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Background: Rates of ventilator-associated events (VAEs), including infection-related ventilator-associated complications (IVACs) and probable ventilator-associated pneumonia (PVAPs) have increased nationwide since the onset of the COVID-19 pandemic. In December 2021, our health system adopted a new electronic medical record (EMR), which changed the way surveillance for VAEs is performed. We reviewed surveillance criteria, COVID-19 status, and culturing practices in attempts to understand why VAE rates continue to be elevated. Methods: We collected data on VAE type, culture data, COVID-19 status, and surveillance criteria for all patients meeting NHSN definitions for VAE from 2018 through November 2022. For all patients in 2022 (post-EMR transition), 2 physicians (A.D. and M.D.) manually reviewed documented ventilator settings from flow sheets to validate the automated EMR data, and they evaluated culture data for appropriateness. Cultures were defined as appropriate unless they were included in “pancultures” for leukocytosis without concern for pneumonia documented. Rates were compared using an interrupted time series (ITS) analysis before and after the onset of the COVID-19 pandemic and the EMR transition. Patient level data were compared across periods using the χ2 test. All analyses were performed using SAS version 9.4 software. Results: COVID-19 has been implicated in the increasing number of VAEs since the pandemic began: 6% of patients in 2020, 18% in 2021, and 23% in 2022 (P < .001). The percentage of patients meeting criteria for VAE by positive end-expiratory pressure (PEEP) decreased from 2018 to 2022 (92%, 95%, 93%, 85%, 85%, respectively; P = .0004). Patients meeting criteria for VAE by fraction of inspired oxygen (FiO2) increased from 2018 to 2022 (9%, 6%, 11%, 17%, 19%, respectively; P = .0002). Manual review of 2022 data indicated opportunities for test stewardship in 8 of 65 patients with cultures (12%). ITS analysis revealed that IVAC+ rates were climbing prior to the onset of the COVID-19 pandemic (Fig. 1). We observed a marked increase in rates with the implementation of our new EMR and the changes to our surveillance process (0.32 cases per 100 ventilator days). Manual review of records from 2022 revealed 5 patients in which documentation of ventilator settings to meet VAE diagnosis could not be retrieved from flow sheets. Conclusions: COVID-19 continues to affect VAE despite vaccine availability and may partially account for elevated rates nationwide. However, changes in EMR-automated VAE surveillance may also affect rates. Our findings suggest that automated surveillance captures transient or spurious changes in ventilator machine settings that do not accurately represent clinical status. These data may contribute to spurious increases in VAE. More studies are needed to better understand the impact of both COVID-19 and automated surveillance on VAE.
The U.S. Department of Agriculture–Agricultural Research Service (USDA-ARS) has been a leader in weed science research covering topics ranging from the development and use of integrated weed management (IWM) tactics to basic mechanistic studies, including biotic resistance of desirable plant communities and herbicide resistance. ARS weed scientists have worked in agricultural and natural ecosystems, including agronomic and horticultural crops, pastures, forests, wild lands, aquatic habitats, wetlands, and riparian areas. Through strong partnerships with academia, state agencies, private industry, and numerous federal programs, ARS weed scientists have made contributions to discoveries in the newest fields of robotics and genetics, as well as the traditional and fundamental subjects of weed–crop competition and physiology and integration of weed control tactics and practices. Weed science at ARS is often overshadowed by other research topics; thus, few are aware of the long history of ARS weed science and its important contributions. This review is the result of a symposium held at the Weed Science Society of America’s 62nd Annual Meeting in 2022 that included 10 separate presentations in a virtual Weed Science Webinar Series. The overarching themes of management tactics (IWM, biological control, and automation), basic mechanisms (competition, invasive plant genetics, and herbicide resistance), and ecosystem impacts (invasive plant spread, climate change, conservation, and restoration) represent core ARS weed science research that is dynamic and efficacious and has been a significant component of the agency’s national and international efforts. This review highlights current studies and future directions that exemplify the science and collaborative relationships both within and outside ARS. Given the constraints of weeds and invasive plants on all aspects of food, feed, and fiber systems, there is an acknowledged need to face new challenges, including agriculture and natural resources sustainability, economic resilience and reliability, and societal health and well-being.
