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To evaluate the association between neighborhood-level social vulnerability and risk of surgical site infection.
Design:
Retrospective cohort study from January 1, 2019-December 31, 2024
Setting:
Large academic hospital in the Deep South
Participants:
Patients undergoing NHSN-defined procedures by CPT coding (coronary artery bypass graft, colon surgery, craniotomy, spinal fusion, hip prosthesis, knee prosthesis, or abdominal hysterectomy) were included. Social vulnerability index (SVI) percentile and themes were defined by the Centers for Disease Control and Prevention criteria and assigned based on residential ZIP code.
Methods:
The primary outcome was development of SSI. Cox proportional hazards models stratified by SSI surveillance duration (30 or 90 days) were used to estimate hazard ratios (HRs) and 95% confidence intervals, adjusting for demographic, clinical, and procedural characteristics.
Results:
Among 40,954 surgeries, 26,067 patients (63.7%) resided in high SVI ZIP codes. The risk of SSI increased across SVI tertiles (low 1.5%, medium 2.2%, high 2.4%). Compared with those in low SVI tertile, SSI risk was higher for patients in the medium-SVI (aHR 1.40, 95% CI 1.03–1.92) and high-SVI tertile (aHR 1.49, 95% CI 1.10–2.01). Higher SVI socioeconomic status was associated with increased SSI risk (aHR 1.33, 95% CI 1.07–1.64) and higher housing and transportation vulnerability was associated with increased deep incisional and organ space SSI.
Conclusions:
Higher neighborhood-level SVI was independently associated with increased risk of SSI across a broad surgical population in the South. Incorporating SVI into preoperative risk assessment may allow targeted infection prevention strategies for hospitals to address barriers to care.
Planamandibulus nevadensis n. gen n. sp. is a newly discovered exceptionally preserved Laurentian phosphatocopid crustacean described from the upper Windfall Formation (Furongian, Stage 10) in Nevada. Planamandibulus nevadensis has closest affinity with the Baltic and Avalonian taxon Cyclotron. Its occurrence in sedimentary facies associated with dysoxia on the Laurentian paleocontinent fills in a gap in the global distribution of phosphatocopid crustaceans, facilitating a paleoenvironmental synthesis of this Cambrian group. We assess 75 taxa from nine paleocontinental areas spanning Cambrian stages 3 to 10 (~521–486.9 Ma). Comparison of these data with paleoclimate model simulations suggests that phosphatocopid distribution is explained partly by biogeography and ocean temperature patterns. Dabashanella species (e.g., D. hemicyclica Huo et al., 1983) are found across the low paleolatitude (<35°) paleocontinents of East Gondwanan (Australia), South China, and the central Asian terranes, spanning marine shelf carbonates to deeper marine black shale lithofacies, but are absent from mid- and high-paleolatitude sites, suggesting a warmer water preference. A similar warm-water preference is inferred for endemic taxa (e.g., Ulopsis, Parashergoldopsis) of East Gondwana, and perhaps for the newly described Laurentian Planamandibulus. By contrast, the mid- to high-paleolatitude paleocontinents Baltica and Avalonia are characterized by Veldotron, Cyclotron, Bidimorpha, Waldoria, Vestrogothia, Falites, and Trapezilites species, which occur in deep-shelf, cooler-water settings, typically below storm wave base. Hesslandona species sensu lato occur in mid-depth (likely above storm-wave base) warm tropical marine waters but are more typically found in deeper shelf and cooler waters in mid to high paleolatitudes. Phosphatocopids are also associated with sedimentary deposits characteristic of low environmental oxygen concentrations; this is emphasized by a peak in occurrences in the Guzhangian (Miaolingian) and Paibian (Furongian) stages, around the interval of the Steptoean Positive Carbon Isotope Excursion (SPICE) and its associated expansion of anoxic water masses onto shallow marine shelves. Our data compilation and data–model comparison support the environmental preference of phosphatocopids for low-oxygen, but not anoxic, water masses, and the new occurrence of Planamandibulus is consistent with this pattern.
Diagnostic stewardship of urine cultures is a recognized tool for CAUTI prevention, yet few diagnostic algorithms have been validated. This study of a novel diagnostic CAUTI algorithm showed a significant and durable improvement in urine culturing, catheter exchange, and CAUTI rate, supporting this algorithm as an effective diagnostic stewardship tool.
The Arctic is at the forefront of climate change, undergoing some of the most rapid environmental transformations globally. Here, we examine the impacts of climate change on the livelihoods in the coastal Inuit community of Hopedale, Nunatsiavut, Canada. The study examines recently evolved adaptation strategies employed by Inuit and the challenges to these adaptations. We document changing sea ice patterns, changing weather patterns and the impact of invasive species on food resources and the environment. Utilising knowledge co-production and drawing upon Indigenous knowledge, we monitor the changes and multiple stresses through direct observations, engagement with rights holders and community experiences to characterise climate risks and associated changes affecting livelihoods. We use both decolonising research and participatory methodologies to develop collaboration and partnership, ensuring that monitoring reflects local priorities and realities while also fostering trust and collaboration. We showcase that monitoring environmental trends involves more than data collection; it includes observing and analysing how environmental changes affect community well-being, particularly in terms of food security, cultural practices, economic activities, mental health, sea ice changes and weather patterns. The paper contributes to a nuanced understanding of Inuit resilience and experiences in confronting climate risks and the broader implications for Indigenous communities confronting climate challenges.
This paper reports new data from both selling and buying versions of the Becker-DeGroot-Marschak (BDM) procedure. First, when using the selling version of BDM, the cross-sectional mean of CRRA risk preference parameter estimates shifts from a value consistent with “as if” risk-seeking behavior in the early baseline to a value closer to “as if” risk neutrality in the late baseline. Second, when using the buying version of BDM, the cross-sectional mean of CRRA risk preference parameter estimates does not appear to change over time in a statistically significant manner. The cross-sectional mean from the late baseline of the buying version of BDM is closer to “as if” risk neutrality and to the late baseline estimates from the selling version of BDM than it is to either early baseline estimates from the selling version of BDM or typical estimates from the first price auction. Use of dominated offers is correlated with deviations from “as if” risk neutrality; this suggests the possibility that the early deviations from “as if” risk neutrality reflect errors.
Goods are said to be combinatorial when the value of a bundle of goods is not equal to the sum of the values of the same goods unbundled. Investigations of combinatorial allocation problems should recognize that there are two separate aspects of such problems: an environmental distinction between multiple-unit allocation problems which involve combinatorial goods and those which do not do so, and an institutional distinction between auctions in which combinatorial values can be expressed as part of the bidding rules and those in which they cannot. Forsythe and Isaac (Research in Experimental Economics, Vol. 2 (1982). Greenwich, Conn.: JAI Press, Inc.) reports the extension of the Vickrey auction into a demand-revealing, multiple unit, private goods auction that can incorporate combinatorial values. This current paper places that theoretically demand-revealing institution in a series of experimental environments in order to generate results (e.g. efficiencies) which may serve as a benchmark for other auctions (combinatorial or otherwise) whose implementation characteristics may be more favorable. To aid in interpretation of our Vickrey experimental results, we also provide results of alternatives to Vickrey allocations from both institutional and heuristic sources, as well as a discussion of the source of the Vickrey auctions high efficiencies even in the presence of misrevelation.
We aimed to determine if implementation of universal nasal decolonization with daily chlorhexidine bathing will decrease blood stream infections (BSI) in patients undergoing extracorporeal membrane oxygenation (ECMO).
Design:
Retrospective cohort study.
Setting:
Tertiary care facility.
Patients:
Patients placed on ECMO from January 1, 2017 to December 31, 2023.
Intervention:
Daily bathing with 4% chlorhexidine soap and universal mupirocin nasal decolonization were initiated for all ECMO patients May 2021. The primary outcome was rate of ECMO-attributable positive blood cultures. Zero-inflated Poisson regression analysis was performed to estimate rate ratios (RRs) for the association between decolonization with BSI rates.
Results:
A total of 776 patients met inclusion criteria during the study period, 425 (55%) preimplementation and 351 (45%) post-implementation. Following implementation of decolonization, the overall incidence rate of BSI increased nonsignificantly from 10.7 to 14.0 infections per 1000 ECMO days (aRR 1.09, 95% CI 0.74–1.59). For gram-positive cocci (GPC) pathogens, a nonsignificant 40% increased rate was observed in the post-implementation period (RR 1.40, 95% CI 0.89–2.21), due mostly to a significant increase in the crude rate of Enterococcus BSI (RR 1.89, 95% CI 1.01–3.55). Excluding Enterococcus resulted in a nonsignificant 28% decreased rate (aRR 0.72, 95% CI 0.39-1.36) due to a nonsignificant 55% decreased rate of MRSA (aRR 0.45, 95% CI 0.18–3.58).
Conclusions:
Implementation of a universal decolonization protocol did not significantly reduce rates of certain BSIs, including MRSA and other gram-positive pathogens. Although nonsignificant, reduction in BSI rates in this patient population has important implications on surveillance metrics, such as MRSA, and in the future, hospital-onset bacteremia.
