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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.
In this paper, we follow and extend a group-theoretic method introduced by Greenleaf–Iosevich–Liu–Palsson (GILP) to study finite points configurations spanned by Borel sets in
We remove a technical continuity condition in a GILP’s theorem in [Revista Mat. Iberoamer31 (2015), 799–810]. This allows us to extend the Wolff–Erdogan dimension bound for distance sets to finite points configurations with k points for
Schizotypy refers to schizophrenia-like traits below the clinical threshold in the general population. The pathological development of schizophrenia has been postulated to evolve from the initial coexistence of ‘brain disconnection’ and ‘brain connectivity compensation’ to ‘brain connectivity decompensation’.
In this study, we examined the brain connectivity changes associated with schizotypy by combining brain white matter structural connectivity, static and dynamic functional connectivity analysis of diffusion tensor imaging data and resting-state functional magnetic resonance imaging data. A total of 87 participants with a high level of schizotypal traits and 122 control participants completed the experiment. Group differences in whole-brain white matter structural connectivity probability, static mean functional connectivity strength, dynamic functional connectivity variability and stability among 264 brain sub-regions of interests were investigated.
We found that individuals with high schizotypy exhibited increased structural connectivity probability within the task control network and within the default mode network; increased variability and decreased stability of functional connectivity within the default mode network and between the auditory network and the subcortical network; and decreased static mean functional connectivity strength mainly associated with the sensorimotor network, the default mode network and the task control network.
These findings highlight the specific changes in brain connectivity associated with schizotypy and indicate that both decompensatory and compensatory changes in structural connectivity within the default mode network and the task control network in the context of whole-brain functional disconnection may be an important neurobiological correlate in individuals with high schizotypy.
Metal additive manufacturing (AM) provides a platform for microstructure optimization via process control, but establishing a quantitative processing-microstructure linkage necessitates an efficient scheme for microstructure representation and regeneration. Here, we present a deep learning framework to quantitatively analyze the microstructural variations of metals fabricated by AM under different processing conditions. The principal microstructural descriptors are extracted directly from the electron backscatter diffraction patterns, enabling a quantitative measure of the microstructure differences in a reduced representation domain. We also demonstrate the capability of predicting new microstructures within the representation domain using a regeneration neural network, from which we are able to explore the physical insights into the implicitly expressed microstructure descriptors by mapping the regenerated microstructures as a function of principal component values. We validate the effectiveness of the framework using samples fabricated by a solid-state AM technology, additive friction stir deposition, which typically results in equiaxed microstructures.
We investigate the phased evolution and variation of the South Asian monsoon and resulting weathering intensity and physical erosion in the Himalaya–Karakoram Mountains since late Pliocene time (c. 3.4 Ma) using a comprehensive approach. Neodymium and strontium isotopic compositions and single-grain zircon U–Pb age spectra reveal the sources of the deposits in the east Arabian Sea, and show a combination of sources from the Himalaya and the Karakoram–Kohistan–Ladakh Mountains, with sediments from the Indian Peninsula such as the Deccan Traps or Craton. We interpret shifts in the sediment sources to have been forced by sea-level changes that correlate with South Asian monsoon rainfall variation since late Pliocene time. We collected 908 samples from the International Ocean Discovery Program Hole U1456A, which was drilled in the east Arabian Sea. Time series of hematite content and grain size of the sediments were examined downcore. We found South Asian monsoon precipitation and weathering intensity experienced three phases from late Pliocene time. Lower monsoon precipitation, with a lower variability and strong weathering intensity, occurred during 3.4–2.4 Ma; an increased and more variable South Asian monsoon rainfall, along with strengthened but fluctuating weathering intensity, occurred at 1.8–1.1 Ma; and a reduced rainfall with lower South Asian monsoon precipitation variability and moderate weathering intensity marked the period 1.1–0.1 Ma. Maximum entropy spectral analysis and wavelet transform show that there were orbital-dominated cycles of periods c. 100 and c. 41 ka in these proxy-based time series. We propose that the monsoon, sea level, global temperature and insolation together forced the weathering and erosion in SW Asia.
To gain more comprehensive understanding of metabolic syndrome (Mets) among in general Chinese population.
Cross-sectional study. Mets was defined by three widely accepted definitions including modified Adults Treatment Panel (ATP) III criteria, International Diabetes Federation (IDF) criteria and harmonized definition. Risk factors were evaluated by using multivariate logistic regression.
Nineteen rural villages in northeast China.
The survey was conducted in September 2017 and May 2018 on 10 926 individuals.
According to modified ATP III criteria, IDF criteria and harmonised definition, the overall prevalence of Mets was 41·3 % (95 % CI 40·3, 42·2), 34·2 % (95 % CI 33·2, 35·1) and 44·1 % (95 % CI 43·1, 45·1), respectively. Females had a higher prevalence, and elevated blood pressure was the most frequent. Age, female sex, non-peasant worker, higher BMI and lower-annual income were independent risk factors of Mets in all three definitions (all ps < 0·05). Based on modified ATP III criteria and harmonised definition, heavy drinking was positively correlated with Mets. In contrast, former drinking was inversely associated with Mets.
Mets is highly prevalent in rural areas of northeast China. Its independent risk factors include higher age, female sex, non-peasantry worker, higher BMI and lower-annual income. Modified ATP III criteria and harmonised definition may be superior definitions of Mets.
The rhoptry kinase 18 of Toxoplasma gondii (TgROP18) has been identified as a key virulence factor that allows the parasite to escape from host immune defences and promotes its proliferation in host cells. Although much research is focused on the interaction between host cells and TgROP18, the development of monoclonal antibodies (mAbs) against TgROP18 has not been reported till date. To produce mAbs targeting TgROP18, two hybridomas secreting mAbs against TgROP18, designated as A1 and T2, were generated using cell fusion technology. The subtypes of the A1 and T2 mAbs were identified as IgG3 λ and IgM κ, and peptide scanning revealed that the core sequences of the antigenic epitopes were 180LRAQRRRSELVFE192 and 351NYFLLMMRAEADM363, respectively. The T2 mAb specifically reacted with both T. gondii type I and Chinese I, but not with T. gondii type II, Plasmodium falciparum or Schistosoma japonicum. Finally, the sequences of heavy chain and light chain complementarity-determining regions of T2 were amplified, cloned and characterized, making the modification of the mAb feasible in the future. The development of mAbs against TgROP18 would aid the investigation of the molecular mechanisms underlying the modulation of host cellular functions by TgROP18, and in the development of strategies to diagnose and treat Toxoplasmosis.
is a polynomial with at least one irrational coefficient on non-constant terms,
is any real number and, for
$a\in [0,\infty )$
is the fractional part of
. With the help of a method recently introduced by Wu, we show that the closure of
must have full Hausdorff dimension.
The surface energy budget over the Antarctic sea ice from 8 April 2016 through 26 November 2016 are presented. From April to October, Sensible heat flux (SH) and subsurface conductive heat flux (G) were the heat source of surface while latent heat flux (LE) and net radiation flux (Rn) were the heat sink of surface. Our results showed larger downward SH (due to the warmer air in our site) and upward LE (due to the drier air and higher wind speed in our site) compared with SHEBA data. However, the values of SH in N-ICE2015 campaign, which located at a zone with stronger winds and more advection of heat in the Arctic, were comparable to our results under clear skies. The values of aerodynamic roughness length (z0m) and scalar roughness length for temperature (z0h), being 1.9 × 10−3 m and 3.7 × 10−5 m, were suggested in this study. It is found that snow melting might increase z0m. Our results also indicate that the value of log(z0h/z0m) was related to the stability of stratification. In addition, several representative parameterization schemes for z0h have been tested and a couple of schemes were found to make a better performance.
As part of our ongoing research on Peltigera, we recognize a morphologically and phylogenetically distinct new species, Peltigera shennongjiana L. F. Han & S. Y. Guo, from the Shennongjia region of Central China. It is distinguished from other members of the P. canina-group by the presence of abundant phyllidia and flat, branched lobules along the margin or laminal cracks, short lobes, and a pruinose, usually greyish upper surface. The various populations sampled share identical ITS nr DNA sequences, of which the ITS2 regions are characterized by a unique secondary structure. Furthermore, we provide a detailed comparison of the characteristics of P. shennongjiana with morphologically similar species and a key to Peltigera species reported from China.
After a 6.0 magnitude earthquake struck Hualien on February 6, 2018, over one hundred and fifty patients crammed into the emergency department of a nearby tertiary hospital within two hours. The mass casualty incident (MCI) call was activated, and over 300 related personnel responded to the call and engaged with the MCI management.
This research aimed to analyze the practice of an MCI call and to form the strategies to improve its efficiency and effectiveness.
The research was conducted in a tertiary hospital in Hualien, Taiwan. Questionnaires regarding the practice of the MCI call were sent out to the healthcare providers in the emergency department who responded to that MCI operation.
Thirty-seven responders in the emergency department were involved in this study. 78% had participated in training courses for hospital incident command system (HICS) or MCI management before this event. On arrival at the emergency department, 69.4% of the responders were aware of the check-in station and received a clear task assignment and briefing. During the operation, 25.7% reported the lack of confidence carrying out the assigned tasks and 54.1% of the participants experienced great stress (stress score over 7 out of 10).
MCI is an uncommon event for hospital management. It is universally challenging owing to its unpredictable and time-sensitive nature. Furthermore, the administration could be further complicated by the associated disasters. Despite regular exercises and drills, there are still a significant number of participants experiencing stress and confusion during the operation. The chaotic situation may further compromise the performance of the participants. This study showed that optimizing task briefing and on-site directions may improve the performance of the MCI participants.
“Tailor-made” training programs have been started in two theme parks in North and East Taiwan after the dust explosion of Ba-xien theme park in 2015. The training programs emphasized several areas. They work to strengthen the incident command system (ICS) and the skills of first responders, especially evacuation, placement, triage, and first aid, as well as to assist the park’s cooperation with local disaster response units, such as the fire department and Health Bureau.
The first step was to find out the practical problems of the two theme parks, and then make a one-year, tailor-made training program according to the needs of parks and different levels of staff: senior supervisors, middle-level district supervisors, and frontline colleagues. After the phased training, the training results are inspected in the non-scripted exercise mode.
It was found that the staff are relatively familiar with the evacuation process and placement of tourists. The initial emergency responses such as triage, first aid skills, and patient transport gradually improve after several drills. The ICS operation and communication also became more effective and efficient. The regional emergency response units could understand these theme parks capability and how to cooperate with them.
The experience of emergency response training and exercise in these two theme parks has shown that such a model is feasible and should be valued.