=0.22, BHP=1.01). BHP patients also reported improved mood (p’s=.026 & .012, d’s=0.61 & 0.62). Study 2: Following a needs assessment about cognitive concerns and QOL in brain metastases patients (N=109) and caregivers (N=31), we developed a novel, brief (3 sessions + homework) Cognitive Support Program to provide education and strategy-training in key areas of concern: executive functions, memory, and communication. Options include caregiver co-training, and in-person or web-based delivery. Preliminary data from a pilot trial in progress demonstrate objective and subjective improvements. Conclusions: Cognitive rehabilitation may be a feasible and effective option for primary or metastatic brain tumor patients, addressing a need that is largely unmet in standard cancer care. Further development and larger trials appear warranted, with capacity for remote delivery recommended.
After the diagnosis of immune-mediated inflammatory diseases (IMID) such as inflammatory bowel disease (IBD), multiple sclerosis (MS) and rheumatoid arthritis (RA), the incidence of psychiatric comorbidity is increased relative to the general population. We aimed to determine whether the incidence of psychiatric disorders is increased in the 5 years before the diagnosis of IMID as compared with the general population.
Using population-based administrative health data from the Canadian province of Manitoba, we identified all persons with incident IBD, MS and RA between 1989 and 2012, and cohorts from the general population matched 5 : 1 on year of birth, sex and region to each disease cohort. We identified members of these groups with at least 5 years of residency before and after the IMID diagnosis date. We applied validated algorithms for depression, anxiety disorders, bipolar disorder, schizophrenia, and any psychiatric disorder to determine the annual incidence of these conditions in the 5-year periods before and after the diagnosis year.
We identified 12 141 incident cases of IMID (3766 IBD, 2190 MS, 6350 RA) and 65 424 matched individuals. As early as 5 years before diagnosis, the incidence of depression [incidence rate ratio (IRR) 1.54; 95% CI 1.30–1.84) and anxiety disorders (IRR 1.30; 95% CI 1.12–1.51) were elevated in the IMID cohort as compared with the matched cohort. Similar results were obtained for each of the IBD, MS and RA cohorts. The incidence of bipolar disorder was elevated beginning 3 years before IMID diagnosis (IRR 1.63; 95% CI 1.10–2.40).
The incidence of psychiatric comorbidity is elevated in the IMID population as compared with a matched population as early as 5 years before diagnosis. Future studies should elucidate whether this reflects shared risk factors for psychiatric disorders and IMID, a shared final common inflammatory pathway or other aetiology.
There have been many studies examining the differences between infant-directed speech (IDS) and adult-directed speech (ADS). However, investigations asking whether mothers clarify vowel articulation in IDS have reached equivocal findings. Moreover, it is unclear whether maternal speech clarification has any effect on a child's developing language skills. This study examined vowel clarification in mothers’ IDS at 0;10–11, 1;6, and 2;0, as compared to their vowel production in ADS. Relationships between vowel space, vowel duration, and vowel variability and child language outcomes at two years were also explored. Results show that vowel space and vowel duration tended to be greater in IDS than in ADS, and that one measure of vowel clarity, a mother's vowel space at 1;6, was significantly related to receptive as well as expressive child language outcomes at two years of age.
In this study, we used an online survey to assess knowledge, attitudes, and practices related to environmental cleaning and other infection prevention strategies among environmental services workers (ESWs) at 5 hospitals. Our findings suggest that ESWs could benefit from additional education and feedback as well as new strategies to address workflow challenges.
This paper outlines the details of astrometric parameter determination of double stars from HIPPARCOS observations as prepared in the FAST consortium. Methods of parameter estimation are developed for relative astrometry and absolute astrometry. The capability of the procedures will be demonstrated using simulated observations, in describing the particular steps of a Monte Carlo simulation which have been executed at the Istituto di Astrofisica Spaziale (IAS) and at the Astronomisches Rechen–Institut (ARI).
After the processing of one year of observations carried out by HIPPARCOS it is possible to provide quantitative results as to the number of new double and multiple stars to be detected and the real capacity of this mission to perform relative astrometry on double stars. We present and discuss the methods developed to this end and include the first results concerning the detection statistics and the determination of separation and position angle for double stars. About 16,000 stars have been recognized as non-single, including 9,000 already known as double and mutliple before the mission. Also, a subset of 10,500 stars have been successfully solved for their relative coordinates with an accuracy in the range of 3 to 10 mas.
In this contribution, we report progress in the preparation of superconducting materials made by Spark Plasma Sintering (SPS). On the one hand, the fabrication process was optimized in order to improve the texturing of Bi2Ca2Sr2CuO8 superconductor ceramics. The new process is referred to as “Spark Plasma Texturing” (SPT). During SPT, the bulk material is free to deform itself. As a result, an inter-grain preferential crystallographic orientation is generated, while materials processed by conventional SPS are usually quasi-isotropic. The crystallographic orientation causes a strong anisotropy in the magnetic properties of the Bi2Ca2Sr2CuO8 bulk.
On the other hand, superconducting MgB2 discs were consolidated using the rapid SPS process. MgB2 has not been yet been seriously considered as a superconductor that could be used for magnetic levitation. Here we present trapped field measurements as a function of the distance to the superconductor and field cooled levitation force measurements that suggests that it presents interesting characteristics for this application.
Misophonia is a condition of unknown cause characterized by atypically intense negative physiological and emotional reactions to hearing certain sounds – most often those associated with oral functions. Individuals with misophonia often report high levels of psychological distress and avoidance behaviours that seriously compromise their occupational and social functioning. As of yet, no effective treatment of misophonia has been identified, and health care providers often struggle when they encounter clients who have it. This case report describes the assessment, case formulation, and treatment of a client with misophonia using cognitive behavioural therapy (CBT), and serves as an initial contribution to the evidence base for the efficacy of CBT in the treatment of misophonia.