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To develop a fully automated algorithm using data from the Veterans’ Affairs (VA) electrical medical record (EMR) to identify deep-incisional surgical site infections (SSIs) after cardiac surgeries and total joint arthroplasties (TJAs) to be used for research studies.
Design:
Retrospective cohort study.
Setting:
This study was conducted in 11 VA hospitals.
Participants:
Patients who underwent coronary artery bypass grafting or valve replacement between January 1, 2010, and March 31, 2018 (cardiac cohort) and patients who underwent total hip arthroplasty or total knee arthroplasty between January 1, 2007, and March 31, 2018 (TJA cohort).
Methods:
Relevant clinical information and administrative code data were extracted from the EMR. The outcomes of interest were mediastinitis, endocarditis, or deep-incisional or organ-space SSI within 30 days after surgery. Multiple logistic regression analysis with a repeated regular bootstrap procedure was used to select variables and to assign points in the models. Sensitivities, specificities, positive predictive values (PPVs) and negative predictive values were calculated with comparison to outcomes collected by the Veterans’ Affairs Surgical Quality Improvement Program (VASQIP).
Results:
Overall, 49 (0.5%) of the 13,341 cardiac surgeries were classified as mediastinitis or endocarditis, and 83 (0.6%) of the 12,992 TJAs were classified as deep-incisional or organ-space SSIs. With at least 60% sensitivity, the PPVs of the SSI detection algorithms after cardiac surgeries and TJAs were 52.5% and 62.0%, respectively.
Conclusions:
Considering the low prevalence rate of SSIs, our algorithms were successful in identifying a majority of patients with a true SSI while simultaneously reducing false-positive cases. As a next step, validation of these algorithms in different hospital systems with EMR will be needed.
In January of 2010, North Carolina (NC) USA implemented state-wide Trauma Triage Destination Plans (TTDPs) to provide standardized guidelines for Emergency Medical Services (EMS) decision making. No study exists to evaluate whether triage behavior has changed for geriatric trauma patients.
Hypothesis/Problem:
The impact of the NC TTDPs was investigated on EMS triage of geriatric trauma patients meeting physiologic criteria of serious injury, primarily based on whether these patients were transported to a trauma center.
Methods:
This is a retrospective cohort study of geriatric trauma patients transported by EMS from March 1, 2009 through September 30, 2009 (pre-TTDP) and March 1, 2010 through September 30, 2010 (post-TTDP) meeting the following inclusion criteria: (1) age 50 years or older; (2) transported to a hospital by NC EMS; (3) experienced an injury; and (4) meeting one or more of the NC TTDP’s physiologic criteria for trauma (n = 5,345). Data were obtained from the Prehospital Medical Information System (PreMIS). Data collected included proportions of patients transported to a trauma center categorized by specific physiologic criteria, age category, and distance from a trauma center.
Results:
The proportion of patients transported to a trauma center pre-TTDP (24.4% [95% CI 22.7%-26.1%]; n = 604) was similar to the proportion post-TTDP (24.4% [95% CI 22.9%-26.0%]; n = 700). For patients meeting specific physiologic triage criteria, the proportions of patients transported to a trauma center were also similar pre- and post-TTDP: systolic blood pressure <90 mmHg (22.5% versus 23.5%); respiratory rate <10 or >29 (23.2% versus 22.6%); and Glascow Coma Scale (GCS) score <13 (26.0% versus 26.4%). Patients aged 80 years or older were less likely to be transported to a trauma center than younger patients in both the pre- and post-TTDP periods.
Conclusions:
State-wide implementation of a TTDP had no discernible effect on the proportion of patients 50 years and older transported to a trauma center. Under-triage remained common and became increasingly prevalent among the oldest adults. Research to understand the uptake of guidelines and protocols into EMS practice is critical to improving care for older adults in the prehospital environment.
Equilibrium relations of lead-tin sulphides in the system SnS-PbSnS2 were studied using a sealed silica-tube technique. A complete series of solid solutions forms in the system, and lattice parameters were found to vary lineally with composition. The melting temperature of the solid solution decreases with increasing amount of PbS from herzenbergite at 880 °C to teallite at 725 °C.
Evidences were found to indicate the existence of this series of solid solution in ore deposits.
