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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.
Academic defenders of sweatshops argue that disregarding labour rights will result in increased welfare in the developing nations where transnational corporations (TNCs) operate. They argue that TNCs should ignore local labour laws in the best interests of the poor. In this article we criticise this ‘ignore the law’ position regarding sweatshops on three separate grounds. First, it fails to acknowledge the demands for businesses to respect the rule of law as part of the development process. Second, it utilises an inadequate account of voluntary contractual bargaining which overlooks how employment practises operate in sectors prone to utilising sweatshop labour, leading to coercive employment conditions incompatible with human dignity and free choice. Third, it fails to adequately account for labour law and international labour standards, which embody a strong moral conception of dignity at work and observance of fundamental human rights in protecting workers against abuse through the resulting legal duties placed on states and corporate actors. We conclude that poverty reduction requires the support of both private and public actors. Advocating the side-stepping of labour laws distracts from the important work of institution building necessary to protect workers and facilitate economic growth consistent with decent work, sustainable development, fairness and human dignity as embodied in international labour standards.
Coercive or restrictive practices such as compulsory admission, involuntary medication, seclusion and restraint impinge on individual autonomy. International consensus mandates reduction or elimination of restrictive practices in mental healthcare. To achieve this requires knowledge of the extent of these practices.
Aims
We determined rates of coercive practices and compared them across countries.
Method
We identified nine country- or region-wide data-sets of rates and durations of restrictive practices in Australia, England, Germany, Ireland, Japan, New Zealand, The Netherlands, the USA and Wales. We compared the data-sets with each other and with mental healthcare indicators in World Health Organization and Organisation for Economic Cooperation and Development reports.
Results
The types and definitions of reported coercive practices varied considerably. Reported rates were highly variable, poorly reported and tracked using a diverse array of measures. However, we were able to combine duration measures to examine numbers of restrictive practices per year per 100 000 population for each country. The rates and durations of seclusion and restraint differed by factors of more than 100 between countries, with Japan showing a particularly high number of restraints.
Conclusions
We recommend a common set of international measures, so that finer comparisons within and between countries can be made, and monitoring of trends to see whether alternatives to restraint are successful. These measurements should include information about the total numbers, durations and rates of coercive measures. We urge the World Health Organization to include these measures in their Mental Health Atlas.
To understand the timing of deglaciation of the northernmost marine-terminating glaciers of the Cordilleran Ice Sheet (CIS), we obtained 26 10Be surface-exposure ages from glacially scoured bedrock surfaces in Prince William Sound (PWS), Alaska. We sampled six elevation transects between sea level and 620 m and spanning a distance of 14 to 70 km along ice flow paths. Most transect age–elevation patterns could not be explained by a simple model of thinning ice; the patterns provide evidence for lingering ice cover and possible inheritance. A reliable set of 20 ages ranges between 17.4 ± 2.0 and 11.6 ± 2.8 ka and indicates ice receded from northwestern PWS around 14.3 ± 1.6 ka, thinned at a rate of ~120–160 m/ka, and retreated from sea-level sites at 12.9 ± 1.1 ka at a rate of 20 m/yr. The retreat rate likely slowed as glaciers retreated into northern PWS. These results are consistent with the growing body of reported deglacial constraints on collapse of ice sheets along the Alaska margin indicating collapse of the CIS soon after 17 ka. These data are consistent with paleotemperature data indicating that a warming North Pacific Ocean caused catastrophic collapse of this part of the CIS.
Debate about the nature of climate and the magnitude of ecological change across Australia during the last glacial maximum (LGM; 26.5–19 ka) persists despite considerable research into the late Pleistocene. This is partly due to a lack of detailed paleoenvironmental records and reliable chronological frameworks. Geochemical and geochronological analyses of a 60 ka sedimentary record from Brown Lake, subtropical Queensland, are presented and considered in the context of climate-controlled environmental change. Optically stimulated luminescence dating of dune crests adjacent to prominent wetlands across North Stradbroke Island (Minjerribah) returned a mean age of 119.9 ± 10.6 ka; indicating relative dune stability soon after formation in Marine Isotope Stage 5. Synthesis of wetland sediment geochemistry across the island was used to identify dust accumulation and applied as an aridification proxy over the last glacial-interglacial cycle. A positive trend of dust deposition from ca. 50 ka was found with highest influx occurring leading into the LGM. Complexities of comparing sedimentary records and the need for robust age models are highlighted with local variation influencing the accumulation of exogenic material. An inter-site comparison suggests enhanced moisture stress regionally during the last glaciation and throughout the LGM, returning to a more positive moisture balance ca. 8 ka.
