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Although preventable through established infection control practices, catheter-associated urinary tract infections (CAUTIs) remain prevalent in acute-care settings. Our goal was to improve the CAUTI rates through multiple hospitals through implementing sustainable practices, including enhancing communication, provider engagement, accountability, and transparency in reporting to achieve long-term improvements.
Design:
Quality improvement with multiple levels of interventions
Setting:
A health system in northern Ohio with 21 affiliated hospitals across 16 counties.
Patients:
Adult patients admitted to the hospital between June 2020 and June 2023.
Methods:
A broad set of quality improvement (QI) strategies was developed by an interdisciplinary team and guided by the Fractal Management System framework to ensure accountability, communication, and alignment across teams and facilities. Key drivers were indwelling urinary catheter (IUC) alternatives, insertion, maintenance, removal, and smart diagnostics. The main outcome measures were standardized infection ratios (SIR) and standardized utilization ratio (SUR), comparing period 1 (P1, June 2020 to December 2021) and period 2 (P2, January 2022 to June 2023).
Results:
Enhanced communication and management played crucial roles in minimizing IUC placement. Updated policies and protocols, coupled with clear guidelines and decision support tools, facilitated effective urinary management. Performance tracking and visual management boards provided real-time insights, while collaborative efforts, including staff huddles and multidisciplinary teamwork, ensured consistent adherence to best practices.
Conclusions:
A systemwide QI initiative focused on enhanced communication, management, and collaboration contributed to improved SIR and reduced CAUTI rates across multiple hospitals, highlighting the impact of strong communication and proactive management in healthcare settings.
The effectiveness of utilizing heating patterns as a drag-reduction tool in sloping channels is analysed. The usefulness of heating is judged by determining the pressure gradient required to maintain the same flow rate as in the isothermal case. The key to reducing pressure loss is the formation of separation bubbles, although these bubbles are washed away at relatively large Reynolds numbers. The bubbles reduce the direct contact between the stream and the side walls, thereby reducing the friction experienced by the flow. Moreover, the fluid inside the bubbles tends to rotate, a motion provoked by longitudinal temperature gradients. This rotation also seems to reduce the resistance. On the other hand, the existence of the bubbles tends to obstruct the stream, increasing the flow resistance. In general, channels oriented close to horizontal experience a relatively small pressure loss, but this loss grows markedly as the channel inclines towards the vertical. When modest heating is applied, the pressure loss is approximately proportional to the square of the associated Rayleigh number. It is also shown that if the heating wavelength is too short or too long, the heating loses its effectiveness. In certain circumstances, it turns out that the theoretical pressure-gradient reduction achieved by judicious heating is so large that it exceeds the pressure gradient required to drive the flow in the isothermal problem. The conclusion is that in these instances, a pressure gradient of the opposite sign must be applied to prevent flow acceleration.
Glaciers in High-Mountain Asia are experiencing varying rates and patterns of mass loss due to a complex interplay between glacier surface processes, local conditions and climate forcing. Spatially distributed surface mass balance (SMB) estimates can provide valuable insight into these drivers, but observations are currently limited in both space and time. We used very-high-resolution optical stereo images acquired by commercial satellites to prepare time series of digital elevation models (DEMs), and derived contemporaneous surface velocity and elevation change products for six debris-covered glaciers in Nepal. We developed new methods to produce flow-corrected Lagrangian SMB maps to isolate local surface ablation signals with enough detail to study individual ice cliffs. Our results show reduced ablation under thick debris cover and enhanced ablation over ice cliffs. Ablating ice cliffs were responsible for $10\!-\!38\%$ of the total ablation over debris-covered areas, even though they covered $\leq \!11\%$ of the total area. Seasonal SMB products reveal the timing and patterns of summer accumulation and ablation, underscoring the importance of snow avalanches for low-elevation debris-covered glaciers in the region. Our approach can be applied to other glaciers with repeat high-resolution DEM coverage and extended for regional analyses of SMB on seasonal to interannual timescales.
