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To establish the epidemiology of cardiac implantable electronic device (CIED) infections in Alberta, Canada, using validated administrative data.
Retrospective, population-based cohort study.
Alberta Health Services is a province-wide health system that services all of Alberta, Canada.
Adult patients who underwent first-time CIED implantation or generator replacement in Alberta, Canada, between January 1, 2011, and December 31, 2019.
CIED implant patients were identified from the Paceart database. Patients who developed an infection within 1 year of the index procedure were identified through validated administrative data (International Classification of Diseases, Tenth Revision in Canada). Demographic characteristics of patients were summarized. Logistic regression models were used to analyze device type, comorbidities, and demographics associated with infection rates and mortality.
Among 27,830 CIED implants, there were 205 infections (0.74%). Having 2 or more comorbidities was associated with higher infection risk. Generator replacement procedures (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.34–0.84; P = .008), age increase of every 10 years (OR, 0.73; 95% CI, 0.66–0.82; P ≤ .001), and index procedure after 2014 were associated with decreased risk. Comparing the infected to uninfected groups, the hospitalization rates were 2.63 compared to 0.69, and the mortality rates were 10.73% compared to 3.49%, respectively (P < .001).
There is a slightly lower overall rate of CIED infections Alberta, Canada compared to previously described epidemiology. Implants after 2014, and generator replacements showed a decreased burden of infection. Patients with younger age, and 2 or more comorbidities are at greatest risk of CIED infection. The burden of hospitalization and mortality is substantially higher in infected patients.
Applying high-resolution electron backscatter diffraction (HR-EBSD) to materials without regions that are amenable to the acquisition of backgrounds for static flat fielding (background subtraction) can cause analysis problems. To address this difficulty, the efficacy of electron beam induced deposition (EBID) of material as a source for an amorphous background signal is assessed and found to be practical. Using EBID material for EBSD backgrounds allows single crystal and large-grained samples to be analyzed using HR-EBSD for strain and small angle rotation measurement.
A study was made of radial crack evolution in curved brittle layers on compliant support substrates. Three-dimensional boundary element analysis was used to compute the stepwise growth of radial cracks that initiate at the bottom surfaces of glass on polymeric support layers, from initiation to final failure. The algorithm calculates reconstituted displacement fields in the near-tip region of the extending cracks, enabling direct evaluation of stress-intensity factors. Available experimental data on the same material systems with prescribed surface curvatures were used to validate the essential features of the predicted crack evolution, particularly the stability conditions prior to ultimate failure. It was shown that the critical loads to failure diminish with increasing surface curvature. Generalization of the ensuing fracture mechanics to include alternative brittle-layer/polymer-substrate systems enabled an explicit expression for the critical load to failure in terms of material properties and layer thicknesses. Implications concerning practical layer systems, particularly dental crowns, are briefly discussed.
Most evidence suggesting an association between schizophrenia, antipsychotic medications and diabetes has been based on retrospective studies not controlled for important confounders.
To compare diabetogenic risk between antipsychotic medications; and to describe the limitations of current prospective data-sets.
Systematic review of prospective clinical data.
No difference in the incidence of glycaemic abnormalities between placebo cohorts and antipsychotic medication cohorts was identified. No significant difference between any of the antipsychotic medications studied in terms of their association with glycaemic abnormalities was identified. Treatment-related weight gain did not appear to increase the risk of developing diabetes.
Diabetogenic potential ascribed to atypical antipsychotic drugs, resulting from retrospective studies, may be incorrect. Cohort sizes and incomplete sampling must preclude any definitive conclusions. Long-term, large, comparative prospective trials are needed, along with agreement upon glucose measurement of choice.
A preceding study of contact damage in a bilayer system consisting of a porcelain coating on a stiff Pd-alloy substrate is here expanded to investigate the role of substrate modulus and hardness. Bilayers are made by fusing the same dental porcelain onto Co-, Pd-, and Au-alloy metal bases. Indentations are made on the porcelain surfaces using spheres of radii 2.38 and 3.98 mm. Critical loads to initiate cone fracture at the top surface of the porcelain and yield in the substrate below the contact are measured as a function of porcelain thickness. Radial cracks form at the lower surface of the coating once the substrate yield is well developed. By virtue of its controlling role in the metal yield process, substrate hardness is revealed to be a key material parameter—substrate modulus plays a secondary role. A simple elasticitybased analysis for predetermining critical loads for a given brittle/plastic bilayer system is presented.
An analysis is made of contact damage in brittle coatings on metal substrates, using a case study of a dental porcelain coating of thickness between 0.1 and 1 mm fused onto a Pd alloy base, with spherical indenter of radii 2.38 and 3.98 mm. At large coating thicknesses (>300 μm), the first damage takes the form of surface-initiated transverse cone cracks outside the contact. At small coating thicknesses (<300 μm), the first damage occurs as yield in the substrate, with attendant formation of subsurface transverse median cracks in the coating. At high loads and thin coatings, both forms of transverse cracking occur, along with subsequent delamination of the ceramic/metal interface, signalling impending failure. Conditions for avoiding such transverse cracking are considered in terms of minimum coating thicknesses and maximum sustainable contact loads. General implications concerning the design of brittle coating systems for optimum damage resistance are considered, with special reference to dental crowns.
Transport, cleanup, and bioremediation properties of polychlorinated biphenyls (PCBs) bound to sediments depend on the specific components to which the PCBs are bound. Analysis of the sediment from Contaminant Cove on the St. Lawrence River by gas chromatography with an electron capture detector shows that the sediment contains 600 ppm PCBs. Previous work showed that there were both weak and strong binding of PCBs to sediment components, but gave no indication of which components were responsible for the binding.2 The average content of PCBs is below the limit of detectability by energy-dispersive x-ray microanalysis (EDX) for CI, but constituents which bind large quantities of PCBs could be detected. Sediment which is not contaminated with PCBs contains no detectable chlorine.
EDX analysis was performed on a JEOL JEM-4000FX, using a cryo-stage (operated at -160° C) and a Tracor TN5500 system.
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