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In preparation for a multisite antibiotic stewardship intervention, we assessed knowledge and attitudes toward management of asymptomatic bacteriuria (ASB) plus teamwork and safety climate among providers, nurses, and clinical nurse assistants (CNAs).
Prospective surveys during January–June 2018.
All acute and long-term care units of 4 Veterans’ Affairs facilities.
The survey instrument included 2 previously tested subcomponents: the Kicking CAUTI survey (ASB knowledge and attitudes) and the Safety Attitudes Questionnaire (SAQ).
A total of 534 surveys were completed, with an overall response rate of 65%. Cognitive biases impacting management of ASB were identified. For example, providers presented with a case scenario of an asymptomatic patient with a positive urine culture were more likely to give antibiotics if the organism was resistant to antibiotics. Additionally, more than 80% of both nurses and CNAs indicated that foul smell is an appropriate indication for a urine culture. We found significant interprofessional differences in teamwork and safety climate (defined as attitudes about issues relevant to patient safety), with CNAs having highest scores and resident physicians having the lowest scores on self-reported perceptions of teamwork and safety climates (P < .001). Among providers, higher safety-climate scores were significantly associated with appropriate risk perceptions related to ASB, whereas social norms concerning ASB management were correlated with higher teamwork climate ratings.
Our survey revealed substantial misunderstanding regarding management of ASB among providers, nurses, and CNAs. Educating and empowering these professionals to discourage unnecessary urine culturing and inappropriate antibiotic use will be key components of antibiotic stewardship efforts.
Geomorphic analysis and optically stimulated luminescence (OSL) ages from undated Lake Agassiz beaches and adjacent fluvial sediments on Riding Mountain in Manitoba provide insight into their early history. New OSL ages of 14.5±2.4 and 13.4±0.7 ka on the oldest (Herman to Norcross) beaches of Lake Agassiz near the Canada-U.S. border indicate that the Laurentide Ice Sheet (LIS) retreated from that part of the Agassiz basin by ~14.5 ka. To the north along Riding Mountain, the Herman strandlines are absent, and OSL ages on the oldest beach there average 12.9 ka, which links it to the younger Norcross-Tintah strandlines. In adjacent Riding Mountain, OSL ages and geomorphological relationships of a large abandoned glacial spillway >200 m above the oldest beaches of Lake Agassiz indicate that this channel predates retreat of the LIS and formation of beaches in this part of the Agassiz basin, with ice remaining in this area until after 14.5 ka. OSL ages on the Gimli beach 170 km to the east are >3000 yr older than conventional assignments, suggesting that it formed during the Moorhead low-water phase 12.8–10.6 ka. Luminescence ages support the conclusion that the Campbell beach formed ~10.9 ka near the end of the Moorhead low-water phase.
Influenza A(H1N1) viruses of the 2009 pandemic (A(H1N1)pdm09) continue to cause outbreaks in the post-pandemic period. During January to May 2015, an upsurge of influenza was recorded that resulted in high fatality in central India. Genetic lineage, mutations in the hemagglutinin (HA) gene and infection by quasi-species are reported to affect disease severity. The objective of this study is to present the molecular and epidemiological trends during the 2015 influenza outbreak in central India. All the referred samples were subjected to qRT–PCR for diagnosis. HA gene sequencing (23 survivors and 24 non-survivors) and cloning were performed and analyzed using Molecular Evolutionary Genomic Analyzer (MEGA 5·05). Of the 3625 tested samples, 1607 (44·3%) were positive for influenza A(H1N1)pdm09, of which 228 (14·2%) individuals succumbed to death. A significant trend was observed in positivity (P = 0·003) and mortality (P < 0·0001) with increasing age. The circulating A(H1N1)pdm09 virus was characterized as belonging to clade-6B. Clinically significant mutations were detected. Patients infected with the quasi-species of the virus had a greater risk of death (P = 0·009). This study proposes a robust molecular and clinical surveillance program for the detection and characterization of the virus, along with prompt treatment protocols to prevent outbreaks.
