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To quantify the frequency and outcomes of receiving an antibiotic prescription upon discharge from the hospital to long-term care facilities (LTCFs).
Retrospective cohort study.
A 576-bed, academic hospital in Portland, Oregon.
Adult inpatients (≥18 years of age) discharged to an LTCF between January 1, 2012, and June 30, 2016.
Our primary outcome was receiving a systemic antibiotic prescription upon discharge to an LTCF. We also quantified the association between receiving an antibiotic prescription and 30-day hospital readmission, 30-day emergency department (ED) visit, and Clostridium difficile infection (CDI) on a readmission or ED visit at the index facility within 60 days of discharge.
Among 6,701 discharges to an LTCF, 22.9% were prescribed antibiotics upon discharge. The most prevalent antibiotic classes prescribed were cephalosporins (20.4%), fluoroquinolones (19.1%), and penicillins (16.7%). The medical records of ~82% of patients included a diagnosis code for a bacterial infection on the index admission. Among patients prescribed an antibiotic upon discharge, the incidence of 30-day hospital readmission to the index facility was 15.9%, the incidence of 30-day ED visit at the index facility was 11.0%, and the incidence of CDI on a readmission or ED visit within 60 days of discharge was 1.6%. Receiving an antibiotic prescription upon discharge was significantly associated with 30-day ED visits (adjusted odds ratio [aOR], 1.2; 95% confidence interval [CI], 1.02–1.5) and with CDI within 60 days (aOR, 1.7; 95% CI, 1.02–2.8) but not with 30-day readmissions (aOR, 1.01; 95% CI, 0.9–1.2).
Antibiotics were frequently prescribed upon discharge to LTCFs, which may be associated with increased risk of poor outcomes post discharge.
We investigate the coupling dynamics of interfacial waves in liquid metal batteries and its effects on the battery’s operation safety. Similar to aluminium reduction cells, liquid metal batteries can be highly susceptible to magnetohydrodynamically exited interfacial instabilities. The resulting waves are capable of provoking short-circuits. Owing to the presence of two metal-electrolyte interfaces that may step into resonance, the wave dynamics in liquid metal batteries is particularly complex. In the first part of this paper, we present a potential flow analysis of coupled gravity–capillary interfacial waves. While we are focusing here on liquid metal batteries with circular cross-section, the theory is applicable to arbitrary stably stratified three-layer systems. Analytical expressions for the amplitude ratio and the wave frequencies are derived. It is shown that the wave coupling can be completely described by two independent dimensionless parameters. We further provide a decoupling criterion that suggests that wave coupling will be present in most future liquid metal batteries. In the second part, the theory is validated by comparing it with multiphase direct numerical simulations. An accompanying parameter study is conducted to analyse the system stability for interfaces coupled to varying degrees. Three different coupling regimes are identified involving characteristic coupling dynamics. For strongly coupled interfaces we observe novel instabilities that may have beneficial effects on the operational safety.
Burn patients are particularly vulnerable to infection, and an estimated half of all burn deaths are due to infections. This study explored risk factors for healthcare-associated infections (HAIs) in adult burn patients.
Retrospective cohort study.
Tertiary-care burn center.
Adults (≥18 years old) admitted with burn injury for at least 2 days between 2004 and 2013.
HAIs were determined in real-time by infection preventionists using Centers for Disease Control and Prevention criteria. Multivariable Cox proportional hazards regression was used to estimate the direct effect of each risk factor on time to HAI, with inverse probability of censor weights to address potentially informative censoring. Effect measure modification by burn size was also assessed.
Overall, 4,426 patients met inclusion criteria, and 349 (7.9%) patients had at least 1 HAI within 60 days of admission. Compared to <5% total body surface area (TBSA), patients with 5%–10% TBSA were almost 3 times as likely to acquire an HAI (hazard ratio [HR], 2.92; 95% CI, 1.63–5.23); patients with 10%–20% TBSA were >6 times as likely to acquire an HAI (HR, 6.38; 95% CI, 3.64–11.17); and patients with >20% TBSA were >10 times as likely to acquire an HAI (HR, 10.33; 95% CI, 5.74–18.60). Patients with inhalational injury were 1.5 times as likely to acquire an HAI (HR, 1.61; 95% CI, 1.17–2.22). The effect of inhalational injury (P=.09) appeared to be larger among patients with ≤20% TBSA.
Larger burns and inhalational injury were associated with increased incidence of HAIs. Future research should use these risk factors to identify potential interventions.
