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The purpose of this document is to highlight practical recommendations to assist acute care hospitals to prioritize and implement strategies to prevent ventilator-associated pneumonia (VAP), ventilator-associated events (VAE), and non-ventilator hospital-acquired pneumonia (NV-HAP) in adults, children, and neonates. This document updates the Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA), and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology, and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
Stochastic Efficiency with Respect to a Function (SERF) is used to rank transgenic cotton technology groups and place an upper and lower bound on their value. Yield and production data from replicated plot experiments are used to build cumulative distribution functions of returns for nontransgenic, Roundup Ready, Bollgard, and stacked gene cotton cultivars. Analysis of Arkansas data indicated that the stacked gene and Roundup Ready technologies would be preferred by a large number of risk neutral and risk averse producers as long as the costs of the technology and seed are below the lower bounds calculated in this manuscript.
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their surgical site infection (SSI) prevention efforts. This document updates “Strategies to Prevent Surgical Site Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
In pregnancies complicated by placental insufficiency (PI), fetal hypoglycemia and hypoxemia progressively worsen during the third trimester, which increases circulating norepinephrine (NE). Pharmacological adrenergic blockade (ADR-block) at 0.9 gestation revealed that NE inhibits insulin secretion and enhanced β-cell responsiveness in fetuses with PI-induced intrauterine growth restriction (IUGR). NE concentrations in PI fetuses at 0.7 gestation were threefold greater compared with age-matched controls, but the levels were similar to near-term controls. Therefore, our objective was to determine whether elevations in plasma NE concentrations inhibit insulin secretion and produce compensatory β-cell responsiveness in PI fetuses at 0.7 gestation. Fetal insulin was measured under basal, glucose-stimulated insulin secretion (GSIS) and glucose-potentiated arginine-stimulated insulin secretion (GPAIS) conditions in the absence and presence of an ADR-block. Placental weights were 38% lower (P < 0.05) in PI fetus than in controls, but fetal weights were not different. PI fetuses had lower (P < 0.05) basal blood oxygen content, plasma glucose, insulin-like growth factor-1 and insulin concentrations and greater plasma NE concentrations (891 ± 211 v. 292 ± 65 pg/ml; P < 0.05) than controls. GSIS was lower in PI fetuses than in controls (0.34 ± 0.03 v. 1.08 ± 0.06 ng/ml; P < 0.05). ADR-block increased GSIS in PI fetuses (1.19 ± 0.11 ng/ml; P < 0.05) but decreased GSIS in controls (0.86 ± 0.02 ng/ml; P < 0.05). Similarly, GPAIS was 44% lower (P < 0.05) in PI fetuses than in controls, and ADR-block increased (P < 0.05) GPAIS in PI fetuses but not in controls. Insulin content per islet was not different between treatments. We conclude that elevations in fetal plasma NE suppress insulin concentrations, and that compensatory β-cell stimulus-secretion responsiveness is present before IUGR.
While the broad-lined Type Ic supernovae (SN Ic-bl) associated with long-duration gamma-ray bursts (GRBs) have been studied, we do not fully understand the conditions that lead to each kind of explosion in a massive star. Here we show clues as to the production mechanism of GRBs by comparing the chemical abundances at the sites of 5 nearby (z < 0.25) broad-lined SN Ic that accompany nearby GRBs with those of 12 nearby (z < 0.14) broad-lined SN Ic that have no observed GRBs. We show that the oxygen abundances at the GRB sites are systematically lower than those found near ordinary broad-lined SN Ic. A unique feature of this analysis is that we present new spectra of the host galaxies and analyze the measurements of both samples in the same set of ways, using 3 independent metallicity diagnostics. We demonstrate that neither SN selection effects (SN found via targeted vs. non-targeted surveys) nor the choice of strong-line metallicity diagnostic can cause the observed trend. Though our sample size is small, the observations are consistent with the hypothesis that low metal abundance is the cause of some massive stars becoming SN-GRB. We derive a cut-off metallicity of 0.2−0.6 Z⊙, with the exact value depending on the adopted metallicity scale and solar abundance value.
To determine whether gases generated during the breakdown of accumulated manure in an environmentally regulated building affects the onset of puberty in gilts, 42 crossbred gilts, born from 1 o t 15 September 1985, were reared indoors from 10 to 30 weeks of age on concrete slats over a pit that was drained and refilled with clean water biweekly (clean group). Forty-two gilts were reared over a pit where manure was allowed to accumulate (control group). These two groups had similar feeding, water, floor space, lighting and room temperature. A third group of 42 crossbred gilts was reared from 10 to 30 weeks of age in an open-front building with a concrete apron (outdoor group). Concentration of aerial ammonia in the control environment was three- to five-fold higher than in either the clean or the outdoor environment (P < 0·001). Average daily gain and food conversion efficiency were similar for the two indoor treatment groups, but the outdoor group gained less weight than either indoor group (P < 0·05). At 26 weeks of age all gilts were exposed to mature boars daily for 2 weeks, then every 2nd day for an additional 2 weeks. A greater proportion of gilts in the clean environment attained puberty 7 days (P < 0·05) and 10 days (P < 0·07) after first exposure to boars. These data suggest that odorous gases, such as ammonia, in the air of environmentally regulated buildings may diminish the stimulatory influence of boars on the onset of puberty in gilts.
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