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Central line-associated bloodstream infection (CLABSI) is one of the most prevalent pediatric healthcare-associated infections and is used to benchmark hospital performance. Pediatric patients have increased in acuity and complexity over time. Existing approaches to risk adjustment do not control for individual patient characteristics, which are strong predictors of CLABSI risk and vary over time. Our objective was to develop a risk adjustment model for CLABSI in hospitalized children and compare observed to expected rates over time.
Design and Setting:
We conducted a prospective cohort study using electronic health record data at a quaternary Children’s Hospital.
Patients:
We included hospitalized children with central catheters.
Methods:
Risk factors identified from published literature were considered for inclusion in multivariable modeling based on association with CLABSI risk in bivariable analysis and expert input. We calculated observed and expected (risk model-adjusted) annual CLABSI rates.
Results:
Among 16,411 patients with 520,209 line days, 633 patients experienced 796 CLABSIs. The final model included age, behavioral health condition, non-English speaking, oncology service, port catheter type, catheter dwell time, lymphatic condition, total parenteral nutrition, and number of organ systems requiring ICU level care. For every organ system receiving ICU level care the odds ratio for CLABSI was 1.24 (95% CI 1.12–1.37). Although not statistically different, observed rates were lower than expected rates for later years.
Conclusions:
Failure to adjust for patient factors, particularly acuity and complexity of disease, may miss clinically significant differences in CLABSI rates, and may lead to inaccurate interpretation of the impact of quality improvement efforts.
In an Indian oncology setting, between August and December 2021, 56 patients, developed Burkholderia cenocepacia bacteremia. An investigation revealed a contaminated batch of the antiemetic drug palonosetron. The outbreak was terminated by withdrawing the culprit batch and the findings were reported promptly to regulatory authorities.
This report is on the synthesis by electrospinning of multiferroic core-shell nanofibers of strontium hexaferrite and lead zirconate titanate or barium titanate and studies on magneto-electric (ME) coupling. Fibers with well-defined core–shell structures showed the order parameters in agreement with values for nanostructures. The strength of ME coupling measured by the magnetic field-induced polarization showed the fractional change in the remnant polarization as high as 21%. The ME voltage coefficient in H-assembled films showed the strong ME response for the zero magnetic bias field. Follow-up studies and potential avenues for enhancing the strength of ME coupling in the core–shell nanofibers are discussed.
A novel pure-vision egomotion estimation algorithm is presented, with extensions to Unmanned Aerial Systems (UAS) navigation through visual odometry. Our proposed method computes egomotion in two stages using panoramic images segmented into sky and ground regions. Rotations (in 3DOF) are estimated by using a customised algorithm to measure the motion of the sky image, which is affected only by the rotation of the aircraft, and not by its translation. The rotation estimate is then used to derotate the optic flow field generated by the ground, from which the translation of the aircraft (in 3DOF) is estimated by another customised, iterative algorithm. Segmentation of the rotation and translation estimations allows for a partial relaxation of the planar ground assumption, inherently increasing the robustness of the approach. The translation vectors are scaled using stereo-based height to compute the current UAS position through path integration for closed-loop navigation. Outdoor field tests of our approach in a small quadrotor UAS suggest that the technique is comparable to the performance of existing state-of-the-art vision-based navigation algorithms, whilst also removing all dependence on additional sensors, such as an IMU or global positioning system (GPS).
There is increased interest in new classes of mini- and micro-UAVs with sizes ranging from one metre to ten centimetres. Many envisioned applications of such UAVs require them to be able to fly close to the ground in complex environments. The difficulties associated with flying in such environments coupled with the reduced payload capacity of such airframes means that new methods of sensing and control need to be considered. Good models for such methods are found in the world of flying insects. One particular visual cue used by insects is optic flow, which is the apparent visual motion seen by the insect as a result of its motion through the environment. This paper discusses several research efforts aimed at developing new sensing and control algorithms inspired by insect vision and flight behaviors. These efforts are part of DARPA's controlled biological and biomimetic systems (CBBS) programme. In these (and related) efforts, many elegant control stratagems have been discovered which suggest that simple reflexive schemes combined with the measurement of optic flow may be sufficient to provide many aspects of autonomous navigation in complex environments. Furthermore, these efforts are implementing these behaviors in real flying UAV platforms by using novel hardware and software to measure optic flow, and inserting optic flow measurements into a control loop using a combination of ‘best engineering approaches’ with inspiration taken from biology. This has resulted in fixed and rotary-wing mini-UAVs that are able to hold an altitude and perform terrain following.
