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Web3
- Blockchain, the New Economy, and the Self-Sovereign Internet
- Ken Huang, Youwei Yang, Fan Zhang, Xi Chen, Feng Zhu
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- August 2024
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- 31 August 2024
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Web3 is a new frontier of internet architecture emphasizing decentralization and user control. This text for MBA students and industry professionals explores key Web3 concepts, starting from foundational principles and moving to advanced topics like blockchain, smart contracts, tokenomics, and DeFi. The book takes a clear, practical approach to demystify the tech behind NFTs and DAOs as well as the complex regulatory landscape. It confronts challenges of blockchain scalability, a barrier to mainstream adoption of this transformative technology, and examines smart contracts and the growing ecosystem leveraging their potential. The book also explains the nuances of tokenomics, a vital element underpinning Web3's new economic model. This book is ideal for readers seeking to stay on top of emerging trends in the digital economy.
National validation of the Centers for Medicare & Medicaid Services strategy for identifying potential surgical-site infections following colon surgery and abdominal hysterectomy
- Michael S. Calderwood, Ken Kleinman, Christina B. Bruce, Lauren Shimelman, Rebecca E. Kaganov, Richard Platt, Susan S. Huang
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 45 / Issue 2 / February 2024
- Published online by Cambridge University Press:
- 07 September 2023, pp. 167-173
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- February 2024
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Objective:
National validation of claims-based surveillance for surgical-site infections (SSIs) following colon surgery and abdominal hysterectomy.
Design:Retrospective cohort study.
Setting:US hospitals selected for data validation by Centers for Medicare & Medicaid Services (CMS).
Participants:The study included 550 hospitals performing colon surgery and 458 hospitals performing abdominal hysterectomy in federal fiscal year 2013.
Methods:We requested 1,200 medical records from hospitals selected for validation as part of the CMS Hospital Inpatient Quality Reporting program. For colon surgery, we sampled 60% with a billing code suggestive of SSI during their index admission and/or readmission within 30 days and 40% who were readmitted without one of these codes. For abdominal hysterectomy, we included all patients with an SSI code during their index admission, all patients readmitted within 30 days, and a sample of those with a prolonged surgical admission (length of stay > 7 days). We calculated sensitivity and positive predictive value for the different groups.
Results:We identified 142 colon-surgery SSIs (46 superficial SSIs and 96 deep and organ-space SSIs) and 127 abdominal-hysterectomy SSIs (58 superficial SSIs and 69 deep and organ-space SSIs). Extrapolating to the full CMS data validation cohort, we estimated an SSI rate of 8.3% for colon surgery and 3.0% for abdominal hysterectomy. Our colon-surgery surveillance codes identified 93% of SSIs, with 1 SSI identified for every 2.6 patients reviewed. Our abdominal-hysterectomy surveillance codes identified 73% of SSIs, with 1 SSI identified for every 1.6 patients reviewed.
Conclusions:Using claims to target record review for SSI validation performed well in a national sample.
Combined laparoscopic and open colon surgery rankings fail to accurately rank hospitals by surgical-site infection rate
- Daniel A. Caroff, Christina Chan, Ken Kleinman, Michael S. Calderwood, Robert Wolf, Richard Platt, Susan S. Huang
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 44 / Issue 4 / April 2023
- Published online by Cambridge University Press:
- 12 July 2022, pp. 624-630
- Print publication:
- April 2023
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Objective:
To compare strategies for hospital ranking based on colon surgical-site infection (SSI) rate by combining all colon procedures versus stratifying by surgical approach (ie, laparoscopic vs open).
Design:Retrospective cohort study.
Methods:We identified SSIs among Medicare beneficiaries undergoing colon surgery from 2009 through 2013 using previously validated methods. We created a risk prediction model for SSI using age, sex, race, comorbidities, surgical approach (laparoscopy vs open), and concomitant colon and noncolon procedures. Adjusted SSI rates were used to rank hospitals. Subanalyses were performed for common colon procedures and procedure types for which there were both open and laparoscopic procedures. We generated ranks using only open and only laparoscopic procedures, overall and for each subanalysis. Rankings were compared using a Spearman correlation coefficient.