Tiafenacil is registered in the United States for use in annual crops such as corn and soybean, but not on orchard crops. Field studies were conducted to determine orchard crop safety and efficacy of tiafenacil on important California orchard weeds. To evaluate crop safety, tiafenacil was applied at 74, 148, and 222 g ai ha−1 alone and with 38 g ai ha−1 of tolpyralate three times per year at the base of almond, pistachio, prune, and walnut trees. The first treatment was applied 2 mo after the trees had been transplanted. In all four tree crop experiments, treatments were applied once in May 2020, then three times again during the winter of 2021 and 2022 at 21-d treatment intervals. There were no visual foliar injury symptoms or treatment-related effects on tree trunk diameter change even at the highest tested rate of tiafenacil applied seven times over three growing seasons. In a separate study of weed control, in most instances, tiafenacil applied at 12 g ai ha−1 performed similarly to that of tiafenacil plus glufosinate. Control of glyphosate-resistant hairy fleabane with tiafenacil applied alone at 25 g ai ha−1 was 65% by 14 d after treatment. Tiafenacil applied at 50 g ai ha−1 to hairy fleabane performed similarly to glufosinate plus glyphosate. In a greenhouse study, tiafenacil applied at 12 g ha−1 provided 95% to 100% control of barnyardgrass and junglerice, and there was no significant difference between tiafenacil applied alone or with glufosinate. Saflufenacil applied alone or in a mixture with glufosinate was not as effective as the tiafenacil treatments for grass weed control. Based on experiments conducted over three growing seasons in four tree fruit and tree nut crops, tiafenacil crop safety appeared to be acceptable even at up to 2- or 3-fold the expected use rate.
ATXN3 is a ubiquitin hydrolase (or deubiquitinase, DUB), product of the ATXN3 gene, ubiquitously expressed in various cell types including peripheral and neuronal tissues and involved in several cellular pathways. Importantly, the expansion of the CAG trinucleotides within the ATXN3 gene leads to an expanded polyglutamine domain in the encoded protein, which has been associated with the onset of the spinocerebellar ataxia type 3, also known as Machado–Joseph disease, the most common dominantly inherited ataxia worldwide. ATXN3 has therefore been under intensive investigation for decades. In this review, we summarize the main functions of ATXN3 in proteostasis, DNA repair and transcriptional regulation, as well as the emerging role in regulating chromatin structure. The mentioned molecular functions of ATXN3 are also reviewed in the context of the pathological expanded form of ATXN3.
This study examined the predictors and sequelae of exposure to peer pressure from close friends in adolescence. Adolescents (99 female; 85 male) were followed from age 13 to 24 utilizing peer, parent, and romantic partner reports and observational data. Participants who were exposed to high levels of peer pressure as teens were more likely to experience higher levels of coercive behavior from romantic partners (as reported by those partners), as well as lower levels of parent-reported functional independence. All findings held even after accounting for baseline levels of teen assertiveness. Adolescents at risk for increasing exposure to peer pressure were characterized by poor-quality parent and peer relationships, as well as baseline deficits in ability to assert autonomy. Results suggest that exposure to peer pressure, aside from its potential effects on deviant or risky behavior, may reflect a powerful threat to the autonomy development process as adolescents transition from parents to peers as primary sources of support and interaction.
Agriculture has been dominated by annual plants, such as all cereals and oilseeds, since the very beginning of civilization over 10,000 years ago. Annual plants are planted and uprooted every year which results in severe disturbance of the soil and disrupts ecosystem services. Science has shown that it is possible to domesticate completely new perennial grain crops, i.e. planted once and harvested year after year. Such crops would solve many of the problems of agriculture, but their development and uptake would be at odds with the current agricultural technology industry.
Technical summary
Agriculture is arguably the most environmentally destructive innovation in human history. A root cause is the reliance on annual crops requiring uprooting and restarting every season. Most environmental predicaments of agriculture can be attributed to the use of annuals, as well as many social, political, and economic ones. Advances in domestication and breeding of novel perennial grain crops have demonstrated the possibility of a future agricultural shift from annual to perennial crops. Such a change could have many advantages over the current agricultural systems which are to over 80% based on annual crops mainly grown in monocultures. We analyze and review the prospects for such scientific advances to be adopted and scaled to a level where it is pertinent to talk about a perennial revolution. We follow the logic of E.O. Wright's approach of Envisioning Real Utopias by discussing the desirability, viability, and achievability of such a transition. Proceeding from Lakatos' theory of science and Lukes' three dimensions of power, we discuss the obstacles to such a transition. We apply a transition theory lens to formulate four reasons of optimism that a perennial revolution could be imminent within 3–5 decades and conclude with an invitation for research.
