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To update current estimates of non–device-associated pneumonia (ND pneumonia) rates and their frequency relative to ventilator associated pneumonia (VAP), and identify risk factors for ND pneumonia.
Academic teaching hospital.
All adult hospitalizations between 2013 and 2017 were included. Pneumonia (device associated and non–device associated) were captured through comprehensive, hospital-wide active surveillance using CDC definitions and methodology.
From 2013 to 2017, there were 163,386 hospitalizations (97,485 unique patients) and 771 pneumonia cases (520 ND pneumonia and 191 VAP). The rate of ND pneumonia remained stable, with 4.15 and 4.54 ND pneumonia cases per 10,000 hospitalization days in 2013 and 2017 respectively (P = .65). In 2017, 74% of pneumonia cases were ND pneumonia. Male sex and increasing age we both associated with increased risk of ND pneumonia. Additionally, patients with chronic bronchitis or emphysema (hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.40–3.06), congestive heart failure (HR, 1.48; 95% CI, 1.07–2.05), or paralysis (HR, 1.72; 95% CI, 1.09–2.73) were also at increased risk, as were those who were immunosuppressed (HR, 1.54; 95% CI, 1.18–2.00) or in the ICU (HR, 1.49; 95% CI, 1.06–2.09). We did not detect a change in ND pneumonia risk with use of chlorhexidine mouthwash, total parenteral nutrition, all medications of interest, and prior ventilation.
The incidence rate of ND pneumonia did not change from 2013 to 2017, and 3 of 4 nosocomial pneumonia cases were non–device associated. Hospital infection prevention programs should consider expanding the scope of surveillance to include non-ventilated patients. Future research should continue to look for modifiable risk factors and should assess potential prevention strategies.
We propose a new theoretical model for metal pad roll instability in idealized cylindrical reduction cells. In addition to the usual destabilizing effects, we model viscous and Joule dissipation and some capillary effects. The resulting explicit formulas are used as theoretical benchmarks for two multiphase magnetohydrodynamic solvers, OpenFOAM and SFEMaNS. Our explicit formula for the viscous damping rate of gravity waves in cylinders with two fluid layers compares excellently to experimental measurements. We use our model to locate the viscously controlled instability threshold in cylindrical shallow reduction cells but also in Mg–Sb liquid metal batteries with decoupled interfaces.
To update current estimates of non–device-associated urinary tract infection (ND-UTI) rates and their frequency relative to catheter-associated UTIs (CA-UTIs) and to identify risk factors for ND-UTIs.
Academic teaching hospital.
All adult hospitalizations between 2013 and 2017 were included. UTIs (device and non-device associated) were captured through comprehensive, hospital-wide active surveillance using Centers for Disease Control and Prevention case definitions and methodology.
From 2013 to 2017 there were 163,386 hospitalizations (97,485 unique patients) and 1,273 UTIs (715 ND-UTIs and 558 CA-UTIs). The rate of ND-UTIs remained stable, decreasing slightly from 6.14 to 5.57 ND-UTIs per 10,000 hospitalization days during the study period (P = .15). However, the proportion of UTIs that were non–device related increased from 52% to 72% (P < .0001). Female sex (hazard ratio [HR], 1.94; 95% confidence interval [CI], 1.50–2.50) and increasing age were associated with increased ND-UTI risk. Additionally, the following conditions were associated with increased risk: peptic ulcer disease (HR, 2.25; 95% CI, 1.04–4.86), immunosuppression (HR, 1.48; 95% CI, 1.15–1.91), trauma admissions (HR, 1.36; 95% CI, 1.02–1.81), total parenteral nutrition (HR, 1.99; 95% CI, 1.35–2.94) and opioid use (HR, 1.62; 95% CI, 1.10–2.32). Urinary retention (HR, 1.41; 95% CI, 0.96–2.07), suprapubic catheterization (HR, 2.28; 95% CI, 0.88–5.91), and nephrostomy tubes (HR, 2.02; 95% CI, 0.83–4.93) may also increase risk, but estimates were imprecise.