Since Holt and Laury (Am Econ Rev 92(5):1644–1655, 2002), the multiple price list (MPL) procedure has widely been used to elicit individual risk preferences. We assess the impact of varying list order and spacing, and of presentation via text or graphs. Relative to the original MPL baseline, some non-linear transformations of lottery prices systematically increase elicited risk aversion, while some graphical displays tend to reduce it.
Whether colliding drops will merge with or bounce off each other is critical to numerous processes, and the physics involved is notoriously complex. In particular, experiments show that both sufficiently slow and fast head-on drop collisions lead to merging, but that there is often an intermediate regime in which bouncing is observed; these transitions in behaviour were recently discovered to be surprisingly sensitive to the radius of the drops and the ambient gas pressure. We show here that these transitions between bouncing and merging are governed by nanoscale phenomena; namely, gas-kinetic and disjoining pressure effects. To capture these crucial effects, a novel, open-source computational model is developed for the simulation of colliding drops. The model uses a hybrid approach, based on solving the Navier–Stokes equations in the drop with a lubrication approach for the unconventional physics of the gas film. Our simulations show remarkably good agreement with experiments of head-on collisions and also provide new experimentally verifiable predictions.
Spray formed by a myriad of secondary droplets generated by the impact of raindrops on a deep-water pool is studied with a laboratory rain facility. Experiments are performed with two rain rates and raindrops fall on the water surface at a nearly constant velocity. The secondary droplets at various heights above the pool's water surface are recorded with a cinematic digital in-line holographic technique that consists of a high-speed camera, a pulsed Nd:YLF laser and associated optics. The experimental results show that in the heat-map scatter plots of radius versus velocity near the water surface of the pool, the droplets are distributed into three regions, corresponding to distinct physical mechanisms of droplet generation. It is found that the diameter distribution of the droplets in the rain field changes with height above the pool's water surfaces. Both numerical simulation and experimental data reveal that the liquid water content, due to the presence of secondary droplets, in the atmospheric surface layer decreases exponentially with increasing height.
The moderation of user-generated content on online platforms remains a key solution to protecting people online, but also remains a perpetual challenge as the appropriateness of content moderation guidelines depends on the online community that they aim to govern. This challenge affects marginalized groups in particular, as they more frequently experience online abuse but also end up falsely being the target of content-moderation guidelines. While there have been calls for democratic, community-moderation, there has so far been little research into how to implement such approaches. Here, we present the co-creation of content moderation strategies with the users of an online platform to address some of these challenges. Within the context of AutSPACEs—an online citizen science platform that aims to allow autistic people to share their own sensory processing experiences publicly—we used a community-based and participatory approach to co-design a content moderation solution that would fit the preferences, priorities, and needs of its autistic user community. We outline how this approach helped us discover context-specific moderation dilemmas around participant safety and well-being and how we addressed those. These trade-offs have resulted in a moderation design that differs from more general social networks in aspects such as how to contribute, when to moderate, and what to moderate. While these dilemmas, processes, and solutions are specific to the context of AutSPACEs, we highlight how the co-design approach itself could be applied and useful for other communities to uncover challenges and help other online spaces to embed safety and empowerment.
Commentaries on the target article offer diverse perspectives on integrative experiment design. Our responses engage three themes: (1) Disputes of our characterization of the problem, (2) skepticism toward our proposed solution, and (3) endorsement of the solution, with accompanying discussions of its implementation in existing work and its potential for other domains. Collectively, the commentaries enhance our confidence in the promise and viability of integrative experiment design, while highlighting important considerations about how it is used.
To investigate the symptoms of SARS-CoV-2 infection, their dynamics and their discriminatory power for the disease using longitudinally, prospectively collected information reported at the time of their occurrence. We have analysed data from a large phase 3 clinical UK COVID-19 vaccine trial. The alpha variant was the predominant strain. Participants were assessed for SARS-CoV-2 infection via nasal/throat PCR at recruitment, vaccination appointments, and when symptomatic. Statistical techniques were implemented to infer estimates representative of the UK population, accounting for multiple symptomatic episodes associated with one individual. An optimal diagnostic model for SARS-CoV-2 infection was derived. The 4-month prevalence of SARS-CoV-2 was 2.1%; increasing to 19.4% (16.0%–22.7%) in participants reporting loss of appetite and 31.9% (27.1%–36.8%) in those with anosmia/ageusia. The model identified anosmia and/or ageusia, fever, congestion, and cough to be significantly associated with SARS-CoV-2 infection. Symptoms’ dynamics were vastly different in the two groups; after a slow start peaking later and lasting longer in PCR+ participants, whilst exhibiting a consistent decline in PCR- participants, with, on average, fewer than 3 days of symptoms reported. Anosmia/ageusia peaked late in confirmed SARS-CoV-2 infection (day 12), indicating a low discrimination power for early disease diagnosis.