Results:In total, 694,813 colon procedures were identified among 508,135 Medicare beneficiaries. The overall SSI rate was 7.6%. The laparoscopic approach was associated with lower SSI risk (OR, 0.5; 95% CI, 0.4–0.5), and higher SSI risk was associated with concomitant abdominal surgeries (OR, 1.4; 95% CI, 1.4–1.5) and higher Elixhauser score (OR, 1.1; 95% CI, 1.0–1.1). Hospital rankings for laparascopic procedures were poorly correlated with rankings for open procedures (r = 0.23).
Conclusions:Hospital rankings based on total colon procedures fail to account for differences in SSI risk from laparoscopic vs open procedures. Stratifying rankings by surgical approach yields a more equitable comparison of surgical performance.
Impact of Roommates on MDRO Spread in Nursing Homes
- Gabrielle M. Gussin, Ken Kleinman, Raveena D. Singh, Raheeb Saavedra, Lauren Heim, Marlene Estevez, Tabitha D. Catuna, Eunjung Lee, Avy Osalvo, Kaye D. Evans, Julie A. Shimabukuro, James A. McKinnell, Loren Miller, Cassiana E. Bittencourt, Ellena M. Peterson, Susan Huang
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s66-s67
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- October 2020
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Background: Addressing the high burden of multidrug-resistant organisms (MDROs) in nursing homes is a public health priority. High interfacility transmission may be attributed to inadequate infection prevention practices, shared living spaces, and frequent care needs. We assessed the contribution of roommates to the likelihood of MDRO carriage in nursing homes. Methods: We performed a secondary analysis of the SHIELD OC (Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, CA) Project, a CDC-funded regional decolonization intervention to reduce MDROs among 38 regional facilities (18 nursing homes, 3 long-term acute-care hospitals, and 17 hospitals). Decolonization in participating nursing homes involved routine chlorhexidine bathing plus nasal iodophor (Monday through Friday, twice daily every other week) from April 2017 through July 2019. MDRO point-prevalence assessments involving all residents at 16 nursing homes conducted at the end of the intervention period were used to determine whether having a roommate was associated with MDRO carriage. Nares, bilateral axilla/groin, and perirectal swabs were processed for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (CRE). Generalized linear mixed models assessed the impact of maximum room occupancy on MDRO prevalence when clustering by room and hallway, and adjusting for the following factors: nursing home facility, age, gender, length-of-stay at time of swabbing, bedbound status, known MDRO history, and presence of urinary or gastrointestinal devices. CRE models were not run due to low counts. Results: During the intervention phase, 1,451 residents were sampled across 16 nursing homes. Overall MDRO prevalence was 49%. In multivariable models, we detected a significant increasing association of maximum room occupants and MDRO carriage for MRSA but not other MDROs. For MRSA, the adjusted odds ratios for quadruple-, triple-, and double-occupancy rooms were 3.5, 3.6, and 2.8, respectively, compared to residents in single rooms (P = .013). For VRE, these adjusted odds ratios were 0.3, 0.3, and 0.4, respectively, compared to residents in single rooms (P = NS). For ESBL, the adjusted odds ratios were 0.9, 1.1, and 1.5, respectively, compared to residents in single rooms (P = nonsignificant). Conclusions: Nursing home residents in shared rooms were more likely to harbor MRSA, suggesting MRSA transmission between roommates. Although decolonization was previously shown to reduce MDRO prevalence by 22% in SHIELD nursing homes, this strategy did not appear to prevent all MRSA transmission between roommates. Additional efforts involving high adherence hand hygiene, environmental cleaning, and judicious use of contact precautions are likely needed to reduce transmission between roommates in nursing homes.
Funding: None
Disclosures: Gabrielle M. Gussin, Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.
Decreased Hospitalizations and Costs From Infection in Sixteen Nursing Homes in the SHIELD OC Regional Decolonization Initiative
- Gabrielle M. Gussin, James A. McKinnell, Raveena D. Singh, Ken Kleinman, Amherst Loren Miller, Raheeb Saavedra, Lauren Heim, Marlene Estevez, Tabitha D. Catuna, Eunjung Lee, Thomas Tjoa, Rachel Slayton, Nimalie Stone, John Jernigan, Matthew Zahn, Lynn Janssen, Shruti K Gohil, Philip Alan Robinson, Steven Park, Robert Weinstein, Mary Hayden, Cassiana E. Bittencourt, Ellena M. Peterson, Susan Huang
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s7-s8
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- October 2020
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Distinguished Oral
Background: Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, California (SHIELD OC) was a CDC-funded regional decolonization intervention from April 2017 through July 2019 involving 38 hospitals, nursing homes (NHs), and long-term acute-care hospitals (LTACHs) to reduce MDROs. Decolonization in NH and LTACHs consisted of universal antiseptic bathing with chlorhexidine (CHG) for routine bathing and showering plus nasal iodophor decolonization (Monday through Friday, twice daily every other week). Hospitals used universal CHG in ICUs and provided daily CHG and nasal iodophor to patients in contact precautions. We sought to evaluate whether decolonization reduced hospitalization and associated healthcare costs due to infections among residents of NHs participating in SHIELD compared to nonparticipating NHs. Methods: Medicaid insurer data covering NH residents in Orange County were used to calculate hospitalization rates due to a primary diagnosis of infection (counts per member quarter), hospital bed days/member-quarter, and expenditures/member quarter from the fourth quarter of 2015 to the second quarter of 2019. We used a time-series design and a segmented regression analysis to evaluate changes attributable to the SHIELD OC intervention among participating and nonparticipating NHs. Results: Across the SHIELD OC intervention period, intervention NHs experienced a 44% decrease in hospitalization rates, a 43% decrease in hospital bed days, and a 53% decrease in Medicaid expenditures when comparing the last quarter of the intervention to the baseline period (Fig. 1). These data translated to a significant downward slope, with a reduction of 4% per quarter in hospital admissions due to infection (P < .001), a reduction of 7% per quarter in hospitalization days due to infection (P < .001), and a reduction of 9% per quarter in Medicaid expenditures (P = .019) per NH resident. Conclusions: The universal CHG bathing and nasal decolonization intervention adopted by NHs in the SHIELD OC collaborative resulted in large, meaningful reductions in hospitalization events, hospitalization days, and healthcare expenditures among Medicaid-insured NH residents. The findings led CalOptima, the Medicaid provider in Orange County, California, to launch an NH incentive program that provides dedicated training and covers the cost of CHG and nasal iodophor for OC NHs that enroll.
Funding: None
Disclosures: Gabrielle M. Gussin, University of California, Irvine, Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.
Automated outbreak detection of hospital-associated pathogens: Value to infection prevention programs
- Meghan A. Baker, Deborah S. Yokoe, John Stelling, Ken Kleinman, Rebecca E. Kaganov, Alyssa R. Letourneau, Neha Varma, Thomas O’Brien, Martin Kulldorff, Damilola Babalola, Craig Barrett, Marci Drees, Micaela H. Coady, Amanda Isaacs, Richard Platt, Susan S. Huang, for the CDC Prevention Epicenters Program
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue 9 / September 2020
- Published online by Cambridge University Press:
- 10 June 2020, pp. 1016-1021
- Print publication:
- September 2020
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Objective:
To assess the utility of an automated, statistically-based outbreak detection system to identify clusters of hospital-acquired microorganisms.
Design:Multicenter retrospective cohort study.
Setting:The study included 43 hospitals using a common infection prevention surveillance system.
Methods:A space–time permutation scan statistic was applied to hospital microbiology, admission, discharge, and transfer data to identify clustering of microorganisms within hospital locations and services. Infection preventionists were asked to rate the importance of each cluster. A convenience sample of 10 hospitals also provided information about clusters previously identified through their usual surveillance methods.
Results:We identified 230 clusters in 43 hospitals involving Gram-positive and -negative bacteria and fungi. Half of the clusters progressed after initial detection, suggesting that early detection could trigger interventions to curtail further spread. Infection preventionists reported that they would have wanted to be alerted about 81% of these clusters. Factors associated with clusters judged to be moderately or highly concerning included high statistical significance, large size, and clusters involving Clostridioides difficile or multidrug-resistant organisms. Based on comparison data provided by the convenience sample of hospitals, only 9 (18%) of 51 clusters detected by usual surveillance met statistical significance, and of the 70 clusters not previously detected, 58 (83%) involved organisms not routinely targeted by the hospitals’ surveillance programs. All infection prevention programs felt that an automated outbreak detection tool would improve their ability to detect outbreaks and streamline their work.
