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To identify urinary catheter (UC)–associated urinary tract infection (CAUTI) incidence and risk factors.
Design:
A prospective cohort study.
Setting:
The study was conducted across 623 ICUs of 224 hospitals in 114 cities in 37 African, Asian, Eastern European, Latin American, and Middle Eastern countries.
Participants:
The study included 169,036 patients, hospitalized for 1,166,593 patient days.
Methods:
Data collection took place from January 1, 2014, to February 12, 2022. We identified CAUTI rates per 1,000 UC days and UC device utilization (DU) ratios stratified by country, by ICU type, by facility ownership type, by World Bank country classification by income level, and by UC type. To estimate CAUTI risk factors, we analyzed 11 variables using multiple logistic regression.
Results:
Participant patients acquired 2,010 CAUTIs. The pooled CAUTI rate was 2.83 per 1,000 UC days. The highest CAUTI rate was associated with the use of suprapubic catheters (3.93 CAUTIs per 1,000 UC days); with patients hospitalized in Eastern Europe (14.03) and in Asia (6.28); with patients hospitalized in trauma (7.97), neurologic (6.28), and neurosurgical ICUs (4.95); with patients hospitalized in lower–middle-income countries (3.05); and with patients in public hospitals (5.89).
The following variables were independently associated with CAUTI: Age (adjusted odds ratio [aOR], 1.01; P < .0001), