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Early replacement of a new central venous catheter (CVC) may pose a risk of persistent or recurrent infection in patients with a catheter-related bloodstream infection (CRBSI). We evaluated the clinical impact of early CVC reinsertion after catheter removal in patients with CRBSIs.
We conducted a retrospective chart review of adult patients with confirmed CRBSIs in 2 tertiary-care hospitals over a 7-year period.
To treat their infections, 316 patients with CRBSIs underwent CVC removal. Among them, 130 (41.1%) underwent early CVC reinsertion (≤3 days after CVC removal), 39 (12.4%) underwent delayed reinsertion (>3 days), and 147 (46.5%) did not undergo CVC reinsertion. There were no differences in baseline characteristics among the 3 groups, except for nontunneled CVC, presence of septic shock, and reason for CVC reinsertion. The rate of persistent CRBSI in the early CVC reinsertion group (22.3%) was higher than that in the no CVC reinsertion group (7.5%; P = .002) but was similar to that in the delayed CVC reinsertion group (17.9%; P > .99). The other clinical outcomes did not differ among the 3 groups, including rates of 30-day mortality, complicated infection, and recurrence. After controlling for several confounding factors, early CVC reinsertion was not significantly associated with persistent CRBSI (OR, 1.59; P = .35) or 30-day mortality compared with delayed CVC reinsertion (OR, 0.81; P = .68).
Early CVC reinsertion in the setting of CRBSI may be safe. Replacement of a new CVC should not be delayed in patients who still require a CVC for ongoing management.
We report our experience with an emergency room (ER) shutdown related to an accidental exposure to a patient with coronavirus disease 2019 (COVID-19) who had not been isolated.
A 635-bed, tertiary-care hospital in Daegu, South Korea.
To prevent nosocomial transmission of the disease, we subsequently isolated patients with suspected symptoms, relevant radiographic findings, or epidemiology. Severe acute respiratory coronavirus 2 (SARS-CoV-2) reverse-transcriptase polymerase chain reaction assays (RT-PCR) were performed for most patients requiring hospitalization. A universal mask policy and comprehensive use of personal protective equipment (PPE) were implemented. We analyzed effects of these interventions.
From the pre-shutdown period (February 10–25, 2020) to the post-shutdown period (February 28 to March 16, 2020), the mean hourly turnaround time decreased from 23:31 ±6:43 hours to 9:27 ±3:41 hours (P < .001). As a result, the proportion of the patients tested increased from 5.8% (N=1,037) to 64.6% (N=690) (P < .001) and the average number of tests per day increased from 3.8±4.3 to 24.7±5.0 (P < .001). All 23 patients with COVID-19 in the post-shutdown period were isolated in the ER without any problematic accidental exposure or nosocomial transmission. After the shutdown, several metrics increased. The median duration of stay in the ER among hospitalized patients increased from 4:30 hours (interquartile range [IQR], 2:17–9:48) to 14:33 hours (IQR, 6:55–24:50) (P < .001). Rates of intensive care unit admissions increased from 1.4% to 2.9% (P = .023), and mortality increased from 0.9% to 3.0% (P = .001).
Problematic accidental exposure and nosocomial transmission of COVID-19 can be successfully prevented through active isolation and surveillance policies and comprehensive PPE use despite longer ER stays and the presence of more severely ill patients during a severe COVID-19 outbreak.
This study compares the investigated water vapor diffusion coefficient in the neat polyurethane (PU) membrane, the silica–PU nanocomposite membrane, and two surface-modified silica–PU nanocomposite membranes. The silane first surface modifier is with an amine functional group known as N-[3-(trimethoxysilyl)propyl]ethylenediamine, while the second one is with an aniline functional group known as N-[3-(trimethoxysilyl)propyl]aniline. The enhancement of water vapor diffusivity values through the polymer nanocomposite is desirable for the membrane air dehumidification application. The diffusivities were calculated via molecular dynamics simulations at the temperature of 298.15 K. The Einstein's relationship known as the mean square displacement method was used to obtain the diffusivity for the membranes. The results showed a significant effect on the diffusivity of water vapor for the surface-modified silica–PU nanocomposite membrane as compared with the neat PU and the unmodified silica–PU nanocomposite membranes. For the amine-modified silica, the diffusion coefficient increased by 80.3% compared with the unmodified silica–PU nanocomposite membrane. On the other hand, the aniline-modified silica outperformed the amine-modified one in terms of the diffusion coefficient by 22.4%.