Conclusions:Automated, statistically-based outbreak detection can increase the consistency, scope, and comprehensiveness of detecting hospital-associated transmission.
Lactose Dehydrogenase in Patients with Severe COVID-19: A Meta-Analysis of Retrospective Study
- Xiaoyi Huang, Fengxiang Wei, Ziqing Yang, Min Li, Liuhong Liu, Ken Chen
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- Prehospital and Disaster Medicine / Volume 35 / Issue 4 / August 2020
- Published online by Cambridge University Press:
- 24 April 2020, pp. 462-463
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- August 2020
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The impact of social media promotion with infographics and podcasts on research dissemination and readership
- Brent Thoma, Heather Murray, Simon York Ming Huang, William Ken Milne, Lynsey J. Martin, Christopher M. Bond, Rohit Mohindra, Alvin Chin, Calvin H. Yeh, William B. Sanderson, Teresa M. Chan
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 20 / Issue 2 / March 2018
- Published online by Cambridge University Press:
- 13 September 2017, pp. 300-306
- Print publication:
- March 2018
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Objective
In 2015 and 2016, the Canadian Journal of Emergency Medicine (CJEM) Social Media (SoMe) Team collaborated with established medical websites to promote CJEM articles using podcasts and infographics while tracking dissemination and readership.
MethodsCJEM publications in the “Original Research” and “State of the Art” sections were selected by the SoMe Team for podcast and infographic promotion based on their perceived interest to emergency physicians. A control group was composed retrospectively of articles from the 2015 and 2016 issues with the highest Altmetric score that received standard Facebook and Twitter promotions. Studies on SoMe topics were excluded. Dissemination was quantified by January 1, 2017 Altmetric scores. Readership was measured by abstract and full-text views over a 3-month period. The number needed to view (NNV) was calculated by dividing abstract views by full-text views.
ResultsTwenty-nine of 88 articles that met inclusion were included in the podcast (6), infographic (11), and control (12) groups. Descriptive statistics (mean, 95% confidence interval) were calculated for podcast (Altmetric: 61, 42-80; Abstract: 1795, 1135-2455; Full-text: 431, 0-1031), infographic (Altmetric: 31.5, 19-43; Abstract: 590, 361-819; Full-text: 65, 33-98), and control (Altmetric: 12, 8-15; Abstract: 257, 159-354; Full-Text: 73, 38-109) articles. The NNV was 4.2 for podcast, 9.0 for infographic, and 3.5 for control articles.
DiscussionLimitations included selection bias, the influence of SoMe promotion on the Altmetric scores, and a lack of generalizability to other journals.
ConclusionCollaboration with established SoMe websites using podcasts and infographics was associated with increased Altmetric scores and abstract views but not full-text article views.
Prevalence of and Factors Associated With Multidrug Resistant Organism (MDRO) Colonization in 3 Nursing Homes
- James A. McKinnell, Loren G. Miller, Raveena Singh, Ken Kleinman, Ellena M. Peterson, Kaye D. Evans, Tabitha D. Dutciuc, Lauren Heim, Adrijana Gombosev, Marlene Estevez, Bryn Launer, Tom Tjoa, Steven Tam, Michael A. Bolaris, Susan S. Huang
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 37 / Issue 12 / December 2016
- Published online by Cambridge University Press:
- 27 September 2016, pp. 1485-1488
- Print publication:
- December 2016
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Nursing home residents are at risk for acquiring and transmitting MDROs. A serial point-prevalence study of 605 residents in 3 facilities using random sampling found MDRO colonization in 45% of residents: methicillin-resistant Staphylococcus aureus (MRSA, 26%); extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL, 17%); vancomycin-resistant Enterococcus spp. (VRE, 16%); carbapenem-resistant Enterobacteriaceae (CRE, 1%). MDRO colonization was associated with history of MDRO, care needs, incontinence, and catheters.
