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Hand hygiene compliance rates were estimated using direct observations. An AHHMS, installed on 4 nursing units in a sequential manner, determined hand hygiene performance rates, expressed as the number of hand hygiene events performed upon entering and exiting patient rooms divided by the number of room entries and exits. Additional strategies implemented to improve hand hygiene included goal setting, hospital leadership support, feeding AHHMS data back to healthcare personnel, and use of Toyota Kata performance improvement methods. HAIs were defined using National Healthcare Safety Network criteria.
Hand hygiene compliance rates generated by direct observation were substantially higher than performance rates generated by the AHHMS. Installation of the AHHMS without supplementary activities did not yield sustained improvement in hand hygiene performance rates. Implementing several supplementary strategies resulted in a statistically significant 85% increase in hand hygiene performance rates (P < .0001). The incidence density of non–Clostridioies difficile HAIs decreased by 56% (P = .0841), while C. difficile infections increased by 60% (P = .0533) driven by 2 of the 4 study units.
Implementation of an AHHMS, when combined with several supplementary strategies as part of a multimodal program, resulted in significantly improved hand hygiene performance rates. Reductions in non–C. difficile HAIs occurred but were not statistically significant.
Researchers sought to determine the extent to which burden related to patients' symptom subtypes could predict informal hospice caregiver depression, and to illustrate the differences between caregivers who experience suicidal ideation and those who do not.
Informal caregivers recruited from a not-for-profit community-based hospice agency participated in a cross-sectional survey. Self-report questionnaires assessed caregiver burden associated with patient symptomatology (via a modified version of the Memorial Symptom Assessment Scale–Short Form) and caregiver depressive symptoms, including suicidal ideation (measured by the Patient Health Questionnaire–9). Multiple regressions evaluated the unique predictability of patients' symptom subtypes on caregiver depression. Exploratory analyses examined mean differences of study variables between participants who did and did not endorse suicidal ideation.
Caregiver burden related to patients' psychological symptoms accounted for significant variance in caregiver depression scores when controlling for burden related to physical symptoms. Among 229 caregivers (M age = 61.4 years), 12 reported suicidal ideation, where 6 of the 12 were male, despite male caregivers comprising less than 20% of the total sample.
Significance of results:
Burden associated with patients' psychological symptoms uniquely contributed to caregiver depression, further highlighting the clinical utility and necessity for hospice providers to address the emotional needs of patients and their caregivers alike. Developing clinical procedures to identify and respond to such needs would not only behoove hospice agencies, but it would likely enhance the caregiving experience holistically, which might be particularly imperative for male caregivers.
We have used the Parkes-MIT-NRAO (PMN) radio survey, at a common frequency of 4.85 GHz (λ=6 cm), to study the distribution of Galactic shell supernova remnants (SNRs). We estimate distances and distribution of the Galactic shell SNRs and find the peak of distances to be between 4 and 6 kpc. Our two-dimensional model of the distribution of Galactic shell SNRs shows a concentration between the Sagittarius and the Scutum arms.
It is, I suppose, an indication of the general bewilderment caused by the apparently abrupt appearance of a new and strangely named religious party in the England of James I, the Arminian, which makes one’s pupils occasionally describe the High Churchmen of those days as ‘Armenians’. It is a pardonable mistake. They are vaguely aware that many have regarded Arminianism as a theological heresy. They have no doubt also heard rumours that the Armenians are regarded by most of the rest of Christendom as heretical. Hence the natural confusion.
Establishing an evidence-based diagnostic system informed by the biological (dys)function of the nervous system is a major priority in psychiatry. This objective, however, is often challenged by difficulties in identifying homogeneous clinical populations. Melancholia, a biological and endogenous subtype for major depressive disorder, presents a canonical test case in the search of biological nosology.
We employed a unique combination of naturalistic functional magnetic resonance imaging (fMRI) paradigms – resting state and free viewing of emotionally salient films – to search for neurobiological signatures of depression subtypes. fMRI data were acquired from 57 participants; 17 patients with melancholia, 17 patients with (non-melancholic) major depression and 23 matched healthy controls.
