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We assessed the impact of an embedded electronic medical record decision-support matrix (Cerner software system) for the reduction of hospital-onset Clostridioides difficile. A critical review of 3,124 patients highlighted excessive testing frequency in an academic medical center and demonstrated the impact of decision support following a testing fidelity algorithm.
Materials can be endowed with unique properties by the integration of molecular motors. Molecular motors can have a biological origin or can be chemically synthesized and produce work from chemical energy or light. Their ability to access large internal or external reservoirs of energy enables a wide range of nonequilibrium behaviors, including the production of force, changes in shape, internal reorganization, and dynamic changes in mechanical properties—muscle tissue is one illustration of the possibilities. Current research efforts advance our experimental capabilities to create such “active matter” by using either biomolecular or synthetic motors, and also advance our theoretical understanding of these materials systems. Here, we introduce this exciting research field and highlight a few of the recent advances as well as open questions.
A gamma-ray density gauge can provide high-resolution and high-precision density measurements of firn and ice cores. This study describes the design, gamma-ray energy optimization and mass attenuation coefficient calibration of the Maine Automated Density Gauge Experiment (MADGE), a portable, field-operable gamma-ray density gauge used on overland traverses in East Antarctica. The MADGE instrument uses a 241Am gamma-ray source, a pulse-mode counting system and electronic core diameter calipers to collect high-precision (±0.004 g cm−3) density data from 3–8 cm diameter firn and ice cores. The data are collected at a 3.3 mm spatial resolution and an average throughput of 1.5 m h−1 for 5 cm diameter cores.
Two single-nucleotide polymorphisms (SNPs) (rs4281084 and rs12155594) within the neuregulin-1 (NRG1) gene have been associated with psychosis transition. However, the neurobiological changes associated with these SNPs remain unclear. We aimed to determine what relationship these two SNPs have on lateral ventricular volume and white matter integrity, as abnormalities in these brain structures are some of the most consistent in schizophrenia.
Structural (n = 370) and diffusion (n = 465) magnetic resonance imaging data were obtained from affected and unaffected individuals predominantly of European descent. The SNPs rs4281084, rs12155594, and their combined allelic load were examined for their effects on lateral ventricular volume, fractional anisotropy (FA) as well as axial (AD) and radial (RD) diffusivity. Additional exploratory analyses assessed NRG1 effects on gray matter volume, cortical thickness, and surface area throughout the brain.
Individuals with a schizophrenia age of onset ⩽25 and a combined allelic load ⩾3 NRG1 risk alleles had significantly larger right (up to 50%, padj = 0.01) and left (up to 45%, padj = 0.05) lateral ventricle volumes compared with those with allelic loads of less than three. Furthermore, carriers of three or more risk alleles, regardless of age of onset and case status, had significantly reduced FA and elevated RD but stable AD in the frontal cortex compared with those carrying fewer than three risk alleles.
Our findings build on a growing body of research supporting the functional importance of genetic variation within the NRG1 gene and complement previous findings implicating the rs4281084 and rs12155594 SNPs as markers for psychosis transition.
Angiopoietin-like protein 4 (ANGPTL4) is a lipoprotein lipase inhibitor that is involved in lipid metabolism and angiogenesis. Animal studies have suggested that the ANGPTL4 protein is modulated by the gut microbiota, possibly through increased concentrations of SCFA, such as C4, found in whole-fat milk or as a result of fermentation of inulin. This study investigated whether a standardised diet either high in fat content or supplemented with inulin powder would increase plasma ANGPTL4 in overweight men and whether this increase was mediated through a compositional change of the gut microbiota. The study had a crossover design with three arms, where participants were given a standardised isoenergetic diet supplemented with inulin powder, whole-fat milk or water (control). Plasma and urine samples were collected before and after each intervention period. Faecal samples and adipose tissue biopsies were collected after each intervention period. The study included twenty-one participants of whom eighteen completed the study. The dietary interventions did not change ANGPTL4 plasma concentration, nor was plasma ANGPTL4 associated with plasma lipids, TAG or NEFA concentration. The relative abundance of bifidobacteria following the inulin diet was higher, compared with the control diet. However, the changes in microbiota were not associated with plasma ANGPTL4 and the overall composition of the microbiota did not change between the dietary periods. Although weight was maintained throughout the dietary periods, weight was negatively associated with plasma ANGPTL4 concentration. In the adipose tissue, ANGPTL4 expression was correlated with leptin expression, but not with hypoxia-inducible factor 1α (HIF-1α) expression.
To determine the clinical diagnoses associated with the National Healthcare Safety Network (NHSN) pneumonia (PNEU) or lower respiratory infection (LRI) surveillance events
Retrospective chart review
A convenience sample of 8 acute-care hospitals in Pennsylvania
All patients hospitalized during 2011–2012
Medical records were reviewed from a random sample of patients reported to the NHSN to have PNEU or LRI, excluding adults with ventilator-associated PNEU. Documented clinical diagnoses corresponding temporally to the PNEU and LRI events were recorded.