The lifestyle of the population has undergone significant changes due to the COVID-19 pandemic, which could have influenced alterations in dietary habits and overall well-being among workers. This study aimed to evaluate healthy eating practices and their relationship with the workers’ quality of life and physical activity during the COVID-19 pandemic. This was a cross-sectional investigation involving workers in the city of Curitiba, southern Brazil. The study was conducted through the application of an online questionnaire. The data were evaluated using non-parametric tests and fitting a logistic regression model. A total of 123 workers participated in the study, most of them male (53.2%), aged between 31 and 40 years (42.2%), with a predominance of workers with postgraduate degrees (62.6%, n = 77), and the majority of workers (68.2%, n = 84) were performing their professional activities remotely for at least one day during the week, and 73.2% (n = 90). It was observed that 52.8% had excellent healthy eating practices, and the older their age and the greater the practice of physical activity (time and frequency), the better the workers’ healthy eating practices. When assessing quality of life, the lowest average score for healthy eating practices was in the domain of social relationships. A direct relationship of older age, social relationships, and the practice of physical activity with the best individuals’ healthy eating practices was detected. Considering that remote work continues to be adopted post-pandemic, evaluating the dietary practices, physical activity, and quality of life of workers is necessary to understand this new labour phenomenon.
Sulfidated nanoscale zerovalent iron (S-nZVI) materials show enhanced reactivity and selectivity towards chlorinated solvents compared to non-sulfidated nZVI, thus they have a high potential for subsurface chlorinated solvent remediation. However, little is known about the possible toxic effects of S-nZVI towards microbial communities, which is of particular concern with regard to combined abiotic–biotic chlorinated solvent treatment scenarios. In this study, the toxicity of two different S-nZVI materials towards Shewanella oneidensis MR-1 (S. MR-1) was examined under anaerobic and aerobic conditions using colony forming units (CFU) and adenosine triphosphate (ATP) measurements, and the results were then compared to identical exposures performed with non-sulfidated nZVI. In a second step, the toxicity of S-nZVI and nZVI materials was tested on the commercial bioremediation culture KB-1® and on an in-house trichloroethylene enrichment culture. Under aerobic conditions, S. MR-1 viability was less affected by S-nZVI materials compared to non-sulfidated nZVI materials (up to three times higher viability) and it was generally lower compared to anaerobic conditions where little difference in S. MR-1 viability was observed between the tested materials. In terms of the two dechlorinating cultures, they exhibited significantly higher ATP viability during anaerobic exposures to S-nZVI and nZVI materials. Particularly for KB-1®, which retained comparable ATP-viability after ~60 hours exposure as S. MR-1 after two hours. Moreover, the ATP viability of the mixed cultures was generally higher in S-nZVI exposures compared to nZVI exposures (up to three times higher viability). The observed viability patterns are explained by differences in the shell structure, chemistry and stability of the tested S-nZVI and nZVI materials towards corrosion, while the substantially enhanced resilience of KB-1® is argued to stem from its year-long cultivation in the presence of reduced FeS particulates.
Parents have reported emotional regulation problems in cognitive disengagement syndrome (CDS) and attention deficit and hyperactivity disorder (ADHD). The first objective of this research was to explore the differences between the parents’ ratings on CDS, ADHD, hyperactivity/impulsivity, inattention, anxiety, depression and emotional dysregulation. The second one was to compare the predictive capacity of CDS and ADHD over anxiety, depression and emotional regulation problems. The third one was to analyze the mediation of emotional dysregulation in CDS, ADHD, hyperactivity/impulsivity, inattention, and anxiety and depression. The sampling used was non-probabilistic. The final sample consisted of 1,070 participants (484 fathers and 586 mothers) who completed the Emotion Regulation Checklist (ERC) and the Child and Adolescent Behavior Inventory (CABI). In relation to the first objective, first, mothers reported more emotional regulation problems in children than in fathers. Second, emotional regulation problems were more strongly correlated with hyperactivity/impulsivity. Significant differences were found in all father scores, except for anxiety and the emotional regulation subscale. Regarding mothers, significant differences were only observed in ADHD scores, hyperactivity/impulsivity, and depression. Both parents reported more problems in older children, except for hyperactivity/impulsivity scores and ADHD rated by mothers. According to the second objective, CDS scores were found to significantly predict anxiety and depression scores, but not those of inattention or emotional regulation problems. Finally, in relation to the third objective, emotional regulation problems mediated the relationships between CDS, ADHD, and anxiety and depression. In conclusion, the data support the importance of emotional regulation problems in understanding CDS and its relationship with ADHD, anxiety, and depression.
