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We performed a retrospective analysis of the impact of using the International Classification of Diseases, Tenth Revision procedure coding system (ICD-10) or current procedural terminology (CPT) codes to calculate surgical site infection (SSI) rates. Denominators and SSI rates vary depending on the coding method used. The coding method used may influence interhospital performance comparisons.
Impairments in learning and recall have been well established in amnestic mild cognitive impairment (aMCI). However, a relative dearth of studies has examined the profiles of memory strategy use in persons with aMCI relative to those with Alzheimer's disease (AD). Participants with aMCI, nonamnestic MCI, AD, and healthy older adults were administered the California Verbal Learning Test-II (CVLT-II). Measures of semantic clustering and recall were obtained across learning and delayed recall trials. In addition, we investigated whether deficits in semantic clustering were related to progression from healthy aging to aMCI and from aMCI to AD. The aMCI group displayed similar semantic clustering performance as the AD participants, whereas the AD group showed greater impairments on recall relative to the aMCI participants. Control participants who progressed to aMCI showed reduced semantic clustering at the short delay at baseline compared to individuals who remained diagnostically stable across follow-up visits. These findings show that the ability to engage in an effective memory strategy is compromised in aMCI, before AD has developed, suggesting that disruptions in semantic networks are an early marker of the disease. (JINS, 2014, 20, 1–11)
Increased dietary Na intake and decreased dietary K intake are associated with higher blood pressure. It is not known whether the dietary Na:K ratio is associated with all-cause mortality or stroke incidence and whether this relationship varies according to race. Between 2003 and 2007, the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort enrolled 30 239 black and white Americans aged 45 years or older. Diet was assessed using the Block 98 FFQ and was available on 21 374 participants. The Na:K ratio was modelled in race- and sex-specific quintiles for all analyses, with the lowest quintile (Q1) as the reference group. Data on other covariates were collected using both an in-home assessment and telephone interviews. We identified 1779 deaths and 363 strokes over a mean of 4·9 years. We used Cox proportional hazards models to obtain multivariable-adjusted hazard ratios (HR). In the highest quintile (Q5), a high Na:K ratio was associated with all-cause mortality (Q5 v. Q1 for whites: HR 1·22; 95 % CI 1·00, 1·47, P for trend = 0·084; for blacks: HR 1·36; 95 % CI 1·04, 1·77, P for trend = 0·028). A high Na:K ratio was not significantly associated with stroke in whites (HR 1·29; 95 % CI 0·88, 1·90) or blacks (HR 1·39; 95 % CI 0·78, 2·48), partly because of the low number of stroke events. In the REGARDS study, a high Na:K ratio was associated with all-cause mortality and there was a suggestive association between the Na:K ratio and stroke. These data support the policies targeted at reduction of Na from the food supply and recommendations to increase K intake.
Six alloys based on Cr-10Ta-7Si (by at.%) with quaternary additions of 0.5Ag, 5Ti, 1Hf, 3Mo, 3Al, or 3Re (by at.%) substituted for Cr were produced by vacuum arc-melting. The microstructures of the alloys were found to predominantly consist of a eutectic mixture of an A2 Cr-based solid solution and a C14 Cr2Ta Laves phase along with proeutectic Cr2Ta dendrites. Microstructural macro- and micro-scale inhomogeneities were observed in all alloy ingots, which were attributed to the non-equilibrium arc-melting process. The measured lattice parameters of the constituent phases and the elemental partitioning behaviour between the phases have been correlated with the respective covalent atomic radii. The bulk hardnesses of the alloys, along with the hardness of individual phases, have also been reported.
The success of central line-associated bloodstream infection (CLABSI) prevention programs in intensive care units (ICUs) has led to the expansion of surveillance at many hospitals. We sought to compare non-ICU CLABSI (nCLABSI) rates with national reports and describe methods of surveillance at several participating US institutions.
Design and Setting.
An electronic survey of several medical centers about infection surveillance practices and rate data for non-ICU Patients.
Participants.
Ten tertiary care hospitals.
Methods.
In March 2011, a survey was sent to 10 medical centers. The survey consisted of 12 questions regarding demographics and CLABSI surveillance methodology for non-ICU patients at each center. Participants were also asked to provide available rate and device utilization data.
Results.
