Background: Patients requiring vascular catheters are at risk for bloodstream infections (BSIs), particularly those with central venous access devices (CVADs). Central-line–associated bloodstream infections (CLABSIs) may occur as a result of the introduction of pathogenic microbes during CVAD access procedures, including through the needleless connector. The use of an antiseptic scrub is recommended to disinfect the needleless connector before device access, and this procedure has been shown to reduce the risk for CLABSI. We identified perceived barriers and facilitators and assessed compliance with instructions for use of chlorhexidine or alcohol antisepsis products (CHG or IPA; 5-second scrub time plus 5-second dry time) and alcohol antisepsis products (IPA; facility protocol 15-second scrub time plus let dry) for needleless connector disinfection. Methods: We performed a multiple-methods study involving focus groups composed of a convenience sample of nurses and clinical observations of CVAD needleless-connector access procedures in 3 medical ICUs and 1 surgical ICU at 2 academic medical centers. We used open-ended questions to guide the focus-group discussions. We directly observed nursing staff performing needleless-connector disinfection following a time–motion paradigm using an electronic tool to document the observed needleless-connector access events and to measure needleless-connector antiseptic scrub times and dry times. Results: In total, 8 focus groups involving 28 nurses revealed access to the antiseptic product and lesser workload as best-practice facilitators of needleless-connector disinfection. Identified barriers were often the opposite of the facilitators, particularly the time required per needleless connector access using IPA and knowledge deficits regarding the need for disinfection between multiple needleless-connector accesses. From 36 observations, including a total of 48 access events, we determined that the mean scrub times were below the recommended times, especially for IPA (Table 1). Drying time after use of either antisepsis product was negligible. Conclusions: A lack of access to the disinfection product, emergency situations, and increased workload were perceived barriers to needleless-connector disinfection. Observed scrub times and drying times were shorter than recommended, much more so for IPA. These deficits in the performance of needleless-connector disinfection may increase the risk of CLABSI. Ongoing education and periodic competency evaluation of needleless-connector disinfection are needed to imbed and sustain best practices.

Funding: Professional Disposables, Inc.

Disclosures: None

The storming of the US Capitol building in January 2021 was a presidential attempt at a self-coup. To make the case, this article reviews elements of the Capitol assault and the events leading up to it, in light of the key conceptual components of a self-coup, and how those compare to attributes of other kinds of attacks on governments. The Trump self-coup will then be compared and contrasted empirically to other self-coups perpetrated by leaders. It is found that what separates successful self-coups from those that fail is whether the military backs the undertaking. Thus, a section is included on US military behaviour in response to Trump's attempts to gain military adherence for his political actions.

This paper presents an experimental study of the interaction of turbulent spots with an initially laminar separation, using schlieren visualisation and dynamic measurements of surface heat transfer and pressure. The separation is generated on a blunt cylinder-flare body, tested at Mach 9, and entropy layer effects result in a boundary layer edge Mach number of 3.43 at separation. A single roughness element is used to produce isolated spots, defined such that separation collapse and re-establishment is completed before arrival of the next spot. On average the spot axial length, at the start of the interaction, is 2.5 times the separation length, growing to 6.8 times as the spot base passes the original reattachment position. As such the spot comprises a large perturbation. The local separation responds almost immediately with passage of the spot, so that the downstream region may be unaffected while the upstream part has already collapsed. Re-establishment of separation is slow, taking up to four times the total transit time of the spot. A basic model is presented to explore the transient wave processes during spot passage.

Marine-terminating glaciers lose mass through melting and iceberg calving, and we find that meltwater drainage systems influence calving timing at Helheim Glacier, a tidewater glacier in East Greenland. Meltwater feeds a buoyant subglacial discharge plume at the terminus of Helheim Glacier, which rises along the glacial front and surfaces through the mélange. Here, we use high-resolution satellite and time-lapse imagery to observe the surface expression of this meltwater plume and how plume timing and location compare with that of calving and supraglacial meltwater pooling from 2011 to 2019. The plume consistently appeared at the central terminus even as the glacier advanced and retreated, fed by a well-established channelized drainage system with connections to supraglacial water. All full-thickness calving episodes, both tabular and non-tabular, were separated from the surfacing plume by either time or by space. We hypothesize that variability in subglacial hydrology and basal coupling drive this inverse relationship between subglacial discharge plumes and full-thickness calving. Surfacing plumes likely indicate a low-pressure subglacial drainage system and grounded terminus, while full-thickness calving occurrence reflects a terminus at or close to flotation. Our records of plume appearance and full-thickness calving therefore represent proxies for the grounding state of Helheim Glacier through time.