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Automated surveillance of healthcare-associated infections reduces workload and improves standardization, but it has not yet been adopted widely. In this study, we assessed the performance and feasibility of an easy implementable framework to develop algorithms for semiautomated surveillance of deep incisional and organ-space surgical site infections (SSIs) after orthopedic, cardiac, and colon surgeries.
Retrospective cohort study in multiple countries.
European hospitals were recruited and selected based on the availability of manual SSI surveillance data from 2012 onward (reference standard) and on the ability to extract relevant data from electronic health records. A questionnaire on local manual surveillance and clinical practices was administered to participating hospitals, and the information collected was used to pre-emptively design semiautomated surveillance algorithms standardized for multiple hospitals and for center-specific application. Algorithm sensitivity, positive predictive value, and reduction of manual charts requiring review were calculated. Reasons for misclassification were explored using discrepancy analyses.
The study included 3 hospitals, in the Netherlands, France, and Spain. Classification algorithms were developed to indicate procedures with a high probability of SSI. Components concerned microbiology, prolonged length of stay or readmission, and reinterventions. Antibiotics and radiology ordering were optional. In total, 4,770 orthopedic procedures, 5,047 cardiac procedures, and 3,906 colon procedures were analyzed. Across hospitals, standardized algorithm sensitivity ranged between 82% and 100% for orthopedic surgery, between 67% and 100% for cardiac surgery, and between 84% and 100% for colon surgery, with 72%–98% workload reduction. Center-specific algorithms had lower sensitivity.
Using this framework, algorithms for semiautomated surveillance of SSI can be successfully developed. The high performance of standardized algorithms holds promise for large-scale standardization.
The aim of this study is to analyse and determine elemental abundances for a large sample of distant B stars in the outer Galactic disk in order to constrain the chemical distribution of the Galactic disk and models of chemical evolution of the Galaxy. Here, we present preliminary results on a few stars along with the adopted methodology based on securing simultaneous O and Si ionization equilibria with consistent NLTE model atmospheres.
The structure and dynamics of young stellar object (YSO) accretion shocks depend strongly on the local magnetic field strength and configuration, as well as on the radiative transfer effects responsible for the energy losses. We present the first 3D YSO shock simulations of the interior of the stream, assuming a uniform background magnetic field, a clumpy infalling gas, and an acoustic energy flux flowing at the base of the chromosphere. We study the dynamical evolution and the post-shock structure as a function of the plasma-beta (thermal pressure over magnetic pressure). We find that a strong magnetic field (~hundreds of Gauss) leads to the formation of fibrils in the shocked gas due to the plasma confinement within flux tubes. The corresponding emission is smooth and fully distinguishable from the case of a weak magnetic field (~tenths of Gauss) where the hot slab demonstrates chaotic motion and oscillates periodically.
The field of ecological immunology currently relies on using a number of immune effectors or markers. These markers are usually used to infer ecological trade-offs (via conflicts in resource allocation), though physiological nature of these markers remains elusive. Here, we review markers frequently used in insect evolutionary ecology research: cuticle darkening, haemocyte density, nodule/capsule formation, phagocytosis and encapsulation/melanization via use of nylon filaments and beads, phenoloxidase activity, nitric oxide production, lysozyme and antimicrobial peptide production. We also provide physiologically based information that may shed light on the probable trade-offs inferred when these markers are used. In addition, we provide a number of methodological suggestions to improve immune marker assessment.
In order to improve the understanding of the physics of accretion shocks around young
stellar objects, we have performed a three dimensional simulation of a radiative shock
generated in a laser installation. We depict the 3D structure of such a shock. Radiation
hydrodynamics is modeled with the HERACLES code; then, radiative transfer post-processing
is performed with the IRIS code.
Advances in laser and Z-pinch technology, coupled with the development of plasma diagnostics, and the availability of high-performance computers, have recently stimulated the growth of high-energy density laboratory astrophysics. In particular, a number of experiments have been designed to study radiative shocks and jets with the aim of shedding new light on physical processes linked to the ejection and accretion of mass by newly born stars. Although general scaling laws are powerful tools to link laboratory experiments with astrophysical plasmas, the phenomena modeled are often too complicated for simple scaling to remain relevant. Nevertheless, the experiments can still give important insights into the physics of astrophysical systems and can be used to provide the basic experimental validation of numerical simulations in regimes of interest to astrophysics. We will illustrate the possible links between laboratory experiments, numerical simulations, and astrophysics in the context of stellar jets. First we will discuss the propagation of stellar jets in a cross-moving interstellar medium and the scaling to Z-pinch produced jets. Our second example focuses on slab-jets produced at the Prague Asterix Laser System laser installation and their practical applications to astrophysics. Finally, we illustrate the limitations of scaling for radiative shocks, which are found at the head of the most rapid stellar jets.
We present recent coronagraphic observations of β Pictoris obtained with the Space Telescope Imaging Spectrograph (STIS) aboard the Hubble Space Telescope. The superb, high-resolution images show that the inner part of the disk is inclined by about 5° with respect to the main disk. Long-slit coronagraphic spectrograms oriented along the inner disk indicate that the reflectance of the inner disk is neutral over the spectral region, 3000-5600 Å.
