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To assess preventability of hospital-onset bacteremia and fungemia (HOB), we developed and evaluated a structured rating guide accounting for intrinsic patient and extrinsic healthcare-related risks.
Design:
HOB preventability rating guide was compared against a reference standard expert panel.
Participants:
A 10-member panel of clinical experts was assembled as the standard of preventability assessment, and 2 physician reviewers applied the rating guide for comparison.
Methods:
The expert panel independently rated 82 hypothetical HOB scenarios using a 6-point Likert scale collapsed into 3 categories: preventable, uncertain, or not preventable. Consensus was defined as concurrence on the same category among ≥70% experts. Scenarios without consensus were deliberated and followed by a second round of rating.
Two reviewers independently applied the rating guide to adjudicate the same 82 scenarios in 2 rounds, with interim revisions. Interrater reliability was evaluated using the κ (kappa) statistic.
Results:
Expert panel consensus criteria were met for 52 scenarios (63%) after 2 rounds.
After 2 rounds, guide-based rating matched expert panel consensus in 40 of 52 (77%) and 39 of 52 (75%) cases for reviewers 1 and 2, respectively. Agreement rates between the 2 reviewers were 84% overall (κ, 0.76; 95% confidence interval [CI], 0.64–0.88]) and 87% (κ, 0.79; 95% CI, 0.65–0.94) for the 52 scenarios with expert consensus.
Conclusions:
Preventability ratings of HOB scenarios by 2 reviewers using a rating guide matched expert consensus in most cases with moderately high interreviewer reliability. Although diversity of expert opinions and uncertainty of preventability merit further exploration, this is a step toward standardized assessment of HOB preventability.
Determine the effectiveness of a personal protective equipment (PPE)-free zone intervention on healthcare personnel (HCP) entry hand hygiene (HH) and PPE donning compliance in rooms of patients in contact precautions.
Design:
Quasi-experimental, multicenter intervention, before-and-after study with concurrent controls.
Setting:
All patient rooms on contact precautions on 16 units (5 medical-surgical, 6 intensive care, 5 specialty care units) at 3 acute-care facilities (2 academic medical centers, 1 Veterans Affairs hospital). Observations of PPE donning and entry HH compliance by HCP were conducted during both study phases. Surveys of HCP perceptions of the PPE-free zone were distributed in both study phases.
Intervention:
A PPE-free zone, where a low-risk area inside door thresholds of contact precautions rooms was demarcated by red tape on the floor. Inside this area, HCP were not required to wear PPE.
Results:
We observed 3,970 room entries. HH compliance did not change between study phases among intervention units (relative risk [RR], 0.92; P = .29) and declined in control units (RR, 0.70; P = .005); however, the PPE-free zone did not significantly affect compliance (P = .07). The PPE-free zone effect on HH was significant only for rooms on enteric precautions (P = .008). PPE use was not significantly different before versus after the intervention (P = .15). HCP perceived the zone positively; 65% agreed that it facilitated communication and 66.8% agreed that it permitted checking on patients more frequently.
Conclusions:
HCP viewed the PPE-free zone favorably and it did not adversely affect PPE or HH compliance. Future infection prevention interventions should consider the complex sociotechnical system factors influencing behavior change.
We present very detailed images of the photosphere of an AGB star obtained with the PIONIER instrument, installed at the Very Large Telescope Interferometer (VLTI). The images show a well defined stellar disc populated by a few convective patterns. Thanks to the high precision of the observations we are able to derive the contrast and granulation horizontal scale of the convective pattern for the first time in a direct way. Such quantities are then compared with scaling relations between granule size, effective temperature, and surface gravity that are predicted by simulations of stellar surface convection.
To test the hypothesis that long-term care facility (LTCF) residents with Clostridium difficile infection (CDI) or asymptomatic carriage of toxigenic strains are an important source of transmission in the LTCF and in the hospital during acute-care admissions.
Design
A 6-month cohort study with identification of transmission events was conducted based on tracking of patient movement combined with restriction endonuclease analysis (REA) and whole-genome sequencing (WGS).
Setting
Veterans Affairs hospital and affiliated LTCF.
Participants
The study included 29 LTCF residents identified as asymptomatic carriers of toxigenic C. difficile based on every other week perirectal screening and 37 healthcare facility-associated CDI cases (ie, diagnosis >3 days after admission or within 4 weeks of discharge to the community), including 26 hospital-associated and 11 LTCF-associated cases.