Patients with melancholia showed a prominent loss of functional connectivity in hub regions [including ventral medial prefrontal cortex, anterior cingulate cortex (ACC) and superior temporal gyrus] during natural viewing, and in the posterior cingulate cortex while at rest. Of note, the default mode network showed diminished reactivity to external stimuli in melancholia, which correlated with the severity of anhedonia. Intriguingly, the subgenual ACC, a potential target for treating depression with deep brain stimulation (DBS), showed divergent changes between the two depression subtypes, with increased connectivity in the non-melancholic and decreased connectivity in the melancholic subsets.
These findings reveal neurobiological changes specific to depression subtypes during ecologically valid behavioural conditions, underscoring the critical need to respect differing neurobiological processes underpinning depressive subtypes.
Non-alcoholic fatty liver disease (NAFLD) is an independent predictor of CVD in otherwise healthy individuals. Low n-3 PUFA intake has been associated with the presence of NAFLD; however, the relationship between a biomarker of n-3 status – the Omega-3 Index – and liver fat is yet to be elucidated. A total of eighty overweight adults (fifty-six men) completed the anthropometric and biochemical measurements, including the Omega-3 Index, and underwent proton magnetic resonance spectroscopy assessment of liver fat. Bivariate correlations and multiple regression analyses were performed with reference to prediction of liver fat percentage. The mean Omega-3 Index was high in both NAFLD (intrahepatic lipid concentration≥5·5 %) and non-NAFLD groups. The Omega-3 Index, BMI, waist circumference, glucose, insulin, TAG, high-sensitive C-reactive protein (hsCRP) and alanine aminotransferase (ALT) were positively correlated, and HDL and erythrocyte n-6:n-3 ratio negatively correlated with liver fat concentration. Regression analysis found that simple anthropometric and demographic variables (waist, age) accounted for 31 % of the variance in liver fat and the addition of traditional cardiometabolic blood markers (TAG, HDL, hsCRP and ALT) increased the predictive power to 43 %. The addition of the novel erythrocyte fatty acid variable (Omega-3 Index) to the model only accounted for a further 3 % of the variance (P=0·049). In conclusion, the Omega-3 Index was associated with liver fat concentration but did not improve the overall capacity of demographic, anthropometric and blood markers to predict NAFLD.
Nanostructured carbon materials, especially activated carbon, carbon nanotubes, and graphene, have been widely studied for supercapacitor applications. To maximize the efficacy of these materials for electrochemical energy storage, a detailed understanding of the relationship between the nanostructure of these materials and their performance as supercapacitors is required. A fundamental structural parameter obtained from the Raman spectra of these materials, the in-plane correlation length or nanocrystalline domain size, is found to correlate with the electrochemical capacitance, regardless of other morphological features. This correlation for a common nanostructural characteristic is believed to be the first result of its kind to span several distinct nanostructured carbon morphologies, including graphene–carbon nanotubes hybrid materials, and may allow more effective nanoscale engineering of supercapacitor electrode materials.
This research implements a recently proposed framework for meander migration, in order to explore the coevolution of planform and channel width in a freely meandering river. In the model described here, width evolution is coupled to channel migration through two submodels, one describing bank erosion and the other describing bank deposition. Bank erosion is modelled as erosion of purely non-cohesive bank material damped by natural armouring due to basal slump blocks, and bank deposition is modelled in terms of a flow-dependent rate of vegetal encroachment. While these two submodels are specified independently, the two banks interact through the medium of the intervening channel; the morphodynamics of which is described by a fully nonlinear depth-averaged morphodynamics model. Since both banks are allowed to migrate independently, channel width is free to vary locally as a result of differential bank migration. Through a series of numerical runs, we demonstrate coevolution of local curvature, width and streamwise slope as the channel migrates over time. The correlation between the local curvature, width and bed elevation is characterized, and the nature of this relationship is explored by varying the governing parameters. The results show that, by varying a parameter representing the ratio between a reference bank erosion rate and a reference bank deposition rate, the model is able to reproduce the broad range of river width–curvature correlations observed in nature. This research represents a step towards providing general metrics for predicting width variation patterns in river systems.