To investigate the impacts of depression screening, diagnosis and treatment on major adverse cardiac events (MACEs) in acute coronary syndrome (ACS).
Prospective cohort study including a nested 24-week randomised clinical trial for treating depression was performed with 5–12 years after the index ACS. A total of 1152 patients recently hospitalised with ACS were recruited from 2006 to 2012, and were divided by depression screening and diagnosis at baseline and 24-week treatment allocation into five groups: 651 screening negative (N), 55 screening positive but no depressive disorder (S), 149 depressive disorder randomised to escitalopram (E), 151 depressive disorder randomised to placebo (P) and 146 depressive disorder receiving medical treatment only (M).
Cumulative MACE incidences over a median 8.4-year follow-up period were 29.6% in N, 43.6% in S, 40.9% in E, 53.6% in P and 59.6% in M. Compared to N, screening positive was associated with higher incidence of MACE [adjusted hazards ratio 2.15 (95% confidence interval 1.63–2.83)]. No differences were found between screening positive with and without a formal depressive disorder diagnosis. Of those screening positive, E was associated with a lower incidence of MACE than P and M. M had the worst outcomes even compared to P, despite significantly milder depressive symptoms at baseline.
Routine depression screening in patients with recent ACS and subsequent appropriate treatment of depression could improve long-term cardiac outcomes.
Mycoplasma pneumoniae is a main pathogen causing community-acquired pneumonia in children and young adults. Since the emergence of macrolide-resistant M. pneumoniae in the early 2000s in Japan, it has been increasingly reported worldwide as a growing problem in treatment for children. With increasing macrolide-resistant M. pneumoniae and limited data regarding its characterization and molecular analysis, we investigated the dominant M. pneumoniae strains during the recent outbreak in South Korea, and evaluated if there was an association between a specific type and macrolide resistance. Between October 2014 and December 2016 in South Korea, 249 respiratory specimens obtained from patients with confirmed M. pneumoniae pneumonia were genotyped the P1 adhesin gene, and the mutations associated with resistance (A2063G and A2064G) were tested by sequencing the targeted domain V regions of the 23S ribosomal RNA gene. Results revealed that M. pneumoniae type 1 were predominant, which was strongly associated with macrolide-resistance during the whole study period. This is the first study assessing whether M. pneumoniae subtype is related to macrolide resistance during the outbreak of M. pneumoniae.
Liquid films on wettable solid surfaces can be disturbed to dewet when low surface tension liquids or surfactants are added because the surface tension difference gives rise to stresses on the film interface. Here we consider an alcohol drop placed above a thin aqueous film, which punctures a hole in the film starting from underneath the alcohol drop. Such film dewetting is attributed to the Marangoni effects caused by the spatial gradient of alcohol vapour concentration. We measure the liquid–gas interfacial tension of aqueous liquids rapidly responding to the surrounding isopropyl alcohol vapour concentration, and observe evolution of the film morphology consisting of central hole, fringe film, thinning region and bulk. We construct scaling laws to predict the dewetting rates of the film by considering the Marangoni stress, viscous shear stress and evaporation. It is shown that our experiments are consistent with our theory.
To verify the validity of a semiautomated surgical site infection (SSI) surveillance system using electronic screening algorithms in 38 categories of surgery.
A cohort study for validation of semiautomated SSI surveillance system using screening algorithms.
A 1,989-bed tertiary-care referral center in Seoul, Republic of Korea.
A dataset of 40,516 surgical procedures in 38 categories stored in the conventional SSI surveillance registry at the Samsung Medical Center between January 2013 and December 2014 was used as the reference standard. In the semiautomated surveillance system, electronic screening algorithms flagged cases meeting at least 1 of 3 criteria: antibiotic prescription, microbial culture, and infectious disease consultation. Flagged cases were audited by infection preventionists. Analyses of sensitivity, specificity, and positive predictive value (PPV) were conducted for the semiautomated surveillance system, and its effect on reducing the workload for chart review was evaluated.