This paper is the fourth in a series of low-frequency searches for technosignatures. Using the Murchison Widefield Array over two nights, we integrate 7 h of data toward the Galactic Centre (centred on the position of Sagittarius
) with a total field-of-view of
. We present a targeted search toward 144 exoplanetary systems, at our best yet angular resolution (75 arcsec). This is the first technosignature search at a central frequency of 155 MHz toward the Galactic Centre (our previous central frequencies have been lower). A blind search toward in excess of 3 million stars toward the Galactic Centre and Galactic bulge is also completed, placing an equivalent isotropic power limit
at the distance to the Galactic Centre. No plausible technosignatures are detected.
The concept of dignity is core to community district nursing practice, yet it is profoundly complex with multiple meanings and interpretations. Dignity does not exist absolutely, but, rather, becomes socially (de)constructed through and within social interactions between nurses and older adult patients in relational aspects of care. It is a concept, however, which has, to date, received little attention in the context of the community nursing care of older adults. Previous research into dignity in health care has often focused on care within institutional environments, very little, however, explores the variety of ways in which dignity is operationalised in community settings where district nursing care is conducted ‘behind closed doors’, largely free from the external gaze. This means dignity (or the lack of it) may go unobserved in community settings. Drawing on observational and interview data, this paper highlights the significance of dignity for older adults receiving nursing care in their own homes. We will demonstrate, in particular, how dignity manifests within the relational aspects of district nursing care delivery and how tasks involving bodywork can be critical to the ways in which dignity is both promoted and undermined. We will further highlight how micro-articulations in caring relationships fundamentally shape the ‘dignity encounter’ through a consideration of the routine and, arguably, mundane aspects of community district nursing care in the home.
The coronavirus disease 2019 (COVID-19) pandemic has resulted in shortages of personal protective equipment (PPE), underscoring the urgent need for simple, efficient, and inexpensive methods to decontaminate masks and respirators exposed to severe acute respiratory coronavirus virus 2 (SARS-CoV-2). We hypothesized that methylene blue (MB) photochemical treatment, which has various clinical applications, could decontaminate PPE contaminated with coronavirus.
The 2 arms of the study included (1) PPE inoculation with coronaviruses followed by MB with light (MBL) decontamination treatment and (2) PPE treatment with MBL for 5 cycles of decontamination to determine maintenance of PPE performance.
MBL treatment was used to inactivate coronaviruses on 3 N95 filtering facepiece respirator (FFR) and 2 medical mask models. We inoculated FFR and medical mask materials with 3 coronaviruses, including SARS-CoV-2, and we treated them with 10 µM MB and exposed them to 50,000 lux of white light or 12,500 lux of red light for 30 minutes. In parallel, integrity was assessed after 5 cycles of decontamination using multiple US and international test methods, and the process was compared with the FDA-authorized vaporized hydrogen peroxide plus ozone (VHP+O3) decontamination method.
Overall, MBL robustly and consistently inactivated all 3 coronaviruses with 99.8% to >99.9% virus inactivation across all FFRs and medical masks tested. FFR and medical mask integrity was maintained after 5 cycles of MBL treatment, whereas 1 FFR model failed after 5 cycles of VHP+O3.
MBL treatment decontaminated respirators and masks by inactivating 3 tested coronaviruses without compromising integrity through 5 cycles of decontamination. MBL decontamination is effective, is low cost, and does not require specialized equipment, making it applicable in low- to high-resource settings.