We reviewed 250 (30%) of 838 eligible PNEU and LRI events reported to the NHSN; 29 reported events (12%) fulfilled neither PNEU nor LRI case criteria. Differences interpreting radiology reports accounted for most misclassifications. Of 81 PNEU events in adults not on mechanical ventilation, 84% had clinician-diagnosed pneumonia; of these, 25% were attributed to aspiration. Of 43 adult LRI, 88% were in mechanically ventilated patients and 35% had no corresponding clinical diagnosis (infectious or noninfectious) documented at the time of LRI. Of 36 pediatric PNEU events, 72% were ventilator associated, and 70% corresponded to a clinical pneumonia diagnosis. Of 61 pediatric LRI patients, 84% were mechanically ventilated and 21% had no corresponding clinical diagnosis documented.
In adults not on mechanical ventilation and in children, most NHSN-defined PNEU events corresponded with compatible clinical conditions documented in the medical record. In contrast, NHSN LRI events often did not. As a result, substantial modifications to the LRI definitions were implemented in 2015.
As an extreme kind of environment, Hickson Compact groups (HCGs) have shown to be very complex systems. HI-VLA observations revealed an intrincated network of HI tails and bridges, tracing pre-processing through extreme tidal interactions. We found HCGs to show a large HI deficiency supporting an evolutionary sequence where gas-rich groups transform via tidal interactions and ISM (interstellar medium) stripping into gas-poor systems. We detected as well a diffuse HI component in the groups, increasing with evolutionary phase, although with uncertain distribution. The complex net of detected HI as observed with the VLA seems hence so puzzling as the missing one. In this talk we revisit the existing VLA information on the HI distribution and kinematics of HCGs by means of X3D visualization. X3D constitutes a powerful tool to extract the most from HI data cubes and a mean of simplifying and easing the access to data visualization and publication via three-dimensional (3-D) diagrams.
The ex situ lift out (EXLO) adhesion forces are reviewed and new applications of EXLO for focused ion beam (FIB)-prepared specimens are described. EXLO is used to manipulate electron transparent specimens on microelectromechanical systems carrier devices designed for in situ electron microscope analysis. A new patented grid design without a support film is described for EXLO. This new slotted grid design provides a surface for holding the specimen in place and also allows for post lift out processing. Specimens may be easily manipulated into a backside orientation to reduce FIB curtaining artifacts with this slotted grid. Large EXLO specimens can be manipulated from Xe+ plasma FIB prepared specimens. Finally, applications of EXLO and manipulation of FIB specimens using a vacuum probe lift out method are shown. The vacuum probe provides more control for placing specimens on the new slotted grids and also allows for easy manipulation into a backside configuration.
This article is an executive summary of a report from the Centers for Disease Control and Prevention Ventilator-Associated Pneumonia Surveillance Definition Working Group, entitled “Developing a new, national approach to surveillance for ventilator-associated events” and published in Critical Care Medicine. The full report provides a comprehensive description of the Working Group process and outcome.
In September 2011, the Centers for Disease Control and Prevention (CDC) convened a Ventilator-Associated Pneumonia (VAP) Surveillance Definition Working Group to organize a formal process for leaders and experts of key stakeholder organizations to discuss the challenges of VAP surveillance definitions and to propose new approaches to VAP surveillance in adult patients (Table 1).
Conflicts, of various sizes and purported purposes, cast a long and dark shadow on the lives of many and on the histories of nations and peoples. Theories of conflict abound – for wars between nations, internal civil conflicts, and terrorist operations – primarily based on national or group leaders convincing followers to take up a fight for some purpose, noble (to advance an idea, a religion, a culture, a form of government) or otherwise (to appropriate). While leaders, on occasion, do profit from conflict, they do so less often than they might ever imagine. Indeed, leaders, depending on institutional constraints, can separate the spoils of war (land, resources) from the dim costs of war.
The men and women who conduct the battles, however, can seldom avoid the costs of war, and so are fully saddled with the loss of life, limb, loved ones, livelihood, and way of life. Nor are the soldiers’ interests fully reflected in the interests of those who make the decision to initiate, continue or to change the course of battle. In his famous letter to his World War I commanding officer, Lt. Siegfried Sassoon of the Royal Welch Fusiliers, wrote:
I believe that the war upon which I entered as a war of defence and liberation has now become a war of agression [sic] and conquest. . . . I have seen and endured the sufferings of the troops and I can no longer be a party to prolonging these sufferings for ends which I believe to be evil and unjust. I am not protesting against the conduct of the war, but against the political errors and insincerities for which the fighting men are being sacrificed. On behalf of those who are suffering now, I make this protest against the deception which is being practised upon them; also I believe it may help to destroy the callous complacency with which the majority of those at home regard the continuance of agonies which they do not share and which they have not enough imagination to realise. July, 1917
To determine whether enhanced daily cleaning would reduce contamination of healthcare worker (HCW) gowns and gloves with methicillin-resistant Staphylococcus aureus (MRSA) or multidrug-resistant Acinetobacter baumannii (MDRAB).