A total of 575 SSI events (1·42%) were identified by conventional SSI surveillance. The sensitivity of the semiautomated SSI surveillance was 96·7%, and the PPV of the screening algorithms alone was 4·1%. Semiautomated SSI surveillance reduced the chart review workload of the infection preventionists from 1,283 to 482 person hours per year (a 62·4% decrease).
Compared to conventional surveillance, semiautomated surveillance using electronic screening algorithms followed by chart review of selected cases can provide high-validity surveillance results and can significantly reduce the workload of infection preventionists.
Cronobacter sakazakii is a life-threatening foodborne pathogen found in powdered infant formula and dairy products. Kefir is a dairy probiotic product and its antimicrobial activity against C. sakazakii was reported in our previous study. To identify key microorganisms that mediate growth suppression, we tested the antimicrobial activity of culture supernatants derived from lactic acid bacteria found in kefir. Lactobacillus kefiri DH5, L. kefiranofaciens DH101, and Bifidobacterium longum 720 (a commercial probiotic strain that served as a positive control) all significantly inhibited the growth of C. sakazakii ATCC 29544, delaying the initiation of exponential growth from 3 to 9 h in the nutrient broth. Among them, L. kefiri DH5 exerted the strongest antimicrobial effects against C. sakazakii, showing bactericidal effect at the addition of 300 µl of supernatant in 1 ml of nutrient broth. Interestingly, the supernatant of L. kefiri DH5 has higher pH and lower titrable acidity than that of L. kefiranofaciens DH101, suggesting metabolites produced by heterofermentation of L. kefiri acted more effectively to antagonise the growth of C. sakazakii. In addition, the supernatant of L. kefiri DH5 induced the leakage of cytoplasmic materials including nucleic acid and proteins, suggesting L. kefiri DH5 disrupted the cellular membrane integrity of C. sakazakii. Considering that pH neutralisation reduced the L. kefiri-dependent growth suppression, it is inferred that this activity is mainly due to organic acids produced during the fermentation process.
It has not been well established whether dietary folate intake reduces the risk of diabetes development. We aimed to clarify the prospective association between dietary folate intake and type 2 diabetes (T2D) risk among 7333 Korean adults aged 40 years or older who were included in the Multi-Rural Communities Cohort. Dietary folate intake was estimated from all 106 food items listed on a FFQ, not including folate intake from supplements. Two different measurements of dietary folate intake were used: the baseline consumption and the average consumption from baseline until just before the end of follow-up. The association between folate intake and T2D risk was determined through a modified Poisson regression model with a robust error estimator controlling for potential confounders. For 29 745 person years, 319 cases of diabetes were ascertained. In multivariable analyses, dietary folate intake was inversely associated with risk of T2D for women, not for men. For women, the incidence rate ratio of diabetes in the third tertile compared with the first tertile was 0·57 (95 % CI 0·38–0·87, Pfor trend=0·0085) in the baseline consumption model and 0·64 (95 % CI 0·43–0·95, Pfor trend=0·0244) in the average consumption model. These inverse associations was found in both normal fasting blood glucose group and impaired fasting glucose group among women. Among non-users of multinutrients and vitamin supplements, the significant inverse association remained. Thus, higher dietary intake of folate is prospectively associated with lower risk of diabetes for women.
Ambidexterity organization, which is defined as the ability of an organization to simultaneously pursues exploration and exploitation, has received attention by researchers who have examined its beneficial effect on organizational performance and success. This study attempted to examine the positive effect of ambidextrous organization culture (AOC), which is regarded as the core characteristic of ambidextrous organizations by using a multilevel model. Specifically, this study examined the effects of AOC on members’ job performance and the mediating role of psychological capital in the relationship between AOC and job performance. The results indicated that AOC had a significantly positive relationship with job performance even after controlling various organizational and individual variables. Moreover, we found that psychological capital fully mediated the relationship between AOC and members’ job performance. This study provides theoretical contributions by empirically examining the positive effect and mechanism of AOC. Furthermore, this study offers practical implications in how practitioners can manage their organizational culture, by helping shape the direction of organizational culture management.