Results
Of the 37 CDI cases, 7 (18·9%) were linked to LTCF residents with LTCF-associated CDI or asymptomatic carriage, including 3 of 26 hospital-associated CDI cases (11·5%) and 4 of 11 LTCF-associated cases (36·4%). Of the 7 transmissions linked to LTCF residents, 5 (71·4%) were linked to asymptomatic carriers versus 2 (28·6%) to CDI cases, and all involved transmission of epidemic BI/NAP1/027 strains. No incident hospital-associated CDI cases were linked to other hospital-associated CDI cases.
Conclusions
Our findings suggest that LTCF residents with asymptomatic carriage of C. difficile or CDI contribute to transmission both in the LTCF and in the affiliated hospital during acute-care admissions. Greater emphasis on infection control measures and antimicrobial stewardship in LTCFs is needed, and these efforts should focus on LTCF residents during hospital admissions.
Coinfection with human immunodeficiency virus (HIV) and viral hepatitis is associated with high morbidity and mortality in the absence of clinical management, making identification of these cases crucial. We examined characteristics of HIV and viral hepatitis coinfections by using surveillance data from 15 US states and two cities. Each jurisdiction used an automated deterministic matching method to link surveillance data for persons with reported acute and chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections, to persons reported with HIV infection. Of the 504 398 persons living with diagnosed HIV infection at the end of 2014, 2.0% were coinfected with HBV and 6.7% were coinfected with HCV. Of the 269 884 persons ever reported with HBV, 5.2% were reported with HIV. Of the 1 093 050 persons ever reported with HCV, 4.3% were reported with HIV. A greater proportion of persons coinfected with HIV and HBV were males and blacks/African Americans, compared with those with HIV monoinfection. Persons who inject drugs represented a greater proportion of those coinfected with HIV and HCV, compared with those with HIV monoinfection. Matching HIV and viral hepatitis surveillance data highlights epidemiological characteristics of persons coinfected and can be used to routinely monitor health status and guide state and national public health interventions.
A multi-scale analysis, ranging from μm → nm → Å-scaie on the influence of thermal treatment on the thermotropic copolyester based on 60 mol% (l,4)-hydroxybenzoic acid (B), 5 mol% (2,6)-hydroxynaphthoic acid (N), 17.5 mol% terephthalic acid (T) and 17.5 mol% biphenol (BP) - COTBP- was carried out. The Å and nm-scale structure was investigated by synchrotron scattering (WAXS and SAXS). Extruded tapes ca. 30 μm thick were annealed at 300 °C under air, without tension. WAXS revealed fibre-like structure with crystalline order, whereas SAXS patterns exhibited diamond-shaped diffuse scattering and discrete meridional scattering elucidating structures along the fibre axis and periodic crystallites. Heat treatment produced roughness reduction, and WAXS patterns showed reflections sharpening indicating an improvement of molecular register and packing (molecular alignment and degree of crystallinity Χ increased). Thermal treatment increased the thermal stability, melting transition and tensile Young’s modulus, E, along extrusion axis, whereas nanoindentation showed decrease of hardness and elastic modulus. Hence, a thermally-induced seif-reinforcing effect was evidenced, with microstructure reorganization correlating with improved thermo-mechanical properties.
The paper analyzes the issues relating to the applicability of innovative material systems for flexible composite armors. The authors made several samplings of aramid fibers (Kevlar 49) by replacing the epoxy resin base, which is often described in the literature, with the thermoplastic matrix - polyethylene (HDPE) and polypropylene (PP). The samples were fired with .38 Special Full Metal Jacketed (FMJ) ammunition produced by the S&B Company, and then the process of firing was modeled in the ABAQUS program. The advantages and disadvantages of the new material system including the possibility of its use in the construction of hybrid composite armors have been presented on the basis of the results of numerical analyses and ballistic tests.