Infect Control Hosp Epidemiol 2016;1485–1488
Does Chlorhexidine Bathing in Adult Intensive Care Units Reduce Blood Culture Contamination? A Pragmatic Cluster-Randomized Trial
- Edward J. Septimus, Mary K. Hayden, Ken Kleinman, Taliser R. Avery, Julia Moody, Robert A. Weinstein, Jason Hickok, Julie Lankiewicz, Adrijana Gombosev, Katherine Haffenreffer, Rebecca E. Kaganov, John A. Jernigan, Jonathan B. Perlin, Richard Piatt, Susan S. Huang
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 35 / Issue S3 / October 2014
- Published online by Cambridge University Press:
- 10 May 2016, pp. S17-S22
- Print publication:
- October 2014
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Objective.
To determine rates of blood culture contamination comparing 3 strategies to prevent intensive care unit (ICU) infections: screening and isolation, targeted decolonization, and universal decolonization.
Design.Pragmatic cluster-randomized trial.
Setting.Forty-three hospitals with 74 ICUs; 42 of 43 were community hospitals.
Patients.Patients admitted to adult ICUs from July 1, 2009, to September 30, 2011.
Methods.After a 6-month baseline period, hospitals were randomly assigned to 1 of 3 strategies, with all participating adult ICUs in a given hospital assigned to the same strategy. Arm 1 implemented methicillin-resistant Staphylococcus aureus (MRSA) nares screening and isolation, arm 2 targeted decolonization (screening, isolation, and decolonization of MRSA carriers), and arm 3 conducted no screening but universal decolonization of all patients with mupirocin and chlorhexidine (CHG) bathing. Blood culture contamination rates in the intervention period were compared to the baseline period across all 3 arms.
Results.During the 6-month baseline period, 7,926 blood cultures were collected from 3,399 unique patients: 1,099 sets in arm 1, 928 in arm 2, and 1,372 in arm 3. During the 18-month intervention period, 22,761 blood cultures were collected from 9,878 unique patients: 3,055 sets in arm 1, 3,213 in arm 2, and 3,610 in arm 3. Among all individual draws, for arms 1,2, and 3, the contamination rates were 4.1%, 3.9%, and 3.8% for the baseline period and 3.3%, 3.2%, and 2.4% for the intervention period, respectively. When we evaluated sets of blood cultures rather than individual draws, the contamination rate in arm 1 (screening and isolation) was 9.8% (N = 108 sets) in the baseline period and 7.5% (N = 228) in the intervention period. For arm 2 (targeted decolonization), the baseline rate was 8.4% (N = 78) compared to 7.5% (N = 241) in the intervention period. Arm 3 (universal decolonization) had the greatest decrease in contamination rate, with a decrease from 8.7% (N = 119) contaminated blood cultures during the baseline period to 5.1% (N = 184) during the intervention period. Logistic regression models demonstrated a significant difference across the arms when comparing the reduction in contamination between baseline and intervention periods in both unadjusted (P = .02) and adjusted (P = .02) analyses. Arm 3 resulted in the greatest reduction in blood culture contamination rates, with an unadjusted odds ratio (OR) of 0.56 (95% confidence interval [CI], 0.044-0.71) and an adjusted OR of 0.55 (95% CI, 0.43-0.71).
Conclusion.In this large cluster-randomized trial, we demonstrated that universal decolonization with CHG bathing resulted in a significant reduction in blood culture contamination.
A walking control strategy combining global sensory reflex and leg synchronization
- Chenglong Fu, Jianmei Wang, Ken Chen, Zhangguo Yu, Qiang Huang
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Biped walking can be regarded as a global limit cycle whose stability is difficult to verify by only local sensory feedback. This paper presents a control strategy combining global sensory reflex and leg synchronization. The inverted pendulum angle is utilized as global motion feedback to ensure global stability, and joint synchronization between legs is designed to stabilize bifurcations. The proposed strategy can achieve a stable gait and stabilize bifurcations. The robustness of this approach was evaluated against external disturbances. Walking experiments of a biped actuated by pneumatic muscles were conducted to confirm the validity of the proposed method. Instead of tracking predetermined trajectories, this method uses sensory reflexes to activate motor neurons and coincides with the biological idea wherein inessential degrees-of-freedom are barely controlled rather than strictly controlled.