A cluster-randomized controlled trial.
Four intensive care units (ICUs) in an urban tertiary care hospital.
ICU rooms occupied by patients colonized with MRSA or MDRAB.
Extra enhanced daily cleaning of ICU room surfaces frequently touched by HCWs.
A total of 4,444 cultures were collected from 132 rooms over 10 months. Using fluorescent dot markers at 2,199 surfaces, we found that 26% of surfaces in control rooms were cleaned and that 100% of surfaces in experimental rooms were cleaned (P < .001). The mean proportion of contaminated HCW gowns and gloves following routine care provision and before leaving the rooms of patients with MDRAB was 16% among control rooms and 12% among experimental rooms (relative risk, 0.77 [95% confidence interval, 0.28-2.11]; P = .23). For MRSA, the mean proportions were 22% and 19%, respectively (relative risk, 0.89 [95% confidence interval, 0.50-1.53]; P = .16).
Intense enhanced daily cleaning of ICU rooms occupied by patients colonized with MRSA or MDRAB was associated with a nonsignificant reduction in contamination of HCW gowns and gloves after routine patient care activities. Further research is needed to determine whether intense environmental cleaning will lead to significant reductions and fewer infections.
The purpose of this chapter is to show how double dividends could be obtained from using market instruments to tax water use in a developing country. The double dividends are namely environmental (water conservation) on the one hand, and poverty reduction dividends on the other. We apply a water tax on selected industries in South Africa to reduce demand for water, and then transfer the revenue from this tax to the poor to achieve reduction in absolute levels of poverty.
South Africa is classified as a semi-arid country. Precipitation has been fluctuating over the years with an average of 500 mm per annum, well below the world average of about 860 mm (DWAF 2002). The total flow of all the rivers in the country combined amounts to approximately 49 200 million m³ per year, while the National Water Resource Strategy estimated the total water requirement for the year 2000 at 13 280 million m3 per year, excluding environmental requirements. In addition, South Africa is poorly endowed in groundwater as most of the country is underlain by hard rock formations that do not contain any major groundwater aquifers (DWAF 2002).
While currently only about 24% of rural people have access to water on site, additional sources of water supply are environmentally, financially and politically hard to develop. At the same time, unemployment in rural areas of South Africa is extremely high, which results in severe poverty conditions in these areas.
The maskless ion implantation with the focused ion beam as a new method for ion beam synthesis of cobalt sulicide wires is presented. In order to perform the implantation a special achromatic mass separator was implemented into the ion column, liquid alloy ion sources for cobalt ions were developed and a substrate heating was built. Ion implantation was performed with 30 keV Co+ and 60 keV Co++ ions. The dose dependence for room temperature implantation and the influence of the substrate temperature were investigated.
The chemical behavior of actinide elements in tank solutions, in soil, and
in groundwater is dependent upon the chemical species that form when aqueous
solutions come in contact with the actinide compounds. In particular the
chemical speciation of the reduced actinide oxidation states (III and IV)
are important, for example, to DOE waste tank processing and, more
generally, to nuclear waste disposal issues. Predicting the solubility of
the actinides in these solutions requires identification of the strong
aqueous complexes, such as carbonates and organic chelating agents, that can
form in aqueous solution.
Previous speciation work has often relied on indirect techniques such as
potentiometric titrations or solubility measurements. Recent XAS experiments
determine directly the speciation of the Th carbonato species of seven
solutions under a range of carbonate concentrations and pH conditions. The
presence of the pentacarbonato complex is confirmed and the complex's
stability at low carbonate concentrations is determined. These experimental
results support a proposed thermodynamic model that describes the solubility
of Th(IV) hydrous oxide in the aqueous Na+-HCO3--CO32--OH--ClO4--H2O system extending to high concentrations at 25°C.
This model is relatively simple in that only two aqueous species are
included Th(OH)3CO3- and Th(CO3)56-.
Various ion exchange materials have been proposed for the removal of Cs from
high level waste streams produced during the reprocessing of fuel rods. Cs
can be released from loaded traditional exchange resins by elution and then
the resin can be reused. However large quantities of secondary wastes are
generated. Another class of “single use” exchangers is directly incorporated
in the loaded state into a solid waste form (e.g. borosilicate glass logs).
A third alternative is electroactive ion-exchange materials, where the
uptake and elution of Cs are controlled by an applied potential. This
approach has several advantages over traditional reusable ion-exchange
resins including much reduced secondary waste, higher Cs selectivity, and
XAS experiments were conducted at the Fe K-edge and Cs Lm-edge on
a series of electrochemically produced nickel ferrocyanide films to
determine the effects of deposition conditions and subsequent alkali
exchange on structural and chemical aspects of the films. The deposition
conditions include methods described in the literature and PNNL proprietary
procedures. Although the performance and the durability of the films do vary
with processing conditions, Fe K-edge EXAFS results indicate that all
deposition conditions result in the. formation of the cubic phase. Initial
results from Cs Lm-edge EXAFS analysis suggest that the Cs ion is
present as a hydrated species.