We use a simple energy-conservation model and a model based on Röthlisberger’s theory for steady-state water flow in a subglacial conduit to model water movement between lakes in the Adventure subglacial trench region of East Antarctica during a 1996–98 jökulhlaup. Using available field evidence to constrain the models suggests that water flow would likely be accommodated in a tunnel with a cross-sectional area of 36 m2 and a value for k (the reciprocal of Manning’s roughness parameter) larger than the 12.5 m1/3 s−1 previously calculated. We also use Nye’s theory for time-dependent conduit water flow to model the temporal evolution of conduit discharge, cross-sectional area, water pressure and lake draining and filling during the flood. We initially assume one source and one sink lake. We perform sensitivity tests on the input parameter set, matching modeled source- and sink-lake depth changes with measured surface elevation data. Using a simple function for vertical ice deformation in which surface deformation scales linearly to the lake depth change, we find the scaling factor is of the order 4 × 10−3 of the ice thickness. The most likely value of k lies in the range 55–68 m1/3 s−1, and the ratio of source to sink-lake radii is approximately 1 : 1.4. Finally, we experiment using Nye’s theory to model water movement between one source and three sink lakes. The model fails to produce the observed patterns of water movement as indicated by the surface deformation data.
Cathars have long been regarded as posing the most organised challenge to orthodox Catholicism in the medieval West, even as a "counter-Church" to orthodoxy in southern France and northern Italy. Their beliefs, understood to be inspired by Balkan dualism, are often seen as the most radical among medieval heresies. However, recent work has fiercely challenged this paradigm, arguing instead that "Catharism" was a construct of its persecutors, mis-named and mis-represented by generations of subsequent scholarship, and its supposedly radical views were a fantastical projection of the fears of orthodox commentators. This volume brings together a wide range of views from some of the most distinguished international scholars in the field, in order to address the debate directly while also opening up new areas for research. Focussing on dualism and anti-materialist beliefs in southern France, Italy and the Balkans, it considers a number of crucial issues. These include: what constitutes popular belief; how (and to what extent) societies of the past were based on the persecution of dissidents; and whether heresy can be seen as an invention of orthodoxy. At the same time, the essays shed new light on some key aspects of the political, cultural, religious and economic relationships between the Balkans and more western regions of Europe in the Middle Ages.
Antonio Sennis isSenior Lecturer in Medieval History at University College London Contributors: John H. Arnold, Peter Biller, Caterina Bruschi, David d'Avray, Jörg Feuchter, Bernard Hamilton, Robert I. Moore, MarkGregory Pegg, Rebecca Rist, Lucy Sackville, Antonio Sennis, Claire Taylor, Julien Théry-Astruc, Yuri Stoyanov
We consider statistical properties of random integer partitions. In order to compute means, variances and higher moments of various partition statistics, one often has to study generating functions of the form P(x)F(x), where P(x) is the generating function for the number of partitions. In this paper, we show how asymptotic expansions can be obtained in a quasi-automatic way from expansions of F(x) around x = 1, which parallels the classical singularity analysis of Flajolet and Odlyzko in many ways. Numerous examples from the literature, as well as some new statistics, are treated via this methodology. In addition, we show how to compute further terms in the asymptotic expansions of previously studied partition statistics.
In this study, we investigated the prevalence, severity, and organisational factors of risk for psychological injury in a national sample of Australian school teachers, using the Psychological Injury Risk Indicator. We predicted that teachers would report higher levels of risk for psychological injury if working in schools located in rural areas, with a low socioeconomic index, and low psychosocial safety climate. Teachers from across Australia (N = 960) completed an online survey that measured risk for psychological injury and relevant organisational factors. We found a high number of teachers (26%) whose responses showed high risk, indicating the need for professional intervention in order to avoid potentially debilitating psychological injury. Analyses also showed main effects for two organisational factors, indicating that teachers most at risk for psychological injury tended to be employed by schools with low psychosocial safety climate and in areas with a low socioeconomic index. These results highlight the severe levels of work-related psychological injury risk in the Australian teacher population, and the important role for school administration and education departments in maintaining a working environment that supports staff psychologically.
Deep boreholes have been proposed for many decades as an option for permanent disposal of high-level radioactive waste and spent nuclear fuel. Disposal concepts are straightforward, and generally call for drilling boreholes to a depth of four to five kilometers (or more) into crystalline basement rocks. Waste is placed in the lower portion of the hole, and the upper several kilometers of the hole are sealed to provide effective isolation from the biosphere. The potential for excellent long-term performance has been recognized in many previous studies. This paper reports updated results of what is believed to be the first quantitative analysis of releases from a hypothetical disposal borehole repository using the same performance assessment methodology applied to mined geologic repositories for high-level radioactive waste. Analyses begin with a preliminary consideration of a comprehensive list of potentially relevant features, events, and processes (FEPs) and the identification of those FEPs that appear to be most likely to affect long-term performance in deep boreholes. The release pathway selected for preliminary performance assessment modeling is thermally-driven flow and radionuclide transport upwards from the emplacement zone through the borehole seals or the surrounding annulus of disturbed rock. Estimated radionuclide releases from deep borehole disposal of spent nuclear fuel, and the annual radiation doses to hypothetical future humans associated with those releases, are extremely small, indicating that deep boreholes may be a viable alternative to mined repositories for disposal of both high-level radioactive waste and spent nuclear fuel.