Use of Medicare Claims to Identify US Hospitals with a High Rate of Surgical Site Infection after Hip Arthroplasty
- Michael S. Calderwood, Ken Kleinman, Dale W. Bratzler, Allen Ma, Christina B. Bruce, Rebecca E. Kaganov, Claire Canning, Richard Piatt, Susan S. Huang, Centers for Disease Control and Prevention Epicenters Program and the Oklahoma Foundation for Medical Quality
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 34 / Issue 1 / January 2013
- Published online by Cambridge University Press:
- 02 January 2015, pp. 31-39
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- January 2013
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Objective.
To assess the ability of Medicare claims to identify US hospitals with high rates of surgical site infection (SSI) after hip arthroplasty.
Design.Retrospective cohort study.
Setting.Acute care US hospitals.
Participants.Fee-for-service Medicare patients 65 years of age and older who underwent hip arthroplasty in US hospitals from 2005 through 2007.
Methods.Hospital rankings were derived from claims codes suggestive of SSI, adjusted for age, sex, and comorbidities, while using generalized linear mixed models to account for hospital volume. Medical records were obtained for validation of infection on a random sample of patients from hospitals ranked in the best and worst deciles of performance. We then calculated the risk-adjusted odds of developing a chart-confirmed SSI after hip arthroplasty in hospitals ranked by claims into worst- versus best-performing deciles.
Results.Among 524,892 eligible Medicare patients who underwent hip arthroplasty at 3,296 US hospitals, a patient who underwent surgery in a hospital ranked in the worst-performing decile based on claims-based evidence of SSI had 2.9-fold higher odds of developing a chart-confirmed SSI relative to a patient with the same age, sex, and comorbidities in a hospital ranked in the best-performing decile (95% confidence interval, 2.2-3.7).
Conclusions.Medicare claims successfully distinguished between hospitals with high and low SSI rates following hip arthroplasty. These claims can identify potential outlier hospitals that merit further evaluation. This strategy can also be used to validate the completeness of public reporting of SSI.
Reply to Moehring et al
- Taliser R. Avery, Ken P. Kleinman, Michael Klompas, Ann Aschengrau, Susan S. Huang
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 33 / Issue 8 / August 2012
- Published online by Cambridge University Press:
- 02 January 2015, pp. 857-858
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- August 2012
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Inclusion of 30-Day Postdischarge Detection Triples the Incidence of Hospital-Onset Methicillin-Resistant Staphylococcus aureus
- Taliser R. Avery, Ken P. Kleinman, Michael Klompas, Ann Aschengrau, Susan S. Huang
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 33 / Issue 2 / February 2012
- Published online by Cambridge University Press:
- 02 January 2015, pp. 114-121
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- February 2012
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Background.
Hospitalized patients are at increased risk for acquisition of methicillin-resistant Staphylococcus aureus (MRSA). As hospital length of stay shortens, hospital-acquired MRSA events may be more likely to be detected after discharge.
Objective.We assessed the impact of attributing MRSA cases discovered within 30 days after discharge to the most recent hospitalization and identified patient characteristics associated with MRSA detection after discharge.
Design.Retrospective cohort study.
Setting.Twenty-seven acute care hospitals in Orange County, California.
Participants.Adult acute care admissions (2002–2007).
Methods.Using a countywide hospital data set containing diagnostic codes with present-on-admission (POA) indicators, we identified the first admission with a MRSA code for each patient. This incident MRSA admission was defined as predischarge-detected (pre-DD) hospital-onset MRSA (HO-MRSA) when MRSA was not POA. If MRSA was POA and a prior admission occurred within 30 days, this prior admission was assigned postdischarge-detected (post-DD) HO-MRSA. We evaluated the impact of including post-DD HO-MRSA in the calculation of hospital HO-MRSA incidence using signed-rank tests and reviewed changes in hospital rankings. We conducted multivariate comparisons of patient characteristics of pre-DD versus post-DD HO-MRSA patients.
Results.Among 1,217,253 at-risk hospitalizations, the inclusion of post-DD HO-MRSA tripled the median hospital HO-MRSA incidence, from 12.2 to 35.7 cases per 10,000 at-risk admissions (P<.0001). Hospital ranking changed substantially when including post-DD HO-MRSA. Patients with shorter stays were more likely to have post-DD MRSA.