Greater than 70% of UTIs are now non–device associated. Current targeted surveillance practices should be reconsidered in light of this changing landscape. We identified several modifiable risk factors for ND-UTIs, and future research should explore the impact of prevention strategies that target these factors.
We report on results obtained from experiments using specially prepared carbon substrates and treatment of the data by means of recently introduced theory. Medium Z grids with known parameters have been coated on top of pyrolytic carbon substrates to achieve well defined absorption geometries. The various copper grids exhibit satisfactory performance in terms of mechanical stability, homogeneity and uniformity of the coating. A detailed study of the measurement results shows that there is a more rapid increase of the associated C-Kα countrate from the coated samples compared to the pure elements and is attributed to the contribution of secondary enhancement effects, including those resulting from photoelectrons generated after the primary ionization.
A lasting legacy of the International Polar Year (IPY) 2007–2008 was the promotion of the Permafrost Young Researchers Network (PYRN), initially an IPY outreach and education activity by the International Permafrost Association (IPA). With the momentum of IPY, PYRN developed into a thriving network that still connects young permafrost scientists, engineers, and researchers from other disciplines. This research note summarises (1) PYRN’s development since 2005 and the IPY’s role, (2) the first 2015 PYRN census and survey results, and (3) PYRN’s future plans to improve international and interdisciplinary exchange between young researchers. The review concludes that PYRN is an established network within the polar research community that has continually developed since 2005. PYRN’s successful activities were largely fostered by IPY. With >200 of the 1200 registered members active and engaged, PYRN is capitalising on the availability of social media tools and rising to meet environmental challenges while maintaining its role as a successful network honouring the legacy of IPY.
Hospital environmental surfaces are frequently contaminated by microorganisms. However, the causal mechanism of bacterial contamination of the environment as a source of transmission is still debated. This prospective study was performed to characterize the nature of multidrug-resistant organism (MDRO) transmission between the environment and patients using standard microbiological and molecular techniques.
Prospective cohort study at 2 academic medical centers.
A prospective multicenter study to characterize the nature of bacterial transfer events between patients and environmental surfaces in rooms that previously housed patients with 1 of 4 ‘marker’ MDROs: methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Clostridium difficile, and MDR Acinetobacter baumannii. Environmental and patient microbiological samples were obtained on admission into a freshly disinfected inpatient room. Repeat samples from room surfaces and patients were taken on days 3 and 7 and each week the patient stayed in the same room. The bacterial identity, antibiotic susceptibility, and molecular sequences were compared between organisms found in the environment samples and patient sources.
We enrolled 80 patient–room admissions; 9 of these patients (11.3%) were asymptomatically colonized with MDROs at study entry. Hospital room surfaces were contaminated with MDROs despite terminal disinfection in 44 cases (55%). Microbiological Bacterial Transfer events either to the patient, the environment, or both occurred in 12 patient encounters (18.5%) from the microbiologically evaluable cohort.
Microbiological Bacterial Transfer events between patients and the environment were observed in 18.5% of patient encounters and occurred early in the admission. This study suggests that research on prevention methods beyond the standard practice of room disinfection at the end of a patient’s stay is needed to better prevent acquisition of MDROs through the environment.
To summarize and discuss logistic and administrative challenges we encountered during the Benefits of Enhanced Terminal Room (BETR) Disinfection Study and lessons learned that are pertinent to future utilization of ultraviolet (UV) disinfection devices in other hospitals
Multicenter cluster randomized trial
SETTING AND PARTICIPANTS
Nine hospitals in the southeastern United States
All participating hospitals developed systems to implement 4 different strategies for terminal room disinfection. We measured compliance with disinfection strategy, barriers to implementation, and perceptions from nurse managers and environmental services (EVS) supervisors throughout the 28-month trial.