The water balance of Alpine regions is strongly determined by the storage of water in the form of snow and ice On the basis of long time series of daily precipitation, air temperature and discharge, the conceptual runoff model HBV3–ETH9 was applied to various basins of the eastern Alps showing a glacierization of 0–80%. Using the results of regional climate modelling under the assumption of doubling of C02 , the meteorological input data files were altered taking into account more frequent hot days and additional connective precipitation events during the summer months, and the consequences of these changes for daily discharge were evaluated. The results show that in regions with insignificant glacierization, runoff reacts primarily to changes in precipitation, and less so to rising summer air temperature. In highly glacierized basins, however, the same scenarios suggest strongly enhanced water yields in an initial phase. Higher flood peaks will result when high melt rates and heavy summer rains coincide. If glacier mass losses continue in the more distant future, the glacierized area will diminish and summer discharge will be gradually reduced, resulting in drastic water shortages in hot, dry summers once the glaciers have disappeared.
Background: Hyponatremia has been found to be associated with increased complications in a variety of surgical populations. No study looked specifically at patients undergoing spine surgery. We also specifically address whether it has an effect on the typical low-risk patient admitted for degenerative spine disease, a population that forms the major bulk of clinical practice. Methods: Data was obtained from the American college of surgeons National Surgical Quality Improvement Program (ACS-NSQIP). All patients who underwent elective spinal surgery for degenerative disease from 2011 to 2013 were included. The two arms (normonatremic and hyponatremic) were then compared. Results: A total of 58049 patients were included, 3037 were hyponatremic. Hyponatremic patients were older and had more comorbidities. They also developed more minor and major complications. When all comorbidities were controlled for, hyponatremia was only associated with increased minor but not major complications. These patients were more likely to require a blood transfusion (OR=1.23, CI 1.10-1.43) and a prolonged hospital stay (OR=1.52, CI 1.33-1.75). Conclusions: This study finds an association between hyponatremia and postoperative adverse events in a low risk population that forms the major bulk of clinical practice. This addresses a potential target for quality improvement strategies with significant cost saving implications.
Recent studies have improved our understanding of nearshore marine ecosystems surrounding Ascension Island (central Atlantic Ocean), but little is known about Ascension's benthic environment beyond its shallow coastal waters. Here, we report the first detailed physical and biological examination of the seabed surrounding Ascension Island at 100–1000 m depth. Multibeam swath data were used to map fine scale bathymetry and derive seabed slope and rugosity indices for the entire area. Water temperature and salinity profiles were obtained from five Conductivity, Temperature, Depth (CTD) deployments, revealing a spatially consistent thermocline at 80 m depth. A camera lander (Shelf Underwater Camera System; SUCS) provided nearly 400 images from 21 sites (100 m transects) at depths of 110–1020 m, showing high variability in the structure of benthic habitats and biological communities. These surveys revealed a total of 95 faunal morphotypes (mean richness >14 per site), complemented by 213 voucher specimens constituting 60 morphotypes collected from seven targeted Agassiz trawl (AGT) deployments. While total faunal density (maximum >300 m−2 at 480 m depth) increased with rugosity, characteristic shifts in multivariate assemblage structure were driven by depth and substratum type. Shallow assemblages (~100 m) were dominated by black coral (Antipatharia sp.) on rocky substrata, cup corals (Caryophyllia sp.) and sea urchins (Cidaris sp.) were abundant on fine sediment at intermediate depths (250–500 m), and shrimps (Nematocarcinus spp.) were common at greater depths (>500 m). Other ubiquitous taxa included serpulid and sabellid polychaetes and brittle stars (Ophiocantha sp.). Cold-water corals (Lophelia cf. pertusa), indicative of Vulnerable Marine Ecosystems (VMEs) and representing substantial benthic carbon accumulation, occurred in particularly dense aggregations at <350 m but were encountered as deep as 1020 m. In addition to enhancing marine biodiversity records at this locality, this study provides critical baseline data to support the future management of Ascension's marine environment.
Little is known about how behavioural and psychological symptoms of dementia (BPSD) manifest in the general hospital. The aim was to examine the frequency of BPSD in general hospitals and their associations with nursing staff distress and complications in care.
Cross-sectional representative study with 1469 patients aged ≥65, including 270 patients with dementia, of 33 randomly selected general hospitals in Germany. BPSD and complications were reported by nurses.
Overall frequency of BPSD was higher in patients with dementia (76%) than without (38%). The most frequent symptoms in patients with dementia were nighttime disturbances (38%), depression (29%) and aberrant motor behaviour (28%) and the most distressing symptoms for nursing staff were delusions, aggression and nighttime disturbances. The overall frequency of BPSD increased from 67% in mild dementia, to 76% in moderate dementia and to 88% in severe dementia. The most frequent symptoms in patients without dementia were depression (19%), nighttime disturbances (13%) and irritability (13%). The most distressing symptoms were aggression and delusions, while the same symptoms were consistently rated as less distressing than in patients with dementia. Factor analysis revealed three independent groups of BPSD that explained 45% of the total variance. First, expansive symptoms (aggression, irritability, nighttime disturbances, aberrant motor behaviour and disinhibition) were frequent, distressing for nursing staff and associated with many complications. Second, psychotic symptoms (delusions and hallucinations) were infrequent, distressing and associated with some complications. Third, affective symptoms (apathy, anxiety and depression) were frequent, non-distressing and associated with few complications. The results did not change when cases with delirium were excluded from both groups.