Dengue is regarded as the most important arboviral disease. Although sporadic cases have been reported, serotypes responsible for outbreaks have not been identified from central India over the last 20 years. We investigated two outbreaks of febrile illness, in August and November 2012, from Korea district (Chhattisgarh) and Narsinghpur district (Madhya Pradesh), respectively. Fever and entomological surveys were conducted in the affected regions. Molecular and serological tests were conducted on collected serum samples. Dengue-specific amplicons were sequenced and phylogenetic analyses were performed. In Korea and Narsinghpur districts 37·3% and 59% of cases were positive, respectively, for dengue infection, with adults being the worst affected. RT–PCR confirmed dengue virus serotype 1 genotype III as the aetiology. Ninety-six percent of infections were primary. This is the first time that dengue virus 1 outbreaks have been documented from central India. Introduction of the virus into the population and a conducive mosquitogenic environment favouring increased vector density caused the outbreak. Timely diagnosis and strengthening vector control measures are essential to avoid future outbreaks.
A relativistically hot electron, positron and ion (e–p–i) plasma relaxes to a triple curl Beltrami (TCB) field. The TCB field being the superposition of three Beltrami fields is characterized by three scale parameters and hence there exist multiscale structures in the system. It is shown that temperatures of the plasma constituents strongly affect the scale parameters. Generally, the scale parameters associated with the TCB field may be a combination of real and complex roots. The numerical results show that for given Beltrami parameters, an increase in the thermal energy of plasma particles could transform the real eigenvalues to complex ones. It is also observed that one component is more strongly affected relative to other components on increasing temperatures of plasma species. Two different vortices become the same at higher thermal energies. This suggests that it is possible to create high β (kinetic to magnetic pressure ratio) and fully diamagnetic plasma configurations. The study has a potential relevance to space, astrophysics and laboratory plasmas.
Solitary waves are investigated in a charge-varying dusty plasma involving dust trapping. A potentially useful neuronal method that may handle a wide variety of non-analytic pseudo-potentials is used. This method could be advantageously exploited in rendering a cumbersome pseudo-potential analytically more tractable. Making use of the approximate Sagdeev pseudo-potential, our results show the possibility of development of localized dust structures in a dusty plasma with variable charge trapped dust grains.
Properties of the coupled dust ion-acoustic drift wave instability in a radially bounded dusty magnetoplasma with an equilibrium sheared parallel ion (SPI) flow are investigated. By using the two-fluid model for the electrons and ions, a wave equation for the low-frequency coupled dust ion-acoustic drift waves in a bounded plasma with stationary charged dust grains is derived. The wave equation admits a linear dispersion relation, which exhibits that the radial boundary affects the growth rate of the coupled ion-acoustic drift wave instability which is excited by the SPI flow. The results should be relevant to dusty magnetoplasma experiments with an SPI flow.
A possibility of relaxation of relativistically hot electron and positron (e − p) plasma with a small fraction of hot or cold ions has been investigated analytically. It is observed that a strong interaction of plasma flow and field leads to a non-force-free relaxed magnetic field configuration governed by the triple curl Beltrami (TCB) equation. The triple curl Beltrami (TCB) field composed of three different Beltrami fields gives rise to three multiscale relaxed structures. The results may have the strong relevance to some astrophysical and laboratory plasmas.
The increasing demand for faster and more reliable integrated circuits (ICs)
has promoted the integration of Copper-based metallization. Electroplated Cu
films demonstrate a microstructural transition at room temperature, known as
self annealing. In this paper we intend to investigate the annealing
behavior of electroplated Cu films grown on a seed Cu layer on top of the
barrier layers over a single crystal silicon substrate. All the samples were
undergone through a multistep annealing process. Grazing incident x-ray
diffraction pattern shows stronger x-ray reflections from Cu (111) and (220)
planes but weaker reflections from (200), (311) and (222) planes in all the
electroplated Cu samples. Transmission electron microscopy was performed on
the cross section of the samples and the diffraction pattern showed the
crystalline behavior of both seed layer and electroplated Cu.
Nanoindentation was performed on all the samples using the continuous
stiffness measurement (CSM) technique and it was found that the elastic
modulus varies from 110 to 130 GPa while the hardness varies from 1 to 1.6
GPa depending on the annealing conditions. The tribological properties of
all the copper films were also measured using the Bench Top CMP tester.
Subsequently, Nanoindentation was performed on the samples after polishing
the top surface in order to investigate the work hardening and an increase
in hardness and modulus was observed. Finite Element Modeling was performed
in order to investigate the stress behavior during nanoindentation.