Initial infection with the sentinel respiratory pathogen in children with cystic fibrosis (CF), Pseudomonas aeruginosa (Pa), is generally with environmental strains of this ubiquitous organism. The purpose of this study was to evaluate the associations between meteorological and geographical factors and risk of initial Pa acquisition in young children with CF. Using the U.S. Cystic Fibrosis Foundation Patient Registry from 2003 to 2009, 3463 patients met inclusion criteria, of which 48% (n = 1659) acquired Pa during follow-up. From multivariable Weibull regression, increased risk of Pa acquisition was associated with increasing temperature [hazard ratio (HR) per 1 °C: 1·13; 95% confidence interval (CI) 1·08–1·13], dew point (HR per 1 °C: 1·10, 95% CI 1·07–1·13), rainfall (HR per cm: 1·10, 95% CI 1·07–1·12), latitude (HR per 1 °C northing: 1·15, 95% CI 1·11–1·20), longitude (HR per 1 °C easting: 1·01, 95% CI 1·01–1·02) and elevation (HR per 100 m: 1·05, 95% CI 1·03–1·07). These results suggest that environmental factors may play a previously unrecognized role in the aetiology of initial Pa acquisition.
Although impaired recognition of affective facial expressions has been conclusively linked to antisocial behavior, little is known about the modifiability of this deficit. This study investigated whether and under which circumstances the proposed perceptual insensitivity can be addressed with a brief implicit training approach.
Method
Facial affect recognition was assessed with an animated morph task, in which the participants (44 male incarcerated violent offenders and 43 matched controls) identified the onset of emotional expressions in animated morph clips that gradually changed from neutral to one of the six basic emotions. Half of the offenders were then implicitly trained to direct attention to salient face regions (attention training, AT) using a modified dot-probe task. The other half underwent the same protocol but the intensity level of the presented expressions was additionally manipulated over the course of training sessions (sensitivity to emotional expressions training, SEE training). Subsequently, participants were reassessed with the animated morph task.
Results
Facial affect recognition was significantly impaired in violent offenders as compared with controls. Further, our results indicate that only the SEE training group exhibited a pronounced improvement in emotion recognition.
Conclusions
We demonstrated for the first time that perceptual insensitivity to facial affect can be addressed by an implicit training that directs attention to salient regions of a face and gradually decreases the intensity of the emotional expression. Future studies should focus on the potential of this intervention to effectively increase empathy and inhibit violent behavior in antisocial individuals.
Microwave heating is used to initiate the ion-cut process for transfer of coherent silicon-layers onto insulator substrates.Hydrogen and boron co-implanted silicon was bonded to an insulative substrate before processing inside a 2.45 GHz, 1300 W cavity applicator microwave system. Sample temperatures measured using a pyrometer were comparable to previous ion – cut studies.Selected samples were further annealed to repair any damage created in the ion implant process.Rutherford backscattering spectrometry and selective area electron diffraction patterns show high crystallinity in transferred layers.RUMP simulation of backscattering spectra and cross-sectional transmission electron microscopy demonstrate that thicknesses of the transferred layers are comparable to previous ion-cut exfoliation techniques.Surface quality as characterized by an atomic force microscope compares well with previous ion-cut studies.Hall measurements were used to characterize electrical properties of transferred layers. The mobility and carrier density of microwave activated ion – cut silicon on insulator processed samples compares well with previous annealing techniques.
A brief overview of the research activities at the Thermionic Energy Conversion (TEC) Center is given. The goal is to achieve direct thermal to electric energy conversion with >20% efficiency and >1W/cm2 power density at a hot side temperature of 300–650C. Thermionic emission in both vacuum and solid-state devices is investigated. In the case of solid-state devices, hot electron filtering using heterostructure barriers is used to increase the thermoelectric power factor. In order to study electron transport above the barriers and lateral momentum conservation in thermionic emission process, the current-voltage characteristic of ballistic transistor structures is investigated. Embedded ErAs nanoparticles and metal/semiconductor multilayers are used to reduce the lattice thermal conductivity. Cross-plane thermoelectric properties and the effective ZT of the thin film are analyzed using the transient Harman technique. Integrated circuit fabrication techniques are used to transfer the n- and p-type thin films on AlN substrates and make power generation modules with hundreds of thin film elements. For vacuum devices, nitrogen-doped diamond and carbon nanotubes are studied for emitters. Sb-doped highly oriented diamond and low electron affinity AlGaN are investigated for collectors. Work functions below 1.6eV and vacuum thermionic power generation at temperatures below 700C have been demonstrated.