Neuropsychiatric surgery has had a long and complex history with examples of less than optimal surgical procedures implemented in wrong settings. Such past errors have raised important philosophical and ethical issues that remain with us for good reasons. However, the existence of enormous suffering due to chronic therapy-resistant disabling neuropsychiatric disorders compels a search for alternative surgical approaches based on a sound understanding of the underlying physiopathological mechanisms. We bring evidence, from single cell physiology and magnetoencephalography, for the existence of a set of neuropsychiatric disorders characterized by localized and protracted low frequency spontaneous recurrent activation of the thalamocortical system. This condition, labeled thalamocortical dysrhythmia, underlies certain chronic psychotic, affective, obsessive compulsive, anxiety and impulse control disorders. Considering the central role of recurrent oscillatory thalamocortical properties in the generation of normal hemispheric functions, we propose a surgical approach that provides a reestablishment of normal thalamocortical oscillations without reduction of cortical tissue and its specific thalamic connectivity. It consists of small strategically placed pallidal and medial thalamic lesions that serve to make subcritical the increased low frequency thalamocortical recurrent network activity. This result is attained via reduction of both thalamic overinhibition and low frequency over-synchronization. Thalamic disinhibition is obtained by a lesion in the anterior medial paralimbic pallidum. The medial thalamic lesion is localized in the posterior part of the central lateral nucleus, where a large majority of cells have been shown to be locked in low frequency production and to have lost their normal activation patterns. We present here our experience with 11 patients, including clinical follow ups and pre- and postsurgical magnetoencephalographic studies. The evidence speaks (1) for a benign and efficient surgical approach, and (2) for the relevance of the patient’s presurgical cognitive and social settings, making them more or less prone to postoperative psychoreactive manifestations upon rekindling of personal goals and social reentry.
We have investigated the properties of main-sequence O-type stars in the SMC. Mass-loss rates, luminosities and Teff are much smaller for these stars than for Galactic ones, resulting in a steeper wind-momentum relation.
The companion paper (Llinás et al., 2001) presents evidence, at both cellular and network levels, for the role of resonant oscillatory thalamocortical properties in normal and pathological brain function. Here we present confirmatory single cell electrophysiology from the thalami of thalamocortical dysrhythmia (TCD) patients and review our surgical approach towards the relief of this chronic disabling condition, in its many forms. The goal of surgery is a rebalancing of the abnormal thalamocortical oscillation responsible for TCD. Our approach uses small strategically placed pre-thalamic and medial thalamic lesions that serve to make subcritical the low frequency thalamocortical reentry network attractor via desinhibition and desamplification. The lesions address classical and new stereotactic targets that provide therapeutic efficiency coupled with the sparing of the specific thalamocortical loops.
The ROSAT and EUVE all-sky surveys have resulted in an important change in our understanding of the general composition of hydrogen-rich DA white dwarf atmospheres, with the photospheric opacity dominated by heavy elements rather than helium in the hottest stars (T > 40, 000 K). Most stars cooler than 40,000 K have more or less pure H atmospheres. However, one question, which has not been resolved, concerned the specific nature of the heavy elements and the role of helium in the hottest white dwarfs. One view of white dwarf evolution requires that H-rich DA stars form by gravitational settling of He from either DAO or He-rich central stars of planetary nebulae. In this case, the youngest (hottest) DA white dwarfs may still contain visible traces of He. Spectroscopic observations now available with EUVE provide a crucial test of these ideas. Analysis of data from the EUVE Guest Observer programme and EUVE public archive allows quantitative consideration of the sources of EUV opacity and places limits on the abundance of He which may be present.
Transient grating (TG) experiments were performed to study carrier diffusion and recombination in amorphous silicon films (a-Si:H) at high light intensities using 8 ns pulses from a frequency-doubled Nd:YAG laser. The ambipolar diffusion coefficients reached about 10−2cm2/s, which is 2 orders of magnitude larger than the steady-state value. Similar results were obtained in intrinsic, p-, and n-doped a-Si:H films, indicating that the diffusion coefficients in all cases reflect the near band edge mobility of the slower carriers, that is holes. In particular, the p-type sample shows an initially fast, then a slow grating efficiency decay, consistent with dispersive transport.
By using a Nd: YAG-pumped optical parametric oscillator (OPO) as excitation light source (8 ns pulse width), the dynamic range of photothermal deflection spectroseopy (PDS) is increased by a factor up to 1000. This enables the study of nonlinear defect absorption in intrinsic, phosphorus and boron doped a-Si:H. To probe nonlinear absorption of defects, the intensity of the fundamental emission of the Nd:YAG (1064 nm) has been varied over three orders of magnitude. For intensities greater than 1024 photons/ (cm2s), a significant increase of a by a factor 1.4 in p-, 1.2 in i-, and 1.15 in n-a-Si:H is detected. From electron spin resonance (ESR) and transient photoconductivity experiments on intrinsic a-Si:H, a bleaching of the defect density by electron excitation into the conduction band is measured. A hole-like signature in the ESR spectra indicates that electrons from the valence band are excited into the defect band as well. The data are interpreted based on a model for IR-induced nonlinear optical effects.
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