Conclusions.On the basis of administrative claims data, the inclusion of post-DD HO-MRSA significantly increased the estimated HO-MRSA incidence and altered hospital rankings. This finding underscores the limitations of single-facility data when deriving HO-MRSA incidence and rank.
Infect Control Hosp Epidemiol 2012;33(2):114-121
COMMISSION 52: RELATIVITY IN FUNDAMENTAL ASTRONOMY
- Gérard Petit, Michael Soffel, Sergei A. Klioner, Victor A. Brumberg, Nicole Capitaine, Agnès Fienga, Bernard Guinot, Cheng Huang, François Mignard, Ken Seidelmann, Patrick Wallace
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- Journal:
- Proceedings of the International Astronomical Union / Volume 7 / Issue T28A / December 2011
- Published online by Cambridge University Press:
- 04 April 2012, pp. 48-49
- Print publication:
- December 2011
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The IAU Commission 52 “Relativity in Fundamental Astronomy” (RIFA) has been established during the 26th General Assembly of the IAU (Prague, 2006). The general scientific goals of the Commission were identified as:
• clarify geometrical and dynamical concepts of Fundamental Astronomy within a relativistic framework,
• provide adequate mathematical and physical formulations to be used in Fundamental Astronomy,
• deepen the understanding of the above results among astronomers and students in astronomy,
• promote research needed to accomplish these tasks.
Use of Medicare Claims to Rank Hospitals by Surgical Site Infection Risk following Coronary Artery Bypass Graft Surgery
- Susan S. Huang, Hilary Placzek, James Livingston, Allen Ma, Fallon Onufrak, Julie Lankiewicz, Ken Kleinman, Dale Bratzler, Margaret A. Olsen, Rosie Lyles, Yosef Khan, Paula Wright, Deborah S. Yokoe, Victoria J. Fraser, Robert A. Weinstein, Kurt Stevenson, David Hooper, Johanna Vostok, Rupak Datta, Wato Nsa, Richard Platt
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 32 / Issue 8 / August 2011
- Published online by Cambridge University Press:
- 02 January 2015, pp. 775-783
- Print publication:
- August 2011
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Objective.
To evaluate whether longitudinal insurer claims data allow reliable identification of elevated hospital surgical site infection (SSI) rates.
Design.We conducted a retrospective cohort study of Medicare beneficiaries who underwent coronary artery bypass grafting (CABG) in US hospitals performing at least 80 procedures in 2005. Hospitals were assigned to deciles by using case mix–adjusted probabilities of having an SSI-related inpatient or outpatient claim code within 60 days of surgery. We then reviewed medical records of randomly selected patients to assess whether chart-confirmed SSI risk was higher in hospitals in the worst deciles compared with the best deciles.
Participants.Fee-for-service Medicare beneficiaries who underwent CABG in these hospitals in 2005.
Results.We evaluated 114,673 patients who underwent CABG in 671 hospitals. In the best decile, 7.8% (958/12,307) of patients had an SSI-related code, compared with 24.8% (2,747/11,068) in the worst decile (P<.001). Medical record review confirmed SSI in 40% (388/980) of those with SSI-related codes. In the best decile, the chart-confirmed annual SSI rate was 3.2%, compared with 9.4% in the worst decile, with an adjusted odds ratio of SSI of 2.7 (confidence interval, 2.2–3.3; P<.001) for CABG performed in a worst-decile hospital compared with a best-decile hospital.
Conclusions.Claims data can identify groups of hospitals with unusually high or low post-CABG SSI rates. Assessment of claims is more reproducible and efficient than current surveillance methods. This example of secondary use of routinely recorded electronic health information to assess quality of care can identify hospitals that may benefit from prevention programs.