Hospitals ranged in size from 238 to 1,400 total beds (median, 815). All hospitals reported using Centers for Disease Control and Prevention (CDC) definitions. Denominators were collected by different means: counting patients with central lines every day (5 hospitals), indirectly estimating on the basis of electronic orders (n = 4), or another automated method (n = 1). Rates of nCLABSI ranged from 0.2 to 4.2 infections per 1,000 catheter-days (median, 2.5). The national rate reported by the CDC using 2009 data from the National Healthcare Surveillance Network was 1.14 infections per 1,000 catheter-days.
Conclusions.
Only 2 hospitals were below the pooled CLABSI rate for inpatient wards; all others exceeded this rate. Possible explanations include differences in average central line utilization or hospital size in the impact of certain clinical risk factors notably absent from the definition and in interpretation and reporting practices. Further investigation is necessary to determine whether the national benchmarks are low or whether the hospitals surveyed here represent a selection of outliers.
The Kordofan Sand is a deposit of unconsolidated surface sands covering large areas to the west of the White Nile in the central part of the Anglo-Egyptian Sudan and especially in the province of Kordofan. In character, it is a typical winddeposited sand of well-rounded quartz grains, with a colour varying from pale buff to deep red. The colour is due to iron staining on the surface of the quartz grains, but only extends to a very shallow depth, sometimes as little as 4 to 5 feet, below which depth the sand is colourless. The absence of colour in the deeper parts of the deposit appears to be due to absence of iron rather than to its presence in a reduced state, and it is thought therefore that the iron must represent a concentration in the upper portion of the deposit. As far as investigation has been made there is no evidence of a downward leaching of iron-bearing solutions with penetration to underlying deposits.
(I) In each of the areas examined the transition zone between the Hecla Hoek rocks of Eastern New Friesland and the more highly metamorphosed belt has been observed and the evidence points to a gradual increase in metamorphism westwards with the same general series of rocks involved. The rocks have been isoclinally folded and repetition occurs more especially on the east flank of the intensely metamorphosed zone. Usually only the Lower Murchison Bay Formation appears in the more highly folded belt, but it may well be that in the Stubendorff Mountains other rocks are also included.
In the northern area, west of Treurenberg Bay, Blomstrand's recognition of a central core of granitic gneiss giving way on both sides to less highly metamorphosed types still stands as the most important contribution to the interpretation of the structure. Recent examination has revealed that the sequence of events has been a folding of the Lower Murchison Bay Formation followed shortly by igneous intrusion and metamorphism of the whole.
In the Gullfaxe area isoclinally folded rocks of the Lower Murchison Bay Formation are associated with a quartz-felspargneiss. We have not been able to decide what this rock was originally. It may be either a metamorphosed igneous rock or an altered arkose. It appears to be concordant with the adjacent altered sedimentaries, but may be igneous material in some way related to the large granitic intrusion which lies farther west in this latitude.
In the Lomme Bay area Odell observed the transition zone.
(2) In the less altered zone to the east of the Duner Glacier we have been able to recognize the members of the Murchison Bay Formation as defined by Kulling, and the correlation is set out in Table I. The least satisfactory identification is of the Salodd and Raudstup Series. According to Kulling these Series have different characteristics in the Lomme Bay area from those which they show in North-East Land, and it may be that throughout New Friesland they attain neidier the thickness nor the distinctive character which is theirs in the type area. The presence of the other members of the Murchison Bay Formation and of the remarkable Sveanor Formation is well established.
Using Persian Blackhead ewes, milk composition and the effect of diet on content of milk fat and milk yield were investigated. Analysis of the milk of nine ewes for fat, protein, ash and lactose (by difference) throughout a twelve-week lactation gave results which were compared with those in the literature. Average values were 5·9, 5·6, 1·0 and 4·8 % respectively. The milk of nine ewes fed on a high plane of nutrition contained significantly more fat than that of ewes fed on a low plane of nutrition; values were 8·8 and 8·3 % respectively. High plane ewes gave significantly more milk than low plane ewes. Ewes suckling twins gave significantly more milk than those suckling singles. Lambs suckling high plane ewes gained significantly more weight than those suckling low plane ewes both from birth to 3 weeks as well as from birth to 12 weeks. Male lambs gained significantly more weight than females.
Highly significant correlation coefficients were obtained between milk consumed by the lamb and its gain in weight. Conversion efficiencies of milk to gain in weight were calculated and compared with literature values.