The archaeological site of Saruq al-Hadid, Dubai, United Arab Emirates, presents a long sequence of persistent temporary human occupation on the northern edge of the Rub’ al-Khali desert. The site is located in active dune fields, and evidence for human activity is stratified within a deep sequence of natural dune deposits that reflect complex taphonomic processes of deposition, erosion and reworking. This study presents the results of a program of radiocarbon (14C) and thermoluminescence dating on deposits from Saruq al-Hadid, allied with studies of material remains, which are amalgamated with the results of earlier absolute dating studies provide a robust chronology for the use of the site from the Bronze Age to the Islamic period. The results of the dating program allow the various expressions of human activity at the site—ranging from subsistence activities such as hunting and herding, to multi-community ritual activities and large scale metallurgical extraction—to be better situated chronologically, and thus in relation to current debates regarding the development of late prehistoric and early historic societies in southeastern Arabia.
We present Phantom, a fast, parallel, modular, and low-memory smoothed particle hydrodynamics and magnetohydrodynamics code developed over the last decade for astrophysical applications in three dimensions. The code has been developed with a focus on stellar, galactic, planetary, and high energy astrophysics, and has already been used widely for studies of accretion discs and turbulence, from the birth of planets to how black holes accrete. Here we describe and test the core algorithms as well as modules for magnetohydrodynamics, self-gravity, sink particles, dust–gas mixtures, H2 chemistry, physical viscosity, external forces including numerous galactic potentials, Lense–Thirring precession, Poynting–Robertson drag, and stochastic turbulent driving. Phantom is hereby made publicly available.
Landsat-5 Thematic Mapper spectral data and field survey information were combined to identify specific land cover types associated with 1741 dyers woad infestation points on the Cache National Forest in northern Utah. Ten of 60 possible cover types were strongly associated with current dyers woad infestations, and therefore considered highly suited to establishment and survival of the weed. Non-infested land of the same “highly suited” cover types comprised an additional 24 714 ha within the 149 021-ha study area, suggesting the potential for an eventual 124-fold increase in dyers woad incidence on the forest.
Genetic variability for loci governing enzyme/morphological variants and for herbicide response was determined in 10 populations of the slender wild oat (Avena barbata Pott. ex Link ♯ AVEBA), six populations of wild oat (Avena fatua L. ♯ AVEFA), and three populations of godetia (Clarkia williamsonii Lewis & Lewis). The enzyme loci were identified by starch gel electrophoresis and included peroxidase, 6-phosphogluconate dehydrogenase, esterase, and leucine aminopeptidase for the slender wild oat; peroxidase, esterase, leucine aminopeptidase, and malate dehydrogenase for the wild oat; and esterase, phosphoglucoisomerase, leucine aminopeptidase, acid phosphatase, and glutamate oxaloacetate transaminase for godetia. Morphological loci included lemma and leaf sheath hairiness for the oats. For both the enzymatic and morphological loci, levels of genetic variation for each population were quantified by a polymorphic index. The herbicide barban (4-chloro-2-butynyl 3-chlorophenylcarbamate) was used on the wild oats; bromoxynil (3,5-dibromo-4-hydroxybenzonitrile) was used on godetia. Genetic variation for herbicide response was based on genetic variances calculated from phytotoxicity scores. Populations were ranked from highest to lowest for the polymorphic indices and the genetic variances. Concordance between the rankings was tested by rank correlation. Statistically significant relationships were found between the enzyme/morphological characters and herbicide response in the slender wild oat and the wild oat. For some species, the level of genetic variation for response to herbicides appears to be associated with genetic variation for enzymatic and morphological loci.