BPSD are common in older hospital patients with dementia and associated with considerable distress in nursing staff, as well as a wide range of special treatments needs and additional behavioural and medical complications. Management strategies are needed to improve the situation for both patients and hospital staff.
Many species of scleractinian reef corals deposit aragonite skeletons with cyclic bands of higher and lower density whose periodicity is annual. As these growth bands are frequently preserved in fossil corals, attention has been focused on their possible use as environmental indicators in as much as density variations may reflect changes in water temperature and/or light intensity. Relationships between skeletal growth banding and environmental parameters have been investigated by X-radiographic examination of 1488 specimens of modern reef corals representing 31 reef localities widely distributed over the Indo-Pacific and Caribbean regions. Average monthly seawater temperature and solar radiation data are available for each locality, and the date of collection is known for each sample. Of the 47 genera and subgenera included in the study, density variations were most pronounced in skeletons of Astreopora, Coscinarea, Cyphastrea, Favia (especially species with small corallites such as F. stelligera), Goniastrea, Hydnophora (massive forms only, e.g. M. microconos), Leptoria, Montastrea (especially M. annularis, with small corallites), Pavona, Polyastra, and Plesiastrea. Less useful are Diploastrea, Diploria, and Favites (which tend to have large corallite diameters), and Goniopora, Alveopora, Porites, Siderastrea, and Stephanaria (which frequently exhibit numerous secondary density variations within the annual cycle). Despite considerable variability among different individual corals from the same population, the average thickness of the skeletal growth bands is positively correlated with mean annual water temperature. By comparing characteristics of the outermost growth increment and the date of collection with monthly records of water temperature and solar radiation, it appears that maximum skeletal density is associated with those periods of the year when seawater temperature is above average.
In humans, maximum brain development occurs between the third trimester of gestation and 2 years of life. Nutrition during these critical windows of rapid brain development might be essential for later cognitive functioning and behaviour. In the last few years, trends on protein recommendations during infancy and childhood have tended to be lower than that in the past. It remains to be demonstrated that lower protein intakes among healthy infants, a part of being able to reduce obesity risk, is safe in terms of mental performance achievement. Secondary analyses of the EU CHOP, a clinical trial in which infants from five European countries were randomised to be fed a higher or a lower protein content formula during the 1st year of life. Children were assessed at the age of 8 years with a neuropsychological battery of tests that included assessments of memory (visual and verbal), attention (visual, selective, focused and sustained), visual-perceptual integration, processing speed, visual-motor coordination, verbal fluency and comprehension, impulsivity/inhibition, flexibility/shifting, working memory, reasoning, visual-spatial skills and decision making. Internalising, externalising and total behaviour problems were assessed using the Child Behaviour Checklist 4–18. Adjusted analyses considering factors that could influence neurodevelopment, such as parental education level, maternal smoking, child’s gestational age at birth and head circumference, showed no differences between feeding groups in any of the assessed neuropsychological domains and behaviour. In summary, herewith we report on the safety of lower protein content in infant formulae (closer to the content of human milk) according to long-term mental performance.
Environmental specimens lining seawater blowholes of Whale Point, Ascension Island in the South Atlantic Ocean were collected (August 2012) and investigated by morphological and molecular techniques. Reported here, Acremonium stroudii (Ascomycota) sp. nov., a filamentous conidia-forming fungus, was the only fungus isolated from the samples collected. Molecular analysis of the material also indicates the presence of a novel species of green algae being present, however, isolation of this alga has not been possible. Instead it appears that this specimen, which belongs to a novel lineage within the Ulvales, sister to the Dilabifilum species, encourages fungal growth in culture and has been shown to form a symbiotic relationship on low nutrition agar plates, supported by investigation through electron microscopy. As no holotype of this species could be isolated in an axenic culture it was not suitable at this point to try to define this alga, especially as no established genus could be attributed. We recommend trying to further sample areas of Ascension Island looking for other members of this green algal lineage, both investigating free-living green algae and those which are found as lichenized photobionts.
Of the many geophysical means that can be used to probe a planet's interior, seismology remains the most direct. Given that the seismic data gathered on the Moon over 40 years ago revolutionized our understanding of the Moon and are still being used today to produce new insight into the state of the lunar interior, it is no wonder that many future missions, both real and conceptual, plan to take seismometers to other planets.