We surveyed 399 US acute care hospitals regarding availability of on-site Legionella testing; 300 (75.2%) did not offer Legionella testing on site. Availability varied according to hospital size and geographic location. On-site access to testing may improve detection of Legionnaires disease and inform patient management and prevention efforts.
The Early Iron Age enclosures and associated sites on Sutton Common on the western edge of the Humberhead Levels contain an exceptional variety of archaeological data of importance not only to the region but for the study of later prehistory in the British Isles. Few other later prehistoric British sites outside the East Anglian fens and the Somerset Levels have thus far produced the quantity and quality of organically preserved archaeological materials that have been found, despite the small scale of the investigations to date. The excavations have provided an opportunity to integrate a variety of environmental analyses, of wood, pollen, beetles, waterlogged and carbonised plant remains, and of soil micromorphology, to address archaeological questions about the character, use, and environment of this Early Iron Age marsh fort. The site is comprised of a timber palisaded enclosure and a succeeding multivallate enclosure linked to a smaller enclosure by a timber alignment across a palaeochannel, with associated finds ranging in date from the Middle Bronze Age to the Roman and medieval periods. Among the four adjacent archaeological sites is an Early Mesolithic occupation site, also with organic preservation, and there is a Late Neolithic site beneath the large enclosure. Desiccation throughout the common is leading to the damage and loss of wooden and organic remains. It is hoped that the publication of these results, of investigations between 1987 and 1993, will lead to a fuller investigation taking place.
Oblique angle deposition (OAD) is a self-organizing physical vapor deposition (PVD) technique that has been used to grow sculpted 3D nanostructures including helices, slanted rods, and zigzag structures, and other shapes. OAD structures can be fabricated from virtually any material that can be deposited using PVD including: polymers, metals, semiconductors, oxides, and nitrides. The control over the nano-scale structural anisotropy of these materials allows one to tailor their electrical, magnetic, mechanical, crystalline, and optical properties. Through the careful design of the OAD structure and material selection this technique can be used to create photonic materials (1D, 2D, and 3D) with unique properties. We will discuss ongoing work using OAD to develop oxide thin film interference filters that can withstand extreme temperatures (800-1000° C) at mTorr vacuum levels, which are being developed for thermal photovoltaic applications.
The Magnetoresistance (MR), Magnetic properties, and crystal structure of dc magnetron sputtered CO/Ag periodic multilayers have been investigated. The Co layer thickness was fixed at -30 Å while the thickness of the Ag layer was systematically varied. ‘Giant’ magnetoresistance was observed. The MR ratio has been found to decline monotonically with increasing Ag thickness in the range 30 Å to 107 Å. Although the maximum room temperature MR ratio is a Modest 4.78%, a more technologically significant measurement of field sensitivity (MR ratio/FWHM of the MR vs. H peak) is a promising 0.1%/Oe at its best. The effect of the number of bilayer units has also been examined and no substantial differences were noted between multilayers containing 8, 9, and 10 bilayer units. Coercivities as determined by both magnetometer and the splitting of the MR peaks are in agreement and increase from 25 to 38 Oe with increasing Ag thickness. Evidence for antiferromagnetic coupling is apparent in the hysteresis loops. High angle X-ray diffractometry (HXRD) in the θ-2θ mode revealed a strong Ag (111) texture in the film, with satellite peaks indicating a layered structure. Low angle XRD (LXRD) also yielded broad superlattice peaks in all samples at least to the second order.
The phenomenon of giant magnetoresistance (GMR), previously measured only in multilayer films comprising ferromagnetic layers separated by nonmagnetic spacers, has recently been observed in single layer ‘granular’ alloy thin films prepared by cosputtering a ferromagnet and a nonmagnet which tend to phase separate (cluster) under equilibrium conditions. We have systematically studied the magnetoresistance of two new phase separating GMR systems (Ni66Fe16Co18-Ag and Co9oFelo-Ag) both of which exhibit large room temperature GMR (>11% and >14%, respectively). We have also attempted to influence the details of the field dependence of the magnetoresistance in the previously studied Co-Ag system by employing novel processing methods including interrupted sputtering and layering of the Co-Ag alloy with Cu spacers.