Magnetic reconnection is a fundamental energy conversion mechanism in nature. Major attempts to study this process in controlled settings on Earth have largely been limited to reproducing approximately two-dimensional (2-D) reconnection dynamics. Other experiments describing reconnection near three-dimensional null points are non-driven, and do not induce any of the 3-D modes of spine fan, torsional fan or torsional spine reconnection. In order to study these important 3-D modes observed in astrophysical plasmas (e.g. the solar atmosphere), laboratory set-ups must be designed to induce driven reconnection about an isolated magnetic null point. As such, we consider the limited range of fundamental resistive magnetohydrodynamic (MHD) and kinetic parameters of dynamic laboratory plasmas that are necessary to induce the torsional spine reconnection (TSR) mode characterized by a driven rotational slippage of field lines – a feature that has yet to be achieved in operational laboratory magnetic reconnection experiments. Leveraging existing reconnection models, we show that within a ${\lesssim}1~\text{m}^{3}$ apparatus, TSR can be achieved in dense plasma regimes (${\sim}10^{24}~\text{m}^{-3}$) in magnetic fields of ${\sim}10^{-1}~\text{T}$. We find that MHD and kinetic parameters predict reconnection in thin ${\lesssim}20~\unicode[STIX]{x03BC}\text{m}$ current sheets on time scales of ${\lesssim}10~\text{ns}$. While these plasma regimes may not explicitly replicate the plasma parameters of observed astrophysical phenomena, studying the dynamics of the TSR mode within achievable set-ups signifies an important step in understanding the fundamentals of driven 3-D magnetic reconnection and the self-organization of current sheets. Explicit control of this reconnection mode may have implications for understanding particle acceleration in astrophysical environments, and may even have practical applications to fields such as spacecraft propulsion.
Neighboring tidewater glaciers often exhibit asynchronous dynamic behavior, despite relatively uniform regional atmospheric and oceanic forcings. This variability may be controlled by a combination of local factors, including glacier and fjord geometry, fjord heat content and circulation, and glacier surface melt. In order to characterize and understand contrasts in adjacent tidewater glacier and fjord dynamics, we made coincident ice-ocean-atmosphere observations at high temporal resolution (minutes to weeks) within a 10 000 km2 area near Uummannaq, Greenland. Water column velocity, temperature and salinity measurements reveal systematic differences in neighboring fjords that imply contrasting circulation patterns. The observed ocean velocity and hydrography, combined with numerical modeling, suggest that subglacial discharge plays a major role in setting fjord conditions. In addition, satellite remote sensing of seasonal ice flow speed and terminus position reveal both speedup and slow-down in response to melt, as well as differences in calving style among the neighboring glaciers. Glacier force budgets and modeling also point toward subglacial discharge as a key factor in glacier behavior. For the studied region, individual glacier and fjord geometry modulate subglacial discharge, which leads to contrasts in both fjord and glacier dynamics.
Recent scholarship in political science identifies emotions as an important antecedent to political behavior. Existing work, however, has focused much more on the political effects of emotions than on their causes. Here, we begin to examine how personality moderates emotional responses to political events. We hypothesized that the personality trait need for affect (NFA) would moderate the emotions evoked by disturbing political news. Drawing data from a survey experiment conducted on a national sample, we find that individuals high in NFA have an especially vivid emotional response to disturbing news—a moderating relationship that has the potential to surpass those associated with symbolic attachments.
Readers’ interest in the Roman army and battles often does not extend to considering veterans, yet they were a significant part of Roman military life. Every man not killed during service became a veteran. Since two of the primary characters in the series Rome start out as soldiers, and the military is present in every episode, it should not be surprising that veterans figure prominently. As with its treatment of active military life, the treatment of veterans in Rome is similarly successful. Once we disregard those production choices made for the dramatic and narrative requirements of a historical television series, what emerges is a useful treatment of some issues veterans faced in ancient Rome. Examining two specific aspects of veterans’ experience in the series and in the historical record – their reintegration into society and relationships with political leaders of the period – highlights some ways in which the treatment of veterans in Rome is useful for an audience seeking to understand veterans better, whether Roman or other.
ROMAN VETERANS IN FILM
Whereas one can write about a tradition of the Roman army in film, there is much less to be reported about Roman veterans on film. In the last forty years there are only four feature films in which Roman veterans appear: Gladiator (2000), King Arthur (2004), The Last Legion (2007), and The Eagle (2011). Admittedly, the protagonist in Gladiator was not a veteran for long on screen, but even so brief a veteran status justifies inclusion. It is no coincidence that in all four films the veterans play similar roles – after being abused, abandoned, or forgotten (or some combination) by flawed leaders and/or policies, the veterans are eventually provoked into picking up weapons and armor to restore freedom and order, if not also Rome itself. The success of Gladiator spawned many imitators, and the plot of a redeemed hero restoring order and getting revenge is a standard one. While it may be surprising that Roman veterans do not appear more often in feature films, it is more astonishing that this “revenge plot” has been the only one for Roman veterans in film, especially given that the military veteran has been a staple character in film history.