To identify correlates of anaemia during the first trimester of pregnancy among 366 urban South Indian pregnant women.
Design
Cross-sectional study evaluating demographic, socio-economic, anthropometric and dietary intake data on haematological outcomes.
Setting
A government maternity health-care centre catering predominantly to the needs of pregnant women from the lower socio-economic strata of urban Bangalore.
Subjects
Pregnant women (n 366) aged ≥18 and ≤40 years, who registered for antenatal screening at ≤14 weeks of gestation.
Results
Mean age was 22·6 (sd 3·4) years, mean BMI was 20·4 (sd 3·3) kg/m2 and 236 (64·5 %) of the pregnant women were primiparous. The prevalence of anaemia (Hb <11·0 g/dl) was 30·3 % and of microcytic anaemia (anaemia with mean corpuscular volume <80 fl) 20·2 %. Mean dietary intakes of energy, Ca, Fe and folate were well below the Indian RDA. In multivariable log-binomial regression analysis, anaemia was independently associated with high dietary intakes of Ca (relative risk; 95 % CI: 1·79; 1·16, 2·76) and P (1·96; 1·31, 2·96) and high intake of meat, fish and poultry (1·94; 1·29, 2·91).
Conclusions
Low dietary intake of multiple micronutrients, but higher intakes of nutrients that inhibit Fe absorption such as Ca and P, may help explain high rates of maternal anaemia in India.
Seven organ/space surgical site infections (SSIs) that occurred after arthroscopic procedures and were due to Pseudomonas aeruginosa of indistinguishable pulsed-field gel electrophoresis (PFGE) patterns occurred at hospital X in Texas from April 22, 2009, through May 7, 2009.
Objective.
To determine the source of the outbreak and prevent future infections.
Design.
Infection control observations and a case-control study.
Methods.
Laboratory records were reviewed for case finding. A case-control study was conducted. A case patient was defined as someone who underwent knee or shoulder arthroscopy at hospital X during the outbreak period and subsequently developed organ/space SSI due toP. aeruginosa. Cultures of environmental and surgical equipment samples were performed, and selected isolates were analyzed by PFGE. Surgical instrument reprocessing practices were reviewed, and surgical instrument lumens were inspected with a borescope after reprocessing to assess cleanliness.
Results.
The case-control study did not identify any significant patient-related or operator-related risk factors. P. aeruginosa grew from 62 of 388 environmental samples. An isolate from the gross decontamination sink had a PFGE pattern that was indistinguishable from that of the case patient isolates. All surgical instrument cultures showed no growth. Endoscopic evaluation of reprocessed arthroscopic equipment revealed retained tissue in the lumen of both the inflow/outflow cannulae and arthroscopic shaver handpiece. No additional cases occurred after changes in instrument reprocessing protocols were implemented. After this outbreak, the US Food and Drug Administration released a safety alert about the concern regarding retained tissue within arthroscopic shavers.
Conclusions.
These SSIs were likely related to surgical instrument contamination with P. aeruginosa during instrument reprocessing. Retained tissue in inflow/outflow cannulae and shaver handpieces could have allowed bacteria to survive sterilization procedures.
Carbapenem-resistant Klebsiella pneumoniae (CRKP) is resistant to almost all antimicrobial agents, and CRKP infections are associated with substantial morbidity and mortality.
Objective.
To describe an outbreak of CRKP in Puerto Rico, determine risk factors for CRKP acquisition, and detail the successful measures taken to control the outbreak.
Design.
Two case-control studies.
Setting.
A 328-bed tertiary care teaching hospital.
Patients.
Twenty-six CRKP case patients identified during the outbreak period of February through September 2008, 26 randomly selected uninfected control patients, and 26 randomly selected control patients with carbapenem-susceptible K. pneumoniae (CSKP) hospitalized during the same period.
Methods.
We performed active case finding, including retrospective review of the hospital's microbiology database and prospective perirectal surveillance culture sampling in high-risk units. Case patients were compared with each control group while controlling for time at risk. We sequenced the blaKPC gene with polymerase chain reaction for 7 outbreak isolates and subtyped these isolates with pulsed-field gel electrophoresis.
Results.