Deep simple morphophysiological dormancy in seeds of the basal taxad Cephalotaxus
- Chia Ju Yang, Ching-Te Chien, Yue Ken Liao, Shun-Ying Chen, Jerry M. Baskin, Carol C. Baskin, Ling-Long Kuo-Huang
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- Journal:
- Seed Science Research / Volume 21 / Issue 3 / September 2011
- Published online by Cambridge University Press:
- 11 May 2011, pp. 215-226
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Although mature seeds of the monogeneric conifer family Cephalotaxaceae sensu stricto have underdeveloped embryos, no definitive studies have been done to classify dormancy in this family. Our primary purpose was to determine the kind of dormancy in seeds of Cephalotaxus wilsoniana and to put the results into a broad phylogenetic context for gymnosperms. The species is of horticultural and medicinal value, and information is needed on how to propagate it efficiently from seeds. Embryo growth and germination were monitored for seeds at warm, cold and warm plus cold temperatures, and germination was monitored for seeds subjected to: (1) cold → warm → cold → warm; and (2) warm → cold → warm → cold → warm temperature sequences. The effects of gibberellic acids GA3 and GA4 were tested on radicle emergence in ungerminated seeds and on shoot emergence in root-emerged seeds. Germination was promoted by ≥ 36 weeks of warm stratification followed by ≥ 8 weeks of cold stratification, but only if seeds were returned to high temperatures. The underdeveloped embryo must increase in length by >120% before the radicle emerges. Neither GA3 nor GA4 was effective in promoting radicle emergence; however, both plant growth regulators increased rate (but not percentage) of shoot emergence in root-emerged seeds. We conclude that seeds of C. wilsoniana have the deep simple level of morphophysiological dormancy (MPD), C1b-C3-B1b; thus, warm stratification followed by cold stratification and then warm-temperature incubation are required for germination. In gymnosperms, MPD is known in cycads, Ginkgo and now in three families of conifers.
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. 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- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- The Cambridge Dictionary of Christianity
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- 05 August 2012
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- 20 September 2010, pp xi-xliv
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COMMISSION 52: RELATIVITY IN FUNDAMENTAL ASTRONOMY
- Sergei A. Klioner, Gérard Petit, Victor A. Brumberg, Nicole Capitaine, Agnès Fienga, Toshio Fukushima, Bernard Guinot, Cheng Huang, François Mignard, Ken Seidelmann, Michael Soffel, Patrick Wallace
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- Journal:
- Proceedings of the International Astronomical Union / Volume 6 / Issue T27B / December 2010
- Published online by Cambridge University Press:
- 14 May 2010, pp. 142-145
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- December 2010
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The IAU Commission 52 “Relativity in Fundamental Astronomy” (RIFA) has been established during the 26th General Assembly of the IAU (Prague, 2006) to centralize the efforts in the field of Applied Relativity and to provide an official forum for corresponding discussions.
Noninvasive methods of accurately diagnosing in children anomalous origin of the left coronary artery from the pulmonary trunk
- Kuang-Jen Chien, Ta-Cheng Huang, Kai-Sheng Hsieh, Chu-Chuan Lin, Ken-Pen Weng, Jun-Yen Pan, Cheng-Liang Lee
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- Cardiology in the Young / Volume 19 / Issue 5 / October 2009
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- 13 August 2009, pp. 474-481
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Background
Anomalous origin of the left coronary artery from the pulmonary trunk is a rare congenital heart defect. Cardiac catheterization remains the standard means of diagnosis. Our purpose in this study is to emphasize the importance of assessing the electrocardiogram when making the diagnosis, in addition to taking note of transthoracic echocardiographic findings. We also analyzed the sensitivity of each parameter under investigation.
Methods and ResultsBetween June, 1999, and March, 2007, we studied 9 patients, 6 males and 3 females, with a mean age of 3.02 years, in whom anomalous origin of the left coronary artery from the pulmonary trunk was suspected subsequent to transthoracic echocardiographic examination. We examined their electrocardiograms, and undertook cardiac catheterization. In all patients, the transthoracic echocardiogram had shown retrograde flow into the pulmonary trunk, with the left coronary artery arising from pulmonary trunk, along with a dilated right coronary artery, or intercoronary collateral vessels. In 8 patients, the electrocardiogram showed deep Q wave in leads I and aVL, with depression of the ST segments over lead V4 through 6, or inversion of the T waves in leads I, II, and aVL. In the remaining patient, the electrocardiogram showed incomplete right bundle branch block. Later, cardiac catheterization confirmed the diagnosis in 8 patients, but the other patient was shown to have the right coronary artery arising from the pulmonary trunk.
ConclusionsBy combining transthoracic echocardiography with study of the electrocardiogram, it is possible to provide accurate evaluation of anomalous origin of the left coronary artery from the pulmonary trunk.