Implementation of enhanced terminal disinfection with UV disinfection devices provides unique challenges, including time pressures from bed control personnel, efficient room identification, negative perceptions from nurse managers, and discharge volume. In the course of the BETR Disinfection Study, we utilized several strategies to overcome these barriers: (1) establishing safety as the priority; (2) improving communication between EVS, bed control, and hospital administration; (3) ensuring availability of necessary resources; and (4) tracking and providing feedback on compliance. Using these strategies, we deployed ultraviolet (UV) disinfection devices in 16,220 (88%) of 18,411 eligible rooms during our trial (median per hospital, 89%; IQR, 86%–92%).
Implementation of enhanced terminal room disinfection strategies using UV devices requires recognition and mitigation of 2 key barriers: (1) timely and accurate identification of rooms that would benefit from enhanced terminal disinfection and (2) overcoming time constraints to allow EVS cleaning staff sufficient time to properly employ enhanced terminal disinfection methods.
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.
To determine whether antimicrobial-impregnated textiles decrease the acquisition of pathogens by healthcare provider (HCP) clothing.
We completed a 3-arm randomized controlled trial to test the efficacy of 2 types of antimicrobial-impregnated clothing compared to standard HCP clothing. Cultures were obtained from each nurse participant, the healthcare environment, and patients during each shift. The primary outcome was the change in total contamination on nurse scrubs, measured as the sum of colony-forming units (CFU) of bacteria.
PARTICIPANTS AND SETTING
Nurses working in medical and surgical ICUs in a 936-bed tertiary-care hospital.
Nurse subjects wore standard cotton-polyester surgical scrubs (control), scrubs that contained a complex element compound with a silver-alloy embedded in its fibers (Scrub 1), or scrubs impregnated with an organosilane-based quaternary ammonium and a hydrophobic fluoroacrylate copolymer emulsion (Scrub 2). Nurse participants were blinded to scrub type and randomly participated in all 3 arms during 3 consecutive 12-hour shifts in the intensive care unit.
In total, 40 nurses were enrolled and completed 3 shifts. Analyses of 2,919 cultures from the environment and 2,185 from HCP clothing showed that scrub type was not associated with a change in HCP clothing contamination (P=.70). Mean difference estimates were 0.118 for the Scrub 1 arm (95% confidence interval [CI], −0.206 to 0.441; P=.48) and 0.009 for the Scrub 2 rm (95% CI, −0.323 to 0.342; P=.96) compared to the control. HCP became newly contaminated with important pathogens during 19 of the 120 shifts (16%).
Antimicrobial-impregnated scrubs were not effective at reducing HCP contamination. However, the environment is an important source of HCP clothing contamination.
This study aimed to compare the view into the maxillary sinus using the posterior translacrimal approach compared with grade 3 antrostomy.
Grade 3 antrostomy followed by a posterior translacrimal approach was performed on four cadavers. The maximum intramaxillary view was documented endoscopically guided by electromagnetic navigation. Representative screenshots were evaluated in a blinded manner by three independent sinus surgeons. In addition, a prospective investigation of specific complications in the post-operative course of consecutive patients was performed.
In the cadaver study, the posterior translacrimal approach provided a significantly better view into the maxillary sinus compared with grade 3 antrostomy. In the clinical study, only 1 out of 20 patients reported on a minor problem with lacrimal drainage at 6 months.
The posterior translacrimal approach to visualising the maxillary sinus should be considered a strong alternative to more radical techniques.
Ventilator-associated pneumonia (VAP) is a frequent complication of severe burn injury. Comparing the current ventilator-associated event-possible VAP definition to the pre-2013 VAP definition, we identified considerably fewer VAP cases in our burn ICU. The new definition does not capture many VAP cases that would have been reported using the pre-2013 definition.