The objective of this investigation is to give experimental support to recent direct numerical simulation (DNS) results which demonstrated that in bypass transition the flow first breaks down to turbulence on the low-speed streaks (or so-called negative jets) that are lifted up towards the boundary-layer edge region. In order to do this, wall-normal profiles of the streamwise fluctuation velocity are presented in terms of maximum positive and negative values over a range of turbulence intensities (1.3–6%) and Reynolds numbers for zero pressure gradient flow upstream of, and including, transition onset. For all turbulence intensities considered, it was found that the peak negative fluctuation velocity increased in magnitude above the peak positive fluctuations and their positions relative to the wall shifted as transition onset approached; the peak negative value moved towards the boundary-layer edge and the peak positive value moved toward the wall. An experimental measure of the penetration depth (PD) of free-stream disturbances into the boundary layer has been gained through the use of the skewness function. The penetration depth (measured from the boundary-layer edge) scales as PD ∝ (ω Rexτw)−0.3), where ω is the frequency of the largest eddies in the free stream, Rex is the Reynolds number of the flow based on the streamwise distance from the leading edge and τw is the wall shear stress. The parameter dependence demonstrated by this scaling compares favourably with recent solutions to the Orr–Sommerfeld equation on the penetration depth of disturbances into the boundary layer. The findings illustrate the importance of negative fluctuation velocities in the transition process, giving experimental support to suggestions from recent DNS predictions that the breakdown to turbulence is initiated on the low-speed regions of the flow in the upper portion of the boundary layer. The representation of pre-transitional disturbances in time-averaged form is shown to be inadequate in elucidating which disturbances grow to cause the breakdown to turbulence.
By
T. M. L. Wigley, National Center for Atmospheric Research Boulder CO 80307–3000, USA,
R. G. Richels, Electric Power Research Institute 2000 L Street NW, Suite 805 Washington, DC 20036, USA,
J. A Edmonds, Pacific Northwest National Laboratory Joint Global Change Research Institute at the University of Maryland
Stabilization of the climate system requires stabilization of greenhouse-gas concentrations. Most work to date has considered only stabilization of CO2, where there are choices regarding both the concentration stabilization target and the pathway towards that target. Here we consider the effects of accounting for non-CO2 gases (CH4 and N2O), for different CO2 targets and different pathways. As primary cases for CO2 we use the standard “WRE” pathways to stabilization at 450 ppm or 550 ppm. We also consider a new “overshoot” concentration profile for CO2 in which concentrations initially exceed and then decline towards a final stabilization level of 450 ppm, as might occur if an initial target choice were later found to be too high.
Emissions reductions for CH4 and N2O are optimized for the different pathways using an energy-economics model (MERGE). The optimization procedure minimizes the total cost of emissions reductions. The CH4 and N2O emissions reductions lead to substantially reduced future warming and future sea-level rise relative to stabilization cases where likely emissions reductions for these gases are ignored. For central climate and sea level model parameter values the reductions are 0.3–0.4 °C and 2–3 cm in 2100 and 0.9–1.0 °C and about 14 cm in 2400. Reduced CH4 and N2O emissions also allow larger CO2 emissions by reducing the magnitude of climate feedbacks on the carbon cycle.
Western diets containing suboptimal Cu concentrations could be widespread. A link between marginal Cu deficiency and CVD has been suggested. The objective of the present study was to investigate the effect of Cu supplementation on both Cu status and CVD risk factors in healthy young women. Sixteen women with a mean age of 24 (sd 2) years participated in a randomised crossover study of three 4-week periods with 3-week washouts between periods. During each intervention period, subjects received 0, 3 or 6 mg elemental Cu/d as CuSO4 in addition to their habitual diet. Blood samples were taken to assess the effect of supplementation on putative markers of Cu status. The content of plasma lipids, lipoprotein (a), apo and certain haemostatic factors, as putative indices of CVD, was also analysed. Daily supplementation with 3 mg Cu significantly increased (P<0·05) serum Cu concentration and the activity of erythrocyte superoxide dismutase, although there was no further significant increase after an intake of 6 mg Cu/d. The concentration of the fibrinolytic factor plasminogen activator inhibitor type 1 was significantly reduced (P<0·05) by about 30% after supplementation with 6 mg Cu/d. No other marker of Cu status or CVD risk factor was affected by Cu supplementation. The results indicate that supplementation with 3 or 6 mg Cu/d may improve Cu status in these healthy young women. Increased Cu intake could reduce the risk of CVD and atherosclerosis in man by promoting improved fibrinolytic capacity.