The morphological and physiological response of the slender oat (Avena barbata Pott ex Link # AVEBA) to the herbicides barban (4-chloro-2-butynyl 3-chlorophenylcarbamate) and difenzoquat (1,2-dimethyl-3,5-diphenyl-1H-pyrazolium) in conjunction with decreased water availability was determined for seven populations, representing three ecotypes, under greenhouse conditions. Generally, within the range of sublethal herbicide doses, with increasing herbicide rates, phytotoxicity ratings increased, but plant dry weight, tiller height, and number of spikelets were decreased. Also, the number of juvenile tillers decreased, while that of fertile tillers increased. Flag leaf area increased and flowering was delayed. The ratio of number of spikelets to plant dry weight and seed weight was influenced the least. Under the highest rates of difenzoquat, the within-plant variance of spikelet number decreased, indicating that there may have been a more equal partitioning of resources amongst tillers for spikelet production. The general influence of water stress was to amplify the effect of the herbicide. For example, the dry treatment reduced dry weight and tiller height, and delayed flowering. Within a particular herbicide treatment, the effect of the water stress was to cause reduced within-plant variance for days to flowering, flag leaf area, and number of spikelets. Three reactions were observed that could have helped buffer decreases in spikelet production: 1) An increased fraction of the dry weight of the plants was partitioned into the spikelets at the expense of other vegetative matter, 2) the increased leaf area of the primary tiller may have helped counterbalance any reduction in photosynthesis caused by herbicide action, and 3) an increased number of juvenile tillers was converted into fertile tillers resulting in an increased number of mature tillers. These data indicate that the slender oat has a remarkable “phenotypic plasticity,” which enables it to maintain reproductive structures under sublethal herbicide doses.
The level of genetic variation for tolerance to herbicides was quantified in populations of slender wild oat (Avena barbata Brott. # AVEBA), wild oat (Avena fatua L. # AVEFA), and godetia (Clarkia williamsonii Lewis & Lewis) that had not been previously exposed to herbicides. Seedlings of wild oat and godetia were treated with barban (4-chloro-2-butynl-m-chlorocarbanilate) and bromoxynil (3,5-dibromo-4-hydroxybenzonitrile), respectively. The plants were rated for phytotoxic effects following treatment. A one-way analysis of variance on arcsin-transformed phytotoxicity ratings showed significant amounts of inter- and intrapopulation variability for herbicide reaction. Furthermore, the amount of genetic variance for herbicide reaction is higher than expected on the basis of mutation alone, suggesting selection favoring genes conferring herbicide tolerance occurs in natural populations.
Seed from 21 common milkweed (Asclepias syriaca L. # ASCSY) populations from six states were germinated on six substrates (filter paper, sand, peat, clay, and mixtures) under three temperature regimes. The variation in germination response between populations and experimental conditions was analyzed. The greatest percent germination (59% average over all substrates) was obtained with an alternating 20 C (16 h), 30 C (8 h) temperature regime. At a constant temperature of 30 C, germination was lower (32% average) and much more variable among seeds from different populations. At 25 C, average percent germination dropped to 1.2% over all substrates. Germination appeared to be strongly correlated with seed source (population), temperature, and substrate type, and poorly correlated with seed size. No association was found between geographical origin and germination response.
Brownspine pricklypear (Opuntia phaecantha Engelm. & Bigel.) was effectively controlled within 2 yr following application of a 1:1 mixture of 2,4,5-T [(2,4,5-trichlorophenoxy)acetic acid] and picloram (4-amino-3,5,6-trichloropicolinic acid) at a rate of 0.6 kg ae/ha. Brownspine pricklypear canopy cover and dry weight declined from approximately 23% and 3800 kg/ha to 8% and 1600 kg/ha, respectively. No significant difference in total herbaceous forage dry weight was found between plants growing inside brownspine pricklypear canopy areas and plants growing outside the canopy areas. Differences between areas in species composition were significant in that cool-season grasses dominated the canopy area of the brownspine pricklypear colonies while warm-season grasses dominated the area outside the canopy. Control of brownspine pricklypear will enhance livestock carrying capacity of rangeland in the Rolling Plains of Texas by increasing forage availability but not forage production.