Outdoor activities have accelerated in the past several years. The authors were tasked with providing medical care for the Union Cycliste International (UCI) mountain biking World Cup in Snowshoe, West Virginia (USA) in September 2021. The Hartman and Arbon models were designed to predict patient presentation and hospital transport rates as well as needed medical resources at urban mass-gathering events. However, there is a lack of standardized methods to predict injury, illness, and insult severity at rural mass gatherings.
Study Objective:
This study aimed to determine whether the Arbon model would predict, within 10%, the number of patient presentations to be expected and to determine if the event classification provided by the Hartman model would adequately predict resources needed during the event.
Methods:
Race data were collected from UCI event officials and injury data were collected from participants at time of presentation for medical care. Predicted presentation and transport rates were calculated using the Arbon model, which was then compared to the actual observed presentation rates. Furthermore, the event classification provided by the Hartman model was compared to the resources utilized during the event.
Results:
During the event, 34 patients presented for medical care and eight patients required some level of transport to a medical facility. The Arbon predictive model for the 2021 event yielded 30.3 expected patient presentations. There were 34 total patient presentations during the 2021 race, approximately 11% more than predicted. The Hartman model yielded a score of four. Based on this score, this race would be classified as an “intermediate” event, requiring multiple Advanced Life Support (ALS) and Basic Life Support (BLS) personnel and transport units.
Conclusion:
The Arbon model provided a predicted patient presentation rate within reasonable error to allow for effective pre-event planning and resource allocation with only a four patient presentation difference from the actual data. While the Arbon model under-predicted patient presentations, the Hartman model under-estimated resources needed due to the high-risk nature of downhill cycling. The events staffed required physician skills and air medical services to safely care for patients. Further evaluation of rural events will be needed to determine if there is a generalized need for physician presence at smaller events with inherently risky activities, or if this recurring cycling event is an outlier.
Close-range sensors are employed to observe glaciological processes that operate over short timescales (e.g. iceberg calving, glacial lake outburst floods, diurnal surface melting). However, under poor weather conditions optical instruments fail while the operation of radar systems below 17 GHz do not have sufficient angular resolution to map glacier surfaces in detail. This letter reviews the potential of millimetre-wave radar at 94 GHz to obtain high-resolution 3-D measurements of glaciers under most weather conditions. We discuss the theory of 94 GHz radar for glaciology studies, demonstrate its potential to map a glacier calving front and summarise future research priorities.
Two extra-Galactic surveys are considered. The first takes observations of nearly 200 GMCs across a small sample of local galaxies in the CANON CO survey. In spite of the local nature of the sample, results confirm essential facts about molecular gas distribution in galaxies other than our own, including a confirmed linear relationship between GMC virial mass and CO luminosity, which implies a constant CO-H2 conversion factor and supports a virialization assumption. The second survey, PHANGS-ALMA (Physics at High Angular Resolution in Nearby Galaxies with the Atacama Large Millimetre-submillimetre Array), maps CO emission from galaxies up to 17 Mpc away, with resolutions of 1″–1.5″ encompassing active star-forming galaxies down to total stellar masses ~5 × 109 M☉. Within 11 of those target galaxies considered here, the results offer tens of thousands of measurements at GMCs scales between 20 and 130 pc, comparable to Galactic-scale observations, and one outcome is confirmation of a positive correlation between GMC surface densities and velocity distributions.
Two HII region surveys are considered. The first is a multi-band survey of over one hundred hypercompact HII (HCHII) candidates using the Jansky-VLA. The second survey, the deep-resolution ALMA Three-millimetre Observations of Massive Star-forming regions (ATOMS-ALMA), studied just under 500 and identified 89 cores that cocoon HCHII or UCHII sources observed in H40α; 32 hot molecular cores (HMCs) showing more than 20 COMs; and 58 HMC candidates not associated with HII regions. The study shows how, in the vicinity of newly formed OB protostars and HII regions at an early stage of evolution, we can begin to understand the dynamics of infall, outflow, and rotational motions, as well as the feedback roles of outflows, stellar winds, and HII regions.
The Orion Bar as the canonical high-flux PDR is examined. In addition to a detailed description of the source, the estimation of physical parameters such as ionization fraction and observational indicators such as carbon recombination lines are considered. High-resolution observations point to the sensitivity of carbon chemistry to CR ionization and the apparent merging of C/C+/CO transition and H/H2 transition zones not readily predicted by theory. A wide range of molecular sulphur observations also presents the opportunity to rethink gas–grain reaction networks and model their consequences, with a following chapter looking at the low-flux PDR case of the Horsehead Nebula, through which the sulphur question will be further explored.