Recent advances in laser deposition technology have made the production of advanced composite materials more technically feasible. By utilizing the unique characteristics of the laser deposition process, materials can be made that are difficult to produce by conventional methods. Structural silicide materials hold promise for high temperature applications, unfortunately, their low toughness has prevented their practical use [1-4]. The introduction of a second phase can greatly increase their low temperature mechanical properties. Laser direct deposition can be used to deposit these materials near net shape and produce an in-situ alloy that has the desired structure for improving properties. In-situ alloying was accomplished by using an Optomec LENS™ (Laser Engineered Net Shaping) machine to deposit elemental niobium-silicon and molybdenum-silicon-boron powder blends. The resultant microstructures showed a homogeneous structure with a primary silicide phase surrounded by a continuous eutectic phase. These deposits were characterized using scanning and transmission electron microscopy, x-ray diffraction, and by energy dispersive spectroscopy.
In vitro runoff transcription using T7 RNA polymerase
has been the method of choice to produce milligram quantities
of RNA for structural studies. Unfortunately, the T7 enzyme
often adds one or more extra nucleotides at the 3′
end, which results in a heterogeneous RNA product (Milligan
et al., 1987). This heterogeneity can be observed at the
5′ end as well, depending on the transcription template
(Ferre-D'Amare & Doudna, 1996). The lack of homogeneity,
which potentially is deleterious for structural studies,
can be overcome with the use of cis- and/or trans-acting
ribozymes, which produce clean RNA ends after their catalytic
reaction (Ferre-D'Amare & Doudna, 1996). This
procedure has been scaled up for large quantities of RNA
for NMR and X-ray crystallographic studies, and is useful
for purification of larger RNAs (greater than 50 nt) where
single-nucleotide resolution by gel electrophoresis is
difficult. Ribozymes that have been used in this manner
include the hairpin ribozyme, the hammerhead ribozyme (HH),
the hepatitis delta ribozyme (δ), and the Neurospora
varkud satellite RNA ribozyme (VS) (Guo & Collins,
1995; Price et al., 1995; Ferre-D'Amare & Doudna,
1996). All of these ribozymes leave a 5′-hydroxyl
and a 3′-cyclic phosphate as products of cleavage.
Microstructure of TiAl produced by Laser Engineered Net Shaping (LENS) has been characterized using optical microscopy, scanning electron microscopy (SEM) and transmission electron microscopy (TEM). It has been shown that the substrate has a significant effect on the microstructure deposited. Depending on operational parameters, either equiaxed γ-TiAl/α2 -Ti3AI or single phase α 2 microstructure can be obtained. In-situ heating experiments reveal that nucleation of lamellae often starts at grain boundaries in this retained α 2grains. By careful control of post heat treatment, an ultra fine lamellar microstructure may be obtained, which may significantly improve tensile property in these alloys [3].
Lattice defects are introduced into the structure to suppress the motion of magnetic vortices and enhance the critical current density in high temperature superconductors. Point defects are not very effective pinning sites for the cuprate superconductors; however, extended defects, such as linear tracks, have been shown to be strong pinning sites. We study the superconducting cuprate TI-2212 (the numbers designate Tl-Ba-Ca-Cu stoichiometry). Large enhancements of vortex pinning potential were observed in TI-2212 after high-intermediate energy heavy-ion irradiations where non-continuous extended defects were induced at dE/dx of 9 to 15.2 keV/nm (60 MeV Au, 60 MeV Cu, and 30 MeV Au) and continuous linear defects were induced at 19.5keV/nm (88MeV Au). Our research addresses the question of pinning in highly anisotropic materials like Tl-2212 where the vortices are “pancakes” rather than “rods” and suitable defect structures may be discontinuous extended damage domains. The defect microstructure and the effectiveness of the pinning potential in TI-2212 after irradiation by intermediate energy Au at lower dE/dx of 5–15 keV/nm, where recoils are more significant, is studied using high resolution transmission electron microscopy digital imaging and a SQUID magnetometer. The nature of the ion irradiation damage at these intermediate dE/dx will be correlated to the average vortex pinning potential and the TRIMRC calculations for recoils.
Aluminum titanate ceramic powder, used in plasma spray coating as a wear resistant material, was prepared from a gel precursor followed by high temperature calcination. The chemically derived gel was made from aluminum sulfate and titanium isopropoxide in an oxalic acid aqueous system. The soluble complex was studied by 13C NMR spectroscopy which showed that the mole ratio of oxalic acid bound to Al and Ti was 2:1. A coprecipitation took place when ammonium hydroxide was added. The gel was examined by solid-state NMR spectroscopy which suggested that aluminum titanium hydroxyl oxalate was present with Al in a distorted octahedral environment. EDX mapping showed that Al and Ti were evenly distributed throughout the gel particles. Thermal analysis indicated that dehydration and combustion of organic groups took place between 100 and 400 ° C. Gel which was heat treated at 1500 °C was identified as a pure AI2TiO5 crystalline phase by XRD.