This study empirically examines gender inequality in tolerance for women's opinions and identifies how the provision of normative gender-egalitarian message can mitigate this inequality by conducting online randomized experiments in Japan. In this experiment, I asked the participants to evaluate the agreement score for 10 anonymous statements and implemented two types of random interventions: disclosing the gender of the statement poster and providing normative statement for gender equality. The results of both cross-sectional and panel data analyses showed that people significantly reduced the agreement score for women's opinions compared with men's and non-gender disclosure opinions. Meanwhile, the negative impact of female gender disclosure was neutralized when participants were provided with a normative message.
Our article describes the lifecycle of Lithuania’s Electoral Action of Poles–Christian Families Alliance (LLRA-KŠS) party that has been a part of country’s political landscape for near 30 years. Despite its seemingly ethnic program, the party has a poor track record for delivering on its electoral promises. Yet, it has been continuously supported by the majority of Polish-speakers in Lithuania. The background of the nationalizing state, which encourages the party elites to conflate substantive representation with the signposting of ethnic identity in party politics, offers one of the reasons for the LLRA-KŠS’s electoral success. Although the party effectively consolidated its regional electorate, it came to control service delivery to their ethnic constituency by engaging in pork barrel politics. Poor performance in recent national and municipal elections put this strategy to bond with its voters into question, casting doubt on the LLRA-KŠS’s ability to survive as an ethnic party in the long term.
The expansion of EU regulatory governance in the financial sector since the end of the global financial crisis 2008 has given rise to the need to examine regulatory consistency in the volumes of financial regulation that may have cross-cutting implications. In this light, this article examines the effectiveness of the Regulation of ESG infomediaries through the lens of “functional regulatory consistency” with other infomediary regulations, for credit rating agencies and stock market benchmarks. It argues that this lens most aptly reveals the three key weaknesses of the regulatory regime for ESG infomediaries. These relate to sub-optimal coverage of scope, over-inclusiveness in the application of regulatory standards and under-inclusiveness where appropriate governance is not provided. the sub-optimal coverage of scope raises the question of whether ESG stock market index providers should indeed be regulated as ESG infomediaries or as stock market benchmarks more generally falling within the Benchmarks Regulation 2016. Over-inclusiveness and under-inclusiveness in the regulatory provision reflects blind spots in applying functional regulatory consistency, where it is inappropriate due to distinguishing features in business models, market structures or market relations.
Climate change and pollution harm the public. The healthcare industry disproportionately contributes to greenhouse gas emissions. Infection diseases professionals including infection preventionists and antimicrobial stewards are uniquely positioned to mitigate the environmental impact of our daily practices. We highlight 10 actionable steps that infectious disease professionals can incorporate into daily practices, thereby mitigating the impact of climate change.
Rigorous antibiotic stewardship is advised by international societies to combat rising antibiotic resistance. A major component of these programs is the metric used for antibiotic consumption measurement. A method for standardized antimicrobial administration ratio (SAAR) is suggested by the Centre for Disease Control & Prevention—National Healthcare Safety Network (NHSN).
Objectives:
We applied the SAAR method to calculate antibiotic consumption in a tertiary care hospital in India. We also validated a limited sampling approach to calculate SAAR.
Method:
The prospective study was conducted in three medical intensive care units over a period of 12 months. Monthly antibiotic consumption was measured by the hospital electronic records. Limited sampling was performed by weekly bedside review of the antibiotic orders. Formulae for SAAR calculation were derived from the NHSN guide. SAAR obtained by electronic records and limited sampling were compared to validate this approach.
Results:
SAAR was calculated as >1 for an Indian hospital (1.49 by electronic records and 1.43 by limited sampling approach). The difference between the two ratios was not statistically significant (P = .47).
Conclusions:
SAAR in our setting is 1.49, which is slightly higher than the NHSN benchmark. Antibiotic usage (AU) risk adjustment based on data from the NHSN might not be adequate for calculating SAAR for Indian hospitals. There is a need to perform AU risk factor analysis for Indian settings for better defining SAAR in Indian context. The limited sampling approach can be adapted for calculation of SAAR in settings with limited resources.