A Model for the field dependence of giant Magnetoresistance (GMR) in ‘granular’ co-sputtered alloy thin films (based on a relatively simple spin-dependent scattering concept appropriate to superparamagnetic and weakly ferromagnetic films) is applied to new experimental data from the Co90Fe10-Ag system. The Model and the experimental data can be shown to compare very well with the help of a single adjustable parameter related to spin correlation of adjacent Co-Fe clusters. A careful fit of field-dependent MR data and theory leads to a fairly reliable determination of spin-cluster radius. An analysis of the relative permeability of granular GMR films derived from the generalized form of the Clausius-Mossoti relationship is also presented. For a non-Magnetic Matrix the effective relative permeability is shown to be materials independent. The permeability model is applied to Co-Au granular films.
NEWAGE is a direction-sensitive dark matter search experiment with a gaseous
time-projection chamber. We improved the direction-sensitive dark matter limits by our
underground measurement. In this paper, R&D activities sinse the first underground
measurement are described.
Models which treat molecules as graphs provide the first approximation to practically all chemical and physical theories of polymers. This paper, worded so as to aim at intelligibility by both chemists and mathematicians, deals with statistical effects of correlations on distributions of molecules in their graph-like states. The correlations are formally equivalent to fertility correlations in family trees, and the theory covers the range of correlation to the point where a man's fertility expectations depend on how many brothers he has. Chemically, this describes the ‘second shell substitution effect’ which includes certain steric hindrance situations; mathematically, the problem is solved by restoring the Markovian nature of a conventional Galton-Watson process. Long-range correlations are an inevitable and troublesome aspect of the structure of gels and this work represents a step towards improving models for real gels.
We are presently using the Chandra X-ray Observatory to conduct the first systematic X-ray survey of planetary nebulae (PNe) in the solar neighborhood. The Chandra Planetary Nebula Survey (ChanPlaNS) is a 570 ks Chandra Cycle 12 Large Program targeting 21 high-excitation PNe within ~1.5 kpc of Earth. When complete, this survey will provide a suite of new X-ray diagnostics that will inform the study of late stellar evolution, binary star astrophysics, and wind interactions. Among the early results of ChanPlaNS (when combined with archival Chandra data) is a surprisingly high detection rate of relatively hard X-ray emission from CSPNe. Specifically, X-ray point sources are clearly detected in roughly half of the ~30 high-excitation PNe observed thus far by Chandra, and all but one of these X-ray-emitting CSPNe display evidence for a hard (few MK) component in their Chandra spectra. Only the central star of the Dumbbell appears to display “pure” hot blackbody emission from a ~200 kK hot white dwarf photosphere in the X-ray band. Potential explanations for the“excess” hard X-ray emission detected from the other CSPNe include late-type companions (heretofore undetected, in most cases) whose coronae have been rejuvenated by recent interactions with the mass-losing WD progenitor, non-LTE effects in hot white dwarf photospheres, self-shocking variable winds from the central star, and slow (re-)accretion of previously ejected red giant envelope mass.
Since hospitals in a region often share patients, an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection in one hospital could affect other hospitals.
Using extensive data collected from Orange County (OC), California, we developed a detailed agent-based model to represent patient movement among all OC hospitals. Experiments simulated MRSA outbreaks in various wards, institutions, and regions. Sensitivity analysis varied lengths of stay, intraward transmission coefficients (β), MRSA loss rate, probability of patient transfer or readmission, and time to readmission.
Each simulated outbreak eventually affected all of the hospitals in the network, with effects depending on the outbreak size and location. Increasing MRSA prevalence at a single hospital (from 5% to 15%) resulted in a 2.9% average increase in relative prevalence at all other hospitals (ranging from no effect to 46.4%). Single-hospital intensive care unit outbreaks (modeled increase from 5% to 15%) caused a 1.4% average relative increase in all other OC hospitals (ranging from no effect to 12.7%).
MRSA outbreaks may rarely be confined to a single hospital but instead may affect all of the hospitals in a region. This suggests that prevention and control strategies and policies should account for the interconnectedness of health care facilities.