As* ion beam irradiation of thin titanium (∼300Å) films deposited on silicon substrates at sufficiently high dose and energy has been shown to induce an athermal thin film reaction (as evidenced by insenstivity of the reaction to irradiation current) leading to the formation of a homogeneous titanium subsilicide phase with an extremely smooth interface to the underlying silicon. RBS indicates a stoichiometry of Ti3Si4 for this silicide phase. Subsequent rapid thermal annealing (RTA) of this silicide results in the incorporation of additional silicon leading ultimately to the formation of the stable C-54 TiSi2 phase. Silicided junctions fabricated using a ion beam irradiation show improved sheet resistance uniformity and leakage characteristics when compared with those fabricated using the conventional RTA salicide process.
Currently, there are a variety of techniques to deposit metal thin films ranging from high vacuum techniques such as chemical vapor deposition (CVD) and physical vapor deposition (PVD), through to solution methods like sol-gel. While the vacuum techniques can be limited by size and cost, sol-gel can be limited be the availability of appropriate precursors. All of these techniques have the further limitation that they cannot be used to coat porous materials conformally.
Polymer assisted deposition (PAD) addresses some of the limitations of sol-gel and costs of high vacuum techniques. PAD utilizes an aqueous polymer to bind a metal or metal complex that serves both to encapsulate the metal to prevent chemical reaction and maintain an even distribution of the metal in solution. Another advantage that PAD has is that the same solution can be used as precursors for the growth of metal oxide or reduced metal films. Herein, we report on the utility of PAD in preparing metal oxide films used to conformally coat porous material and reduced metal films.
This paper focuses on the progress in understanding the shielding around a test charge in the presence of ion-acoustic waves in multispecies plasmas, whose constituents are positive ions, two negative ions, and Boltzmann distributed electrons. By solving the linearized Vlasov equation with Poisson equation, the Debye–Hückel screening potential and wakefield (oscillatory) potential distribution around a test charge particle are derived. It is analytically found that both the Debye–Hückel potential and the wakefield potential are significantly modified due to the presence of two negative ions. The present results might be helpful to understand and to form new materials from plasmas containing two negative ions such as Xe+ − F− − SF−6 and Ar+ − F− − SF−6 plasmas, as well as to tackle extension of the test charge problem in multinegative ions' coagulation/agglomeration.
Mechanical and tribological properties of thin films draw special attention and differ from those of bulk materials due to the effects of interfaces, microstructure and thick underlying substrates. In this study hard wear resistant nitride coatings (TiN, ZrN, TiAlN, TiCN and CrN) were coated on high speed steel substrates using cathodic arc deposition method. Mechanical properties of the films were evaluated using nanoindentation technique. Continuous stiffness method was employed to evaluate the depth sensing hardness and modulus values. Studies of tribological properties were performed using ball-on-disk friction and wear test. We have also investigated the wear track using optical microscopy. Variation of coefficient of friction with time has been analyzed and coating endpoint was estimated. Nanoindentation evaluation of mechanical properties along with the measurement of tribological properties is very useful in order to use them as wear resistant hard coatings.
Search for novel multi-functional materials, especially multiferroics, which are ferromagnetic above room temperature and at the same time exhibit a ferroelectric behavior much above room temperature, is an active topic of extensive studies today. Ability to address an entity with an external field, laser beam, and also electric potential is a welcome challenge to develop multifunctional devices enabled by nanoscience. While most of the studies to date have been on various forms of Bi- and Ba based Ferrites, rare earth chromites are a new class of materials which appear to show some promise. However in the powder and bulk form these materials are at best canted antiferromagnetics with the magnetic transition temperatures much below room temperature. In this presentation we show that thin films of YbCrO3 deposited by Pulsed Laser Deposition exhibit robust ferromagnetic properties above room temperature. It is indeed a welcome surprise and a challenge to understand the evolution of above room temperature ferromagnetism in such a thin film. The thin films are amorphous in contrast to the powder and bulk forms which are crystalline. The magnetic properties are those of a soft magnet with low coercivity. We present extensive investigations of the magnetic and ferroelectric properties, and spectroscopic studies using XAS techniques to understand the electronic states of the constituent atoms in this novel Chromite. While the amorphous films are ferromagnetic much above room temperature, we show that any observation of ferroelectric property in these films is an artifact of a leaky highly resistive material.