Single crystal thin films with compositions from the A1N-InN-GaN system were grown via metal-organic chemical vapor deposition (MOCVD) on single crystal 6H-SiC substrates. Blue light emitting (LED) and laser diode (LD) structures were fabricated. The conducting buffer layer LEDs employed an AlGaN buffer layer which provides a conduction path between SiC and the active device region. The external quantum efficiency of the LEDs was 3% at 20 mA- 3.6V and peak emission wavelength of 430 nm. Violet and blue LDs were fabricated and consisted of an 8-well InGaN/GaN multiple quantum well (MQW) active region in a separate confinement heterostructure (SCH) design. Lasing was obtained both on structures using an insulating buffer layer, and also on structures using a conducting buffer layer. The resulting lasers operated at room temperature using pulsed and continuous wave operation with an emission wavelength of 404-435 rim. The lowest threshold current density obtained for lasing was 11 kA/cm2.
The Early Iron Age enclosures and associated sites on Sutton Common on the western edge of the Humberhead Levels contain an exceptional variety of archaeological data of importance not only to the region but for the study of later prehistory in the British Isles. Few other later prehistoric British sites outside the East Anglian fens and the Somerset Levels have thus far produced the quantity and quality of organically preserved archaeological materials that have been found, despite the small scale of the investigations to date. The excavations have provided an opportunity to integrate a variety of environmental analyses, of wood, pollen, beetles, waterlogged and carbonised plant remains, and of soil micromorphology, to address archaeological questions about the character, use, and environment of this Early Iron Age marsh fort. The site is comprised of a timber palisaded enclosure and a succeeding multivallate enclosure linked to a smaller enclosure by a timber alignment across a palaeochannel, with associated finds ranging in date from the Middle Bronze Age to the Roman and medieval periods. Among the four adjacent archaeological sites is an Early Mesolithic occupation site, also with organic preservation, and there is a Late Neolithic site beneath the large enclosure. Desiccation throughout the common is leading to the damage and loss of wooden and organic remains. It is hoped that the publication of these results, of investigations between 1987 and 1993, will lead to a fuller investigation taking place.
This paper reports the events at NCSU leading up to and including those of June 5, 1997 which produced the first demonstration of a nitride laser diode on silicon carbide – and the very first nitride laser demonstration outside of Japan. All of the laser diode samples tested at NCSU were designed, grown, and fabricated into cleaved cavity test structures at Cree Research. Laser testing at NCSU consisted of spectral emission versus current measurements, light output power versus current (L-I) measurement, and light output polarization measurements versus current. The first successful laser on silicon carbide emitted at 402.6 nm. Subsequently, lasers displaying outputs ranging from 402.6 to 430.2 have been successfully tested at NCSU.
MBE growth of III-V nitrides is being studied at NCSU using MOVPE grown GaN buffer layers on SiC as substrates. Rf plasma sources are being used for the generation of active nitrogen during MBE deposition. Through the use of multiple rf plasma sources, sufficient active nitrogen is generated in order to examine the properties of III-V nitride layers grown at higher substrate temperatures and growth rates. The resulting MBE-grown GaN films exhibit remarkably intense photoluminescence (PL) dominated by a sharp band-edge peak at 3.409 eV having a FWHM of 36 meV at 300K. No deep level emission is observed. AlGaN and InGaN films and quantum well structures have also been prepared using multiple sources. A modulated beam MBE approach is used in conjunction with the multiple rf plasma sources to grow InGaN. RHEED and TEM studies reveal flat 2D InGaN quantum well structures. Depending on the indium content, GaN/InGaN single-quantum-well structures exhibit electroluminescence at 300K peaked in the blue-violet to the green spectral region.
Photoluminescence in the neighborhood of 1.54μm due to the 4I13/2 → 4l15/2 transitions is observed from 2 K up to 520 K in erbium implanted 6H SiC. The integrated 1.54 μm photoluminescence (PL) intensity is almost constant from 2 K up to about 400 K, with slight sample to sample variation. The shallow nitrogen donors play an important role in the excitation of the Er3+ centers. 1.54 μm electroluminescence (EL) is observed in erbium implanted 6H SiC p-n junctions under forward bias conditions. The EL spectrum is identical to the PL spectrum.
Reactive N and H, created using rf plasma sources, were used to grow undoped GaN along with p-type GaN:Mg and p-type GaN:Mg:H thin films. By comparing the optical emission spectra from several rf sources with observed GaN grow rates, we deduce that nitrogen atoms and I stpositive series nitrogen molecules (3.95 eV binding energy) are the reactive species responsible for GaN film growth. A Mg ground state acceptor binding energy of about 224 meV was determined from low temperature photoluminescence (PL) experiments for both p-type GaN:Mg and p-type GaN:Mg:H films.