We demonstrate the tungsten disulfide (WS2) thin film catalysts prepared by the sulfurization of vacuum deposited WO3 thin films for efficient hydrogen production with over 90% Faradaic efficiency. The 23-nm-thick WS2 thin film catalyst heterojunction with p-type silicon photocathode could exhibit a photocurrent density of 8.3 mA/cm2 at 0 V versus a reversible hydrogen electrode (RHE), a low onset potential of 0.2 V versus RHE when photocurrent density reaches −1 mA/cm2 and long-term stability over 10 h. The enhanced catalytic activities of WS2/p-Si photocathodes compared with the bare p-Si photocathode originate from a number of edge sites in the synthesized polycrystalline thin films, which could act as hydrogen evolution catalyst.
A cellulose sponge is a mundane porous medium composed of numerous microporous cellulose sheets surrounding macroscale voids. Here, we quantify the capillary rise dynamics of non-aqueous liquids in a sponge using a combination of experiment and theory. Although the classical law of Washburn is obeyed in the early stages, the wet front propagation is no longer diffusive in the late stages and follows a power law,
being the capillary rise height and time respectively. The transition of the power law is a consequence of the peculiar heterogeneous pore structure of cellulose sponges. The permeability and driving pressure change at the rise height above which the macro voids can no longer be filled completely due to significant effects of gravity. We rationalize the
law by considering liquid flows along the corners of macro voids driven by capillary pressure of microscale wall pores.
In the 1990s, a part of the North Korean economy underwent a process of marketization and de facto privatization. While largely spontaneous, this process was eerily reminiscent of developments in other post-Communist countries in Eastern Europe. One of the results was the emergence of a new entrepreneurial class, a nascent bourgeoisie. In order to overcome the obstacles that arose from the lack of any legal framework for their activities, they often chose to register their enterprises with state agencies, creating what we call Pseudo-state Enterprises (PSEs). Utilizing an agency theory approach, with particular emphasis on property rights and contracting problems, this article traces the origin of the PSE, their interaction with the state, how they are managed and the challenges they face. The article is based on refugee interviews with five North Koreans involved with the PSE-related activities in nine entities covering a range of different sectors.
In this study, we design a differential CMOS power amplifier using a 180-nm SOI RFCMOS process for 802.11n (64-QAM, 20 MHz bandwidth, 9.6 dB peak to average power ratio (PAPR)) applications. To minimize the chip area and mismatch in differential signals, we propose a layout method with an inter-stage matching network using a split inductor. By virtue of the symmetrical layout of the proposed split inductor, the mismatch in the differential signals is minimized, while the interconnection lines between the driver and power stages are shortened to minimize the overall chip area and the loss induced by the resistive parasitic components. The designed power amplifier is measured using a wireless local area network (WLAN) 802.11n signal to verify the feasibility of the proposed layout technique. The power amplifier achieved 20.34 dBm output power, while the measured EVM for the 802.11n applications is satisfied. From the measured results, we successfully prove the feasibility of the proposed power amplifier.
Hemiwicking refers to the spreading of a liquid on a rough hydrophilic surface driven by capillarity. Here, we construct scaling laws to predict the velocity of hemiwicking on a rough substrate and experimentally corroborate them with various arrangements and dimensions of micropillar arrays. At the macroscopic scale, where the wetting front appears parallel to the free surface of the reservoir, the wicking distance is shown to grow diffusively, i.e. like
being time. We show that our model is consistent with pillar arrays of a wide range of pitch-to-height ratios, either square or skewed. At the microscopic scale, where the meniscus extension from individual pillars at the wetting front is considered, the extension distance begins to grow like
but the spreading slows down to behave like
when the meniscus is far from the pillar. Our microscopic flow modelling allows us to find pillar spacing conditions under which the assumption of densely spaced pillars is valid.