The influence of the intrinsic spin of electrons on the propagation of circularly polarized waves in a magnetized plasma is considered. New eigenmodes are identified, one of which propagates below the electron cyclotron frequency, one above the spin-precession frequency, and another close to the spin-precession frequency. The latter corresponds to the spin modes in ferromagnets under certain conditions. In the non-relativistic motion of electrons, the spin effects become noticeable even when the external magnetic field B0 is below the quantum critical magnetic field strength, i.e. B0 < BQ = 4.4138 × 109T and the electron density satisfies n0 ≫ nc ≃ 1032m−3. The importance of electron spin (paramagnetic) resonance (ESR) for plasma diagnostics is discussed.
Nonlinear wave-driven processes in plasmas are normally described by either a monochromatic pump wave that couples to other monochromatic waves, or as a random phase wave coupling to other random phase waves. An alternative approach involves a random or broadband pump coupling to monochromatic and/or coherent structures in the plasma. This approach can be implemented through the wave-kinetic model. In this model, the incoming pump wave is described by either a bunch (for coherent waves) or a sea (for random phase waves) of quasi-particles. This approach has been applied to both photon acceleration in laser wakefields and drift wave turbulence in magnetized plasma edge configurations. Numerical simulations have been compared to experiments, varying from photon acceleration to drift mode-zonal flow turbulence, and good qualitative correspondences have been found in all cases.
We theoretically investigate conditions for the refraction of long-wavelength dust acoustic waves by arrays of periodic cylinders in a dusty plasma. This is based on a recent analysis of the refraction of shallow water waves by periodic cylinder arrays (Hu and Chan, Phys. Rev. Lett.95 (2005), 154501). In the dusty plasma case, however, the boundary conditions involve the formation of voids around the cylinders. Possible experimental conditions are discussed.
Counterstreaming plasma systems with intrinsic temperature anisotropies are unstable against the excitation of Weibel-type instabilities, namely, filamentation and Weibel instabilities, and their cumulative effect. Here, the analysis is extended to counterstreaming plasmas with weakly relativistic bulk velocities, while the thermal velocities are still considered to be non-relativistic. Such plasma systems are relevant for fusion plasma experiments and the more violent astrophysical phenomena, such as jets in gamma-ray burst sources. Simple analytical forms of the dispersion relations are derived in the limit of a small transverse temperature or a large temperature anisotropy of the beams. The aperiodic growing solutions are plotted systematically for the representative cases chosen in Paper I (Lazar et al. 2009 J. Plasma Phys. 75, in press). In the limit of slow non-relativistic plasma flows, the numerical solutions fit well with those obtained in Paper I, but for weakly relativistic streams an important deviation is found.
The aim of the present study was to determine the impact of universal salt iodization (USI) on the prevalence of iodine deficiency in the population of an area previously known to have severe iodine deficiency in India.
In a cross-sectional survey, a total of 2860 subjects residing in fifty-three villages of four sub-districts of Gonda District were examined for goitre and urinary iodine concentration. Free thyroxine and thyroid-stimulating hormone levels were also measured. Salt samples from households were collected for estimation of iodine content.
A reduction in goitre prevalence was observed from 69 % reported in 1982 to 27·7 % assessed in 2007. However, 34 % of villages still had very high endemicity of goitre (goitre prevalence >30 %). Twenty-three per cent of households consumed a negligible amount (<5 ppm) and 56 % of households consumed an insufficient amount (5–15 ppm) of iodine from salt.
Although there was an overall improvement in iodine nutrition as revealed by decreased goitre prevalence and increased median urinary iodine levels, there were several pockets of severe deficiency that require a more targeted approach. Poor coverage, the use of unpackaged crystal salt with inadequate iodine and the washing of salt before use by 90 % of rural households are the major causes of persisting iodine-deficiency disorders. This demonstrates lapses in USI implementation, lack of monitoring and the need to identify hot spots. We advocate strengthening the USI programme with a mass education component, the supply of adequately iodized salt and the implementation of complementary strategies for vulnerable groups, particularly neonates and lactating mothers.