In matched, multivariable analysis, the presence of wounds (hazard ratio, 19.0 [95% confidence interval {CI}, 2.5-142.0]) was associated with CRKP compared with no K. pneumoniae. Transfer between units (adjusted odds ratio [OR], 7.5 [95% CI, 1.8-31.1]), surgery (adjusted OR, 4.0 [95% CI, 1.0-15.7]), and wounds (adjusted OR, 4.9 [95% CI, 1.1-21.8]) were independent risk factors for CRKP compared to CSKP. A novel K. pneumoniae carbapenemase variant (KPC-8) was present in 5 isolates. Implementation of active surveillance for CRKP colonization and cohorting of CRKP patients rapidly controlled the outbreak.
Conclusions.
Enhanced surveillance for CRKP colonization and intensified infection control measures that include limiting the physical distribution of patients can reduce CRKP transmission during an outbreak.
While undernutrition and anaemia have previously been linked to poor development of children, relatively little is known about the role of B-vitamins and fatty acids on cognition. The present study aims to explore the associations between indicators of body size, fatty acid and micronutrient status on cognitive performance in 598 Indian school children aged 6–10 years. Baseline data of a clinical study were used to assess these associations by analyses of variance adjusting for age, sex, school, maternal education and cognitive tester. The Kaufman Assessment Battery for Children II was used to measure four cognitive domains, including fluid reasoning, short-term memory, retrieval ability and cognitive speediness. Scores were combined into an overall measure, named mental processing index (MPI). Body size indicators and Hb concentrations were significantly positively related to cognitive domains and MPI, such that increases of 1 sd in height-for-age and weight-for-age z-scores would each translate into a 0·09 sd increase in MPI, P = 0·0006 and 0·002, respectively. A 10 g/l increase in Hb concentrations would translate into a 0·08 sd increase in MPI, P = 0·0008. Log-transformed vitamin B12 concentrations were significantly inversely associated with short-term memory, retrieval ability and MPI (β (95 % CI) = − 0·124 ( − 0·224, − 0·023), P = 0·02). Other indicators of Fe, iodine, folate and fatty acid status were not significantly related to cognition. Our findings for body size, fatty acids and micronutrients were in agreement with previous observational studies. The inverse association of vitamin B12 with mental development was unexpected and needed further study.
Although gradient schemes for detecting the motion of images and measuring their velocities are commonly used in computer vision, and although there is increasing evidence to support the existence of such schemes in biological vision, little attention has been directed to suggesting how such computations might be realized by neural hardware. This paper proposes two simple models, consisting of physiologically realistic networks of neurons, that approximate the gradient scheme. Computer simulations demonstrate that the models measure the speed of an object or pattern independently of its structural properties.
When negotiating a narrow gap, honeybees tend to fly through the middle of the gap, balancing the distances to the boundary on either side. To investigate the basis of this “centering response,” bees were trained to fly through a tunnel on their way to a feeding site and back, while their flight trajectories were filmed from above. The wall on either side carried a visual pattern. When the patterns were stationary vertical gratings, bees tended to fly through the middle of the tunnel, i.e. along its longitudinal axis. However, when one of the gratings was in motion, bees flying in the same direction as the moving grating tended to fly closer to while bees flying in the opposite direction tended to fly closer to the stationary grating. This demonstrates, directly and unequivocally, that flying bees estimate the distances of surfaces in terms of the apparent motion of their images. A series of further experiments revealed that the distance to the gratings is gauged in terms of their apparent angular speeds, and that the visual system of the bee is capable of measuring angular speed largely independently of the spatial period, intensity profile, or contrast of the grating. Thus, the motion-sensitive mechanisms mediating range perception appear to be qualitatively different from those that mediate the well-known optomotor response in insects, or those involved in motion detection and ocular tracking in man.
The strength of the flanking inhibitory regions of the receptive fields of fly lamina cells (LMC) decreases as the mean luminance is lowered. Simultaneously, the biphasic temporal flash (impulse) response of the lamina cells becomes monophasic on lowering luminance. For a moving-edge stimulus at high mean luminance, this implies that the spatial integration by the larnina cell yields a temporal waveform which is congruent to the waveform of the temporal impulse response of the lamina cell. In other words, the temporal waveform generated by the moving edge is matched to the temporal waveform most preferred by the lamina cell. The edge is the stimulus causing the largest amplitude response at high (above 1 cd/m2) levels of luminance. On lowering luminance, the now monophasic nature of the spatial and temporal impulse responses of the lamina gives a preference not for the edges but for the center of a uniform region. We describe this theory and its behavioral corroboration in walking flies (Lucilia cuprina).