Dose–response analysis is widely used in biological sciences and has application to a variety of risk assessment, bioassay, and calibration problems. In weed science, dose–response methodologies have typically relied on least squares estimation under the assumptions of normal, homoscedastic, and independent errors. Advances in computational abilities and available software, however, have given researchers more flexibility and choices for data analysis when these assumptions are not appropriate. This article will explore these techniques and demonstrate their use to provide researchers with an up-to-date set of tools necessary for analysis of dose–response problems. Demonstrations of the techniques are provided using a variety of data examples from weed science.
Objectives: Kids in Control OF Food (KICk-OFF) is a 5-day structured education program for 11- to 16-year-olds with type 1 diabetes mellitus (T1DM) who are using multiple daily insulin injections. This study evaluates the cost-effectiveness of the KICk-OFF education program compared with the usual care using data from the KICk-OFF trial.
Methods: The short-term within-trial analysis covers the 2-year postintervention period. Data on glycated hemoglobin (HbA1c), severe hypoglycemia, and diabetic ketoacidosis (DKA) were collected over a 2-year follow-up period. Sub-group analyses have been defined on the basis of baseline HbA1c being below 7.5 percent (58.5 mmol/mol) (low group), between 7.5 percent and 9.5 percent (80.3 mmol/mol) (medium group), and over 9.5 percent (high group). The long-term cost-effectiveness evaluation has been conducted by using The Sheffield Type 1 Diabetes Policy Model, which is a patient-level simulation model on T1DM. It includes long-term microvascular (retinopathy, neuropathy, and nephropathy) and macrovascular (myocardial infarction, stroke, revascularization, and angina) diabetes-related complications and acute adverse events (severe hypoglycemia and DKA).
Results: The most favorable within-trial scenario for the KICk-OFF arm led to an incremental cost-effectiveness ratio (ICER) of £23,688 (base year 2009) with a cost-effectiveness probability of 41.3 percent. Simulating the long-term complications using the full cohort data, the mean ICER for the base case was £28,813 (base year 2011) and the probability of the KICk-OFF intervention being cost-effective at £20,000/QALY threshold was 42.6 percent, with considerable variation due to treatment effect duration. For the high HbA1c sub-group, the KICk-OFF arm was “dominant” (meaning it provided better health gains at lower costs than usual care) over the usual care arm in each scenario considered.
Conclusions: For the whole study population, the cost-effectiveness of KICk-OFF depends on the assumption for treatment effect duration. For the high baseline HbA1c sub-group, KICk-OFF arm was estimated to be dominant over the usual care arm regardless of the assumption on the treatment effect duration.
To determine the source and identify control measures of an outbreak of Tsukamurella species bloodstream infections at an outpatient oncology facility.
Epidemiologic investigation of the outbreak with a case-control study.
A case was an infection in which Tsukamurella species was isolated from a blood or catheter tip culture during the period January 2011 through June 2012 from a patient of the oncology clinic. Laboratory records of area hospitals and patient charts were reviewed. A case-control study was conducted among clinic patients to identify risk factors for Tsukamurella species bloodstream infection. Clinic staff were interviewed, and infection control practices were assessed.
Fifteen cases of Tsukamurella (Tsukamurella pulmonis or Tsukamurella tyrosinosolvens) bloodstream infection were identified, all in patients with underlying malignancy and indwelling central lines. The median age of case patients was 68 years; 47% were male. The only significant risk factor for infection was receipt of saline flush from the clinic during the period September–October 2011 (P = .03), when the clinic had been preparing saline flush from a common-source bag of saline. Other infection control deficiencies that were identified at the clinic included suboptimal procedures for central line access and preparation of chemotherapy.
Although multiple infection control lapses were identified, the outbreak was likely caused by improper preparation of saline flush syringes by the clinic. The outbreak demonstrates that bloodstream infections among oncology patients can result from improper infection control practices and highlights the critical need for increased attention to and oversight of infection control in outpatient oncology settings.