Ice observations and sediment samples were collected in the Beaufort Gyre in 1988. Fine sediment occurred in very small patches of turbid ice, as thin spotty surface layers, in mud pellets or in old snowdrifts. The latter were widespread south of 74°N, containing an estimated 22 tonnes of silt and clay km−2. Average particle concentration in sea ice (40mg l−1) was much higher than in sea water (0.8 mg l−1) or in new snow, but the sediment load was significantly smaller and of finer texture compared to that observed in a shelfal source area after a major entrainment event. About 30% of the sediment consisted of small pellets. Mud in pellets has similar texture, clay minerals and organic/inorganic carbon content as dispersed mud. Particle sizes <16μm dominate, sand is less than 1%, compared to as much as 8% in four samples obtained in 1971 and 1972. Organic carbon content is about 2%, illite dominates clay minerals (~50%), and diatoms suggest a shelf sediment source. From the prevalence of wind-reworked surficial deposits, the spotty occurrence of only small patches of turbid ice in old clean ice, and the virtual lack of sand-size material, we assume the sediment had drifted at least 2 years since entrainment and was distant from its source. Assuming one-third of the load is released each year, the estimated deposition rate would equal the measured Holocene rate (~2cm 1000year−1). Therefore, modern sea-ice rafting represents a substantial fraction of the total Arctic Ocean sediment budget.
A young woman with Epstein’s anomaly had a large endocardial scar in the atrialised ventricular myocardium. In patients with significant preoperative ventricular scarring, more information is needed to help appropriately manage the risk of ventricular arrhythmias and sudden death.
Historically, alloy development with better radiation performance has been focused on traditional alloys with one or two principal element(s) and minor alloying elements, where enhanced radiation resistance depends on microstructural or nanoscale features to mitigate displacement damage. In sharp contrast to traditional alloys, recent advances of single-phase concentrated solid solution alloys (SP-CSAs) have opened up new frontiers in materials research. In these alloys, a random arrangement of multiple elemental species on a crystalline lattice results in disordered local chemical environments and unique site-to-site lattice distortions. Based on closely integrated computational and experimental studies using a novel set of SP-CSAs in a face-centered cubic structure, we have explicitly demonstrated that increasing chemical disorder can lead to a substantial reduction in electron mean free paths, as well as electrical and thermal conductivity, which results in slower heat dissipation in SP-CSAs. The chemical disorder also has a significant impact on defect evolution under ion irradiation. Considerable improvement in radiation resistance is observed with increasing chemical disorder at electronic and atomic levels. The insights into defect dynamics may provide a basis for understanding elemental effects on evolution of radiation damage in irradiated materials and may inspire new design principles of radiation-tolerant structural alloys for advanced energy systems.
Extensive radiocarbon dating of human remains from Neolithic and Bronze Age hunter-gatherer cemeteries in the Cis-Baikal region of Siberia has been undertaken as a part of the multidisciplinary examination of this material conducted by the Baikal Archaeology Project (BAP; http://baikal.arts.ualberta.ca). Due to the large number of analyzed samples, this paper reports the 14C results only in the context of the basic archaeological information about each of the cemeteries. Comprehensive evaluation, analysis, and interpretation of this entire data set will be undertaken in separate publications. In fact, the dates for one such cemetery have already been examined on 2 recent occasions (Weber et al. 2004, 2005).
We report on progress with PL imaging applications in silicon solar cell production, specifically focusing on the characterization of silicon bricks prior to wafer cutting. Silicon bricks represent an ideal opportunity to characterize and quantify the electronic material quality at an early stage of the PV value chain. Quantitative data on bulk lifetime can be obtained on bricks without any specific sample preparation, unlike unprocessed wafers. Spatially resolved bulk lifetime, interstitial iron concentration, and defect density measurements are demonstrated on bricks from different manufacturers including both high performance multicrystalline and older generation multicrystalline bricks. We find significant variability in bulk lifetime and iron concentration across the samples which is not related to its date of manufacture. However we do see a qualitative reduction in crystallographic defects in the newer high performance multicrystalline bricks. Data is parameterized in different ways to suggest possible paths to better predict solar cell efficiencies from an early stage of inspection.
Brick level PL measurements were previously performed using a conventional area scanning PL imaging system, which is associated with light spreading artefacts of weakly absorbed light. To overcome these artefacts, a new line scanning photoluminescence imaging system is used. We show a reduction in contrast smearing between high- and low lifetime regions in the new setup leading to image quality suitable for defect detection and quantitative measurements without deconvolution correction.
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.