The ability of freely-flying honeybees to track moving targets was examined by training to collect a reward on a target, and then videotaping their approach to the target while it was in motion. Training experiments were carried out with several groups of bees, using various colors for the target and the background. Computer-aided frame-by-frame analysis of video recordings was used to plot the instantaneous positions of the target, as well as the position and orientation of the approaching bee in three dimensions. The results show that bees are perfectly capable of tracking moving targets and landing on them. When the distance of the target is greater than 15 cm, approaching bees correct for angular deviations of the target from the midline, both in the horizontal and in the vertical plane. In either plane, the input vaariables that are important to the tracking system seem to be (1) the angular bearing of the target with respect and (2) the angular velocity of the target with respect to the eye. The tracking control system tends to orient the bee such that the target is located frontally, at an angle of Ca. 35 deg below the bee's long axis. The chromatic properties of tracking behavior were investigated by employing combinations of colors for the target and background such that the boundary between the target and the background presented a contrast that was visible either only to the green-sensitive receptors of the bee's eye, or only to theblue-sensitive receptors. The results of these experiments suggest that, in controlling tracking, the measurement of the angular velocity of the target is derived almost exclusively from signals from the green-sensitive receptors, as is the case with previously studied movement-sensitive behavior. However, the measurement of the angular bearing of the target is derived from the blue-sensitive receptors as well as the green-sensitive noes. When the target is closer than Ca. 15 cm, approaching bees use translational maneuvers, in addition to rotational ones, to track the moving target. Translational target tracking appears to be driven primarily by signals from the green-sensitive receptors.
Linkage was detected between brown planthopper resistance and anthocyanin or nonanthocyanin pigmentation in rice cultivars. The crossover values were: 21·9–37% for leaf sheath, 31% for junctura, 41% for auricle, 12·5–40% for ligule, 14·32–1% for leaf tip and margin, 19·7–37% for stigma, 19·7–36% for apiculus and 46·7% for pericarp colour. Genes governing resistance and black hull colour or glabrousness of leaf blade assorted independently. The genes identified and designated for brown planthopper resistance and pigmentation have been tentatively proposed to linkage groups II, IV and V.
The polyvinylidenefluoride (PVdF) based novel polymer electrolytes have been prepared by solution casting technique for solid state rechargeable magnesium batteries. Tetraglyme and tetrabutyl ammoniumchloride were used respectively as plasticizer and filler. The Mg(ClO$_{4})_{4}$ was used as conducting source. A.c. impedance spectroscopy results reveal that 5 wt% TBACl containing electrolyte show the maximum conductivity of 4.32 × 10-4 S/cm at ambient temperature. This electrolyte was electrochemically stable upto 1.5 V which was observed through linear sweep voltammetry. X-ray diffractograms studies suggest that the electrolytes are completely in amorphous phase. The improved entanglement like surface morphology was well observed for 5 wt% TBACl containing electrolyte by scanning electron microscope. The activation energy and coherence length were calculated.
Early results from the SAGE-SMC (Surveying the Agents of Galaxy Evolution in the tidally-disrupted, low-metallicity Small Magellanic Cloud) Spitzer legacy program are presented. These early results concentrate on the SAGE-SMC MIPS observations of the SMC Tail region. This region is the high H i column density portion of the Magellanic Bridge adjacent to the SMC Wing. We detect infrared dust emission and measure the gas-to-dust ratio in the SMC Tail and find it similar to that of the SMC Body. In addition, we find two embedded cluster regions that are resolved into multiple sources at all MIPS wavelengths.
Vestibular schwannomas are the most common tumours encountered in the cerebellopontine angle (CPA) region, accounting for 90 per cent of all lesions. Early pyogenic abscess following surgery and delayed abscesses due to retained foreign bodies have been reported. We describe a case of sterile abscess of unknown aetiology in the CPA region, occurring 13 years after surgical excision of a vestibular schwannoma. The clinical and radiological features were suggestive of recurrent vestibular schwannoma or malignant transformation.
We believe this is the first reported case of delayed occurrence of sterile abscess in the CPA region. Further the diagnostic difficulties of such rare lesions occurring in the CPA after vestibular schwannoma surgery are discussed.