Systemic risks such as climate change and pandemics are complex and interconnected. Managing such risks requires effective organisational structures and processes. This publication presents conceptually robust, evidence-based approaches for assessing and managing systemic risks.
Technical summary
Systemic risks originate and evolve in the nexus of tightly coupled dynamic systems, which are a characteristic of modern societies in the Anthropocene. Systemic risk implies the breakdown of a system which provides essential functions to society. Connectivity between systems is a key enabler for systemic risk to manifest through cascading effects. Thus, systemic risks originate and evolve in the nexus of tightly coupled dynamic systems. Cascading effects and the convergence of systemic risks with conventional risks as well as other systemic risks challenge the established modes of risk governance that still rest to a large extent on differentiation and compartmentalisation. Thus, governance of systemic risks requires an integrative approach towards risk governance that combines interdisciplinary risk analysis with iterative, adaptive and inclusive governance procedures. By drawing on the case studies of the COVID-19 pandemic and climate change, this paper proposes an innovative risk governance framework for systemic risks based on the integration of systems analysis and a governance procedure with the salient features of reflection, iteration, inclusion, transparency and accountability.
Social media summary
Systemic risks highlight the interconnected nature of our contemporary societies which calls for tailored responses.
The social defeat hypothesis posits that low status and repeated humiliation increase the risk for psychotic disorders (PDs) and psychotic experiences (PEs). The purpose of this paper was to provide a systematic review of studies on risk of PDs and PEs among lesbian, gay, or bisexual (LGB) people and a quantitative synthesis of any difference in risk. PubMed, PsycINFO, Embase, and Web of Science were searched from database inception until January 30, 2024. Two independent reviewers assessed the eligibility and quality of studies, extracted effect sizes, and noted the results of mediation analyses. Using a random effects model we computed pooled odds ratios (ORs). Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The search identified seven studies of PDs and six of PEs. As for PDs, the unadjusted (2.13; 95% confidence interval 0.72–6.34) and covariate-adjusted pooled OR (2.24; 1.72–3.53) were not significantly increased for LGB individuals. After exclusion of a study of limited quality, both the unadjusted pooled OR (2.77; 1.21–6.32) and the covariate-adjusted pooled OR (2.67; 1.53–4.66) were significantly increased. The pooled ORs were increased for PEs: unadjusted, pooled OR = 1.97 (1.47–2.63), covariate-adjusted, pooled OR = 1.85 (1.50–2.28). Studies of PE that examined the mediating role of several variables reported that the contribution of drug abuse was small compared to that of psychosocial stressors. The results of a study in adolescents suggested a protective effect of parental support. These findings suggest an increased psychosis risk for LGB people and support the social defeat hypothesis.
This study investigated the impact of diallyl disulfide (DADS) on oxidative stress induced by hydrogen peroxide (H2O2) in ovine rumen epithelial cells (RECs). Initially, the effects of DADS were evaluated on cellular reactive oxygen species (ROS) levels, antioxidant capacity in RECs were estimated. Then, RNA-seq analysis was conducted in DADS-treated and untreated cells to analyze the differential gene expression, as well as Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways. Finally, the effects of DADS on Kelch-like ECH associated protein 1/the nuclear factor erythroid 2-related factor 2 (Keap1/Nrf2) signaling pathway in RECs were evaluated. Results showed that DADS remarkably enhanced superoxide dismutase (SOD) activity and total antioxidant capacity (T-AOC) (P < 0.05) while reducing ROS and malonaldehyde production (P < 0.05) in H2O2-treated RECs. Transcriptomic analysis revealed that DADS might influence glutathione synthesis through cysteine and methionine metabolism, thereby affecting the transcription of genes involved in immunity and oxidative stress. The DADS treatment resulted in increased nuclear translocation of Nrf2 and upregulation of mRNA and protein levels of quinone oxidoreductase 1, heme oxygenase 1, and Nrf2. The Nrf2-specific inhibitor nullified the protective effects of DADS on malonaldehyde formation induced by H2O2 and decreased T-AOC and SOD activities. In conclusion, DADS demonstrated the ability to alleviate oxidative stress in RECs by promoting antioxidative capacity through the Keap1/Nrf2 signaling pathway.