To best facilitate the return of high-quality data from these instruments, as well as to further our understanding of the dynamic processes that modify a planet's interior, various modeling approaches are used to quantify parameters such as the amount and distribution of seismicity, tidal deformation, and seismic structure on and of the terrestrial planets. In addition, recent advances in wavefield modeling have permitted a renewed look at seismic energy transmission and the effects of attenuation and scattering, as well as the presence and effect of a core, on recorded seismograms. In this chapter, we will review these approaches.
Site selection for future planetary seismology missions
The ability of a seismic network to accurately locate an event improves as the number of seismometers increases. On Earth we take for granted that any given event will be relatively well located, due to the comparative ease of installation of seismometers. For planetary applications, we cannot count on a large distribution of stations. Various factors including cost, difficulty of installation, instrumentation longevity, and data transmission severely limit the number of instruments that have been or will be deployed on other planetary bodies. In this section, we will review various methods that can be employed to help determine the best landing sites for future planetary seismology missions, in order to maximize their scientific return. We focus here on the Moon and Mars, although many of these methods are adaptable to other planetary bodies.
CuxO thin films have been deposited on a quartz substrate by reactive radio frequency (rf) magnetron sputtering at different target powers Pt (140-190 W) while keeping other growth process parameters fixed. Room-temperature photoluminescence (PL) measurements indicate considerable improvement of crystallinity for the films deposited at Pt>170 W, with most pronounced excitonic features being observed in the film grown using Pt=190 W. These results corroborate well with the surface morphology of the films, which was found more flat, smooth and homogeneous for Pt >170 W films in comparison with those deposited at lower powers.
Nanosphere lithography (NSL) is a technique capable of creating large-area arrays of small objects with tailor-made shapes. Here we present an algorithm, which simulates the shape and morphology of nanoparticles produced via NSL in combination with physical vapor deposition from variable angles. The key idea is based on a ray-tracing technique. Mask clogging effects have a major influence on the shape of resulting nanoobjects and are therefore taken into account. In addition, we implemented a metaball concept for the precise description of thermally modified masks. The calculated results are compared exemplarily with atomic force microscopy (AFM) data of experimentally fabricated nanostructures.
PolarBase contains stellar spectropolarimetric data collected with the NARVAL & ESPaDOnS instruments (Petit et al. 2014). Their respective spectral resolutions are 65 000 and 68 000, in spectropolarimetric mode. As the first part of this work, we use the NARVAL spectropolarimetric repositories. We selected spectra from a sample of cool stars with effective Temperature (Teff) ranging between 4900 to 6000 K. This sample contains stellar systems with and without reported exoplanets. We exploit the full wavelength range from 380 to 900 nm in order to obtain chromospheric indexes such as the Ca ii H&K S-Index, and a Ca ii IRT and Hα index. We calibrated our measurements using the Mount Wilson S-Index values. Furthermore, we employ lithium (Li) abundance measurements from the literature (Gonzalez et al. 2010; Delgado Mena et al. 2014; Israelian et al. 2004), investigating in this way a possible correlation between the chromospheric activity measurements and the Li abundance in 32 selected cool stars.
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their Clostridium difficile infection (CDI) prevention efforts. This document updates “Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
A correlation of the local indium concentration measured on an atomic scale with luminescence properties of InxGa1−xN quantum wells reveals two different types of recombination mechanisms. A piezoelectric-field based mechanism is shown to dominate in samples with thick wells (L > 3 nm) of low indium concentration (x < 0.15−0.20). Spatial indium concentration fluctuations dominate luminescence properties in samples of higher indium concentrations in thinner wells. Quantum confinement is shown to have a major effect on the radiative recombination energy. A model is presented that relates the experimentally measured nano scale structural and chemical properties of quantum wells to the characteristics of the luminescence.
The (1 0 0) face of γ-LiAlO2 has attracted attention as a possible substrate for GaN epitaxial growth. This is partly because this face has an excellent lattice and structural match to (1 0 0) GaN. This orientation would have a misfit of only −1.4% along the c-direction and −0.1% along the b-direction of LiAlO2. We find that in practice this orientation relationship does not occur; instead, (0 0 0 1) oriented GaN grows with a small tilt (0.6° towards the c-direction) between the film and substrate. Although the misfit along the substrate b direction is large (−6.3%) for this orientation, the tilt perfectly accommodates the −1.4% misfit in the c direction. We present characterization of these films by RHEED, X-ray diffraction, and TEM. We propose that the tilt is driven by a reduction of interface energy which occurs in polar, incoherent interfaces.