Studies have been carried out on the structures and mechanical characteristics of an unusual family of sea sponges under the classification of Hexactinellida, genus Euplectella. The sponge spicules have been of interest to materials scientists because of their potentially important optical, coupled with mechanical, properties. The structures of the class Hexactinellida are characterized by a concentric ring appearance in the cross-section, which is a composite of hydrated silica, coupled with silicatein as a thin layer at the ring interfaces. The mechanical behavior and the toughness of the spicules have been examined with the aid of a special fiber testing method, coupled with scanning electrom microscopy (SEM) observations. It appears that there may be common mechanisms underlying toughness in rigid natural composites with high ratios of mineral/organic phase. In addition, novel pressurization tests of a portion of the sponge skeleton have provided information about the resilience of the skeleton, which resembles a selfsupporting glass winding of a cylindrical composite structure.
Ovarian cancer is the commonest cause of death from gynaecological malignancy in the Western world. About 5000 new cases of this cancer are diagnosed each year in England and Wales (5% of all cancers), and it is the fourth commonest cancer in all women up to 85 years (after cancers of the breast, lung and large bowel). The life-time risk of developing ovarian cancer, in England and Wales, is 1 in 56, or 1.8% by the age of 85. Ovarian cancer incidence in England and Wales has increased gradually in the last two decades. Mortality rates are only slightly lower than the incidence rates – a reflection of its poor prognosis. In England and Wales, only 29% of women with the malignancy survive as long as five years after diagnosis although younger women do survive longer: 69% of those who are under 40 years old at diagnosis survive for five years compared to less than 20% for those aged 70 or more. Because of its high incidence and poor prognosis, ovarian cancer also represents the fourth most common cause of death from cancer among women in England and Wales, accounting for about 3600 deaths per year (7% of all cancer deaths).
The increasing number of energy filtering transmission electron microscopes (EFTEMs) has given many microscopists the ability to apply the fast and very efficient tool of electron spectroscopic imaging (ESI) for analytical characterisation, rather than to record EELS spectra. In a more general framework, the new ESI methods and the standard PEELS technique both aim at exploring the same three-dimensional data space. This data space is represented by the spatial co-ordinates x, y and the energy loss ΔE. The resulting intensity distribution I(x,y, ΔE) is frequently referred to as a spectrum image and the experimental techniques to acquire the corresponding data are referred to as spectrum imaging. The actual analysis can either be based on recording PEELS spectra for a twodimensional array of probe positions, or on recording series of energy filtered images across inner shell loss edges or in the low loss region.
Our central goal in this concluding chapter is to make the presentation of BASE findings accessible to readers from different backgrounds and to elucidate some implications for social policy and application. To this end, a certain degree of overlap in the material presented is unavoidable.
To begin, we address readers with a general interest in aging research. Our aim is to show discrepancies between social expectations of old age and the evidence obtained in the Berlin Aging Study. We employ a format developed by Palmore (1988) in the Facts on Aging Quiz that confronts readers with a list of assertions about old age and aging. Using new questions and BASE findings, we then reveal the “correct” response (see Section 2).
In Section 3, we address specialists in the field of gerontology and summarize important results from each of the four BASE research units. In Section 4, we take a systemic perspective, combine these discipline-specific findings, and examine whether certain groups of older people or patterns of aging can be distinguished. In a sense, the observations offered in Section 4 are the closest we come to a wholistic view of aging, one of the stated primary objectives of BASE.
Finally, in the light of BASE findings, we consider whether current images of old age are too positive or too negative. We also discuss the implications of BASE results in terms of the theoretical conceptions of differential aging, continuity versus discontinuity, and systemic aspects of aging.
In this chapter we discuss those characteristics of the participants in the Berlin Aging Study which can be attributed to their belonging to different birth cohorts. We ask whether general trends in societal development can be discerned by examining the educational achievement, employment and occupational careers, family formation, and health impairments of three cohort groups (born 1887–1900, 1901–10, and 1911–22). We further investigate the differential effects of historical events and periods, in particular the two world wars and the Great Depression, and examine how these effects are still perceptible in old age. We would like to highlight two of the many descriptive findings. First, the younger cohorts did not have more successful career paths than the older ones. Although the younger men and women had a better education, they were hit harder by historical events, and ended their careers on the same level as the older cohorts. Second, we invalidate the myth of the “golden age” where large families cared for the oldest cohorts. In fact, older cohorts more often remained single, had less children, and were at a higher risk of losing their children at an early age.
Introduction
The Berlin Aging Study (BASE) focuses both on the present situation of elderly people and on the correlates and determinants of aging processes. However, the older adults observed in the study are characterized not only by their age, but also by being members of certain birth cohorts, and sharing the collective life history of their generation.