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To institute facility-wide Kamishibai card (K-card) rounding for central venous catheter (CVC) maintenance bundle education and adherence and to evaluate its impact on bundle reliability and central-line–associated bloodstream infection (CLABSI) rates.
Design:
Quality improvement project.
Setting:
Inpatient units at a large, academic freestanding children’s hospital.
Participants:
Data for inpatients with a CVC in place for ≥1 day between November 1, 2017 and October 31, 2018 were included.
Intervention:
A K-card was developed based on 7 core elements in our CVC maintenance bundle. During monthly audits, auditors used the K-cards to ask bedside nurses standardized questions and to conduct medical record documentation reviews in real time. Adherence to every bundle element was required for the audit to be considered “adherent.” We recorded bundle reliability prospectively, and we compared reliability and CLABSI rates at baseline and 1 year after the intervention.
Results:
During the study period, 2,321 K-card audits were performed for 1,051 unique patients. Overall maintenance bundle reliability increased significantly from 43% at baseline to 78% at 12 months after implementation (P < .001). The hospital-wide CLABSI rate decreased from 1.35 during the 12-month baseline period to 1.17 during the 12-month intervention period, but the change was not statistically significant (incidence rate ratio [IRR], 0.87; 95% confidence interval [CI], 0.60–1.24; P = .41).
Conclusions:
Hospital-wide CVC K-card rounding facilitated standardized data collection, discussion of reliability, and real-time feedback to nurses. Maintenance bundle reliability increased after implementation, accompanied by a nonsignificant decrease in the CLABSI rate.
The re-emergence of debates on the decolonisation of knowledge has revived interest in the National Question, which began over a century ago and remains unresolved. Tensions that were suppressed and hidden in the past are now being openly debated. Despite this, the goal of one united nation living prosperously under a constitutional democracy remains elusive. This edited volume examines the way in which various strands of left thought have addressed the National Question, especially during the apartheid years, and goes on to discuss its relevance for South Africa today and in the future. Instead of imposing a particular understanding of the National Question, the editors identified a number of political traditions and allowed contributors the freedom to define the question as they believed appropriate – in other words, to explain what they thought was the Unresolved National Question. This has resulted in a rich tapestry of interweaving perceptions. The volume is structured in two parts. The first examines four foundational traditions: Marxism-Leninism (the Colonialism of a Special Type thesis); the Congress tradition; the Trotskyist tradition; and Africanism. The second part explores the various shifts in the debate from the 1960s onwards, and includes chapters on Afrikaner nationalism, ethnic issues, black consciousness, feminism, workerism and constitutionalism. The editors hope that by revisiting the debates not popularly known among the scholarly mainstream, this volume will become a catalyst for an enriched debate on our identity and our future.
Three types of geographic isolation—land barriers, deep water barriers, and climatic barriers—resulted in three distinct evolutionary responses in Neogene and Quaternary species of the epineritic ostracode genus Puriana. Through systematic, paleobiogeographic, and morphologic study of several hundred fossil and Recent populations from the eastern Pacific, western Atlantic, Gulf of Mexico, and the Caribbean, the phylogeny of the genus and the geography of speciation events were determined. Isolation of large populations by the Isthmus of Panama during the Pliocene did not lead to lineage splitting in species known to have existed before the Isthmus formed. Conversely, the establishment of small isolated populations on Caribbean islands by passive dispersal mechanisms frequently led to the evolution of new species or subspecies. Climatic changes along the southeastern United States during the Pliocene also catalyzed possible parapatric speciation as populations that immigrated to the northeastern periphery of the genus' range split to form new species. The results provide evidence that evolutionary models describing the influence of abiotic events on patterns of evolution and speciation can be tested using properly selected tectonic and climatic events and fossil groups amenable to species-level analysis. Two new species, P. bajaensis and P. paikensis, are described.
The Champlain Sea occupied the Champlain Valley from about 12,500 to 10,000 yr BP. Following an initial maximum limit of inundation, isostatic crustal rebound caused the sea's gradual regression, which is documented by the parallel alignment of tilted shoreline features at successively low elevations along a north-south profile. Two new radiocarbon shell dates, 11,665 ± 175 (QC 200), elevation 95 m, and 10,300 ± 180 (QC 199), elevation 47 m, date early and late Champlain Sea deposits, respectively. From the elevation (ASL) and invertebrate fauna of littoral deposits, three environmentally distinct phases of the sea were recognized. Early Champlain Sea Transitional phase deposits at high elevations are characterized by a mixed association of fresh and euryhaline marine ostracodes. Frigid-subfrigid climates and fluctuating salinities of this period possibly reflect intermixing of the fresh waters of Lake Vermont with incoming marine waters. Hiatella arctica phase faunas indicate similar climatic conditions but significantly higher salinities (polyhaline). Deposits from the final phase of the sea, the Mya arenaria phase, were found at low elevations just above the present level of Lake Champlain. A predominantly cold-temperate, mesohaline fauna characterizes this period. The influences of Lake Algonquin drainage, warm Gulf Stream water and perhaps the retreating Laurentide Ice Sheet are discussed as possible causes for the observed faunal and environmental changes.
Rapidly accumulating Holocene sediments in estuaries commonly are difficult to sample and date. In Chesapeake Bay, we obtained sediment cores as much as 20 m in length and used numerous radiocarbon ages measured by accelerator mass spectrometry methods to provide the first detailed chronologies of Holocene sediment accumulation in the bay. Carbon in these sediments is a complex mixture of materials from a variety of sources. Analyses of different components of the sediments show that total organic carbon ages are largely unreliable, because much of the carbon (including coal) has been transported to the bay from upstream sources and is older than sediments in which it was deposited. Mollusk shells (clams, oysters) and foraminifera appear to give reliable results, although reworking and burrowing are potential problems. Analyses of museum specimens collected alive before atmospheric nuclear testing suggest that the standard reservoir correction for marine samples is appropriate for middle to lower Chesapeake Bay. The biogenic carbonate radiocarbon ages are compatible with 210Pb and 137Cs data and pollen stratigraphy from the same sites.
Post-settlement changes in sediment transport and accumulation is an important environmental issue in many estuaries, including the Chesapeake. Our data show that large variations in sediment mass accumulation rates occur among sites. At shallow water sites, local factors seem to control changes in accumulation rates with time. Our two relatively deep-water sites in the axial channel of the bay have different long-term average accumulation rates, but the history of sediment accumulation at these sites appears to reflect overall conditions in the bay. Mass accumulation rates at the two deep-water sites rapidly increased by about fourfold coincident with widespread land clearance for agriculture in the Chesapeake watershed.
Marine ostracodes from 50 localities were studied to determine the age and elevation of Pleistocene sea levels in the Atlantic coastal plain from Maryland to northern Florida. Using ostracode taxon and concurrent ranges, published planktic biostratigraphic, paleomagnetic, and radiometric data, ostracode assemblage zones representing early (1.8-1.0 my), middle (0.7-0.4 my), and late (0.3-0.01 my) Pleistocene deposition were recognized and used as a basis for correlation. Ostracode biofacies signifying lagoonal, oyster bank, estuarine, open sound, and inner sublittoral environments provided estimated ranges of paleodepths for each locality. From these data the following minimum and maximum Pleistocene sea-level estimates were determined for the southeastern coastal plain: late Pleistocene, 2–10 m from Maryland to northern Florida; middle Pleistocene, 6–15 m in northern South Carolina; early Pleistocene, 4–22 m in central North Carolina, 13–35 m in southern North Carolina, and 6–27 m in South Carolina. Climatically induced glacio-eustatic sea-level fluctuations adequately account for the late Pleistocene sea-level data, but other factors, possibly differential crustal uplift, may have complicated the early Pleistocene record.
Radiocarbon-dated sediment cores from the Champlain Valley (northeastern USA) contain stratigraphic and micropaleontologic evidence for multiple, high-magnitude, freshwater discharges from North American proglacial lakes to the North Atlantic. Of particular interest are two large, closely spaced outflows that entered the North Atlantic Ocean via the St. Lawrence estuary about 13,200–12,900 cal yr BP, near the beginning of the Younger Dryas cold event. We estimate from varve chronology, sedimentation rates and proglacial lake volumes that the duration of the first outflow was less than 1 yr and its discharge was approximately 0.1 Sv (1 Sverdrup = 106 m3 s−1). The second outflow lasted about a century with a sustained discharge sufficient to keep the Champlain Sea relatively fresh for its duration. According to climate models, both outflows may have had sufficient discharge, duration and timing to affect meridional ocean circulation and climate. In this report we compare the proglacial lake discharge record in the Champlain and St. Lawrence valleys to paleoclimate records from Greenland Ice cores and Cariaco Basin and discuss the two-step nature of the inception of the Younger Dryas.
Although post-glacial marine sediments of late Wisconsinan and early Holocene age are common in eastern Canada and the northeastern United States, remnants of older Pleistocene marine sediments are scarce. A fossiliferous marine clay that predates the classical Wisconsinan was recently discovered in the St. Lawrence Valley. A dominantly estuarine environment is inferred from the geochemistry of the shells (δ18O = −7.1) and from benthic foraminifer and ostracode assemblages. The clay indicates a marine invasion (Cartier Sea) shallower and probably shorter than that during the upper late Wisconsinan Champlain Sea episode (12,000–9,500 yr B.P.). The pollen content shows that regional vegetation during the marine episode began as open tundra, then became a Betula and Alnus crispa forest, reached a climatic optimum with Quercus, Corylus, and Abies, and concluded as a Pinus/Picea boreal forest. A corrected infrared stimulated luminescence age of 98,000 ± 9000 yr is compatible with the epimerization ratio of shells. The Cartier Sea resulted from a post-glacial glacio-isostatic marine invasion in the St. Lawrence lowlands. It probably occurred during late stage 5 and is tentatively assigned to the transition of oxygen isotope substages 5b/5a. This marine episode dates to stage 5 of the preceding continental glacier which extended to middle latitudes in NE America.
On the western side of the Tjörnes Peninsula in northern Iceland exposures of fossiliferous marine sediments, basalts, and glacial tills record the climatic history of this region of the North Atlantic Ocean. Seventy-five marine ostracode species were recovered from the Pliocene Tjörnes sediments and Quaternary sediments known as the Breidavik beds. The ostracode assemblages contain many warm-water genera that do not inhabit Iceland today and indicate early to middle Pliocene (4.5–3.0 Ma) winter and summer bottom-water temperatures that averaged 5–6°C and 14–16°C, respectively (maximum 20°C in summer, rarely below 3°C in winter except during a brief cooling 3.5–3.2 Ma). An intensified North Atlantic Drift and a diminished or absent East Greenland Current account for warm-water oceanographic conditions at 66°N. Late Pliocene marine climates were cooler with winter and summer averages of about 9°C and 8°C. Early Pleistocene ostracode assemblages dated at 1.7–1.3 Ma contain extant arctic–subarctic species that indicate winter and summer temperatures of about − 1.5°C and 4–5°C. New species Bensonocythere eirikssoni, Robertsonites williamsi, Hemicythere rekaensis, Thaerocythere mayburyae, Thaerocythere whatleyi, Leptocythere tjornesensis, Tetracytherura bardarsoni, and Cytheromorpha einarssoni are described.
The compound eyes of trilobites provide the best examples of fossilized sensory organs for which the function in life can be worked out today because the optical array of their corneal lenses preserves the geometry with which the eye originally sampled the visual world. An analysis of trilobite vision is strengthened by the use of new mathematical approaches to compound eye design. In particular, the product of the facet diameter (D) and the interommatidial angle (Δϕ) gives the value of the eye parameter, DΔϕ, which is a reliable indicator of the photic conditions in which the eye was used. In modern arthropods, DΔϕ values range from 0.3 for animals active in bright sunlight to 20 or more for nocturnal or deep-sea animals. Two major types of compound eyes existed in trilobites: schizochroal and holochroal. In our previous work with schizochroal eyes in the phacopids Phacops rana crassituberculata and Phacops rana milleri, we found that eye parameter values ranged from 10 to >150. These values of the eye parameter are much greater than in any living arthropod, implying that modern compound eye theory does not apply to schizochroal eyes. We suggested that each ommatidium of the schizochroal eye served as a miniature lens eye. If so, phacopid vision must have been unique, with multiply overlapping visual fields. In the new work of this paper, we examined holochroal compound eyes in Asaphus cornutus, Isotelus gigas, and Homotelus sp. Holochroal eyes contain far more ommatidia than do schizochroal types, reducing both facet diameter (D) and interommatidial angle (Δϕ). Thus, DΔϕ values in these species fall into the same range as in modern nocturnal compound eyes. This implies that function of the holochroal eye was similar to that of modern arthropods, and that they were used in moderate to dim intensities of light.
There is growing evidence that changes in deep-sea benthic ecosystems are modulated by climate changes, but most evidence to date comes from the North Atlantic Ocean. Here we analyze new ostracod and published foraminiferal records for the last 250,000 years on Shatsky Rise in the North Pacific Ocean. Using linear models, we evaluate statistically the ability of environmental drivers (temperature, productivity, and seasonality of productivity) to predict changes in faunal diversity, abundance, and composition. These microfossil data show glacial-interglacial shifts in overall abundances and species diversities that are low during glacial intervals and high during interglacials. These patterns replicate those previously documented in the North Atlantic Ocean, suggesting that the climatic forcing of the deep-sea ecosystem is widespread, and possibly global in nature. However, these results also reveal differences with prior studies that probably reflect the isolated nature of Shatsky Rise as a remote oceanic plateau. Ostracod assemblages on Shatsky Rise are highly endemic but of low diversity, consistent with the limited dispersal potential of these animals. Benthic foraminifera, by contrast, have much greater dispersal ability and their assemblages at Shatsky Rise show diversities typical for deep-sea faunas in other regions.
Statistical analyses also reveal ostracod-foraminferal differences in relationships between environmental drivers and biotic change. Rarefied diversity is best explained as a hump-shaped function of surface productivity in ostracods, but as having a weak and positive relationship with temperature in foraminifera. Abundance shows a positive relationship with both productivity and seasonality of productivity in foraminifera, and a hump-shaped relationship with productivity in ostracods. Finally, species composition in ostracods is influenced by both temperature and productivity, but only a temperature effect is evident in foraminifera. Though complex in detail, the global-scale link between deep-sea ecosystems and Quaternary climate changes underscores the importance of the interaction between the physical and biological components of paleoceanographical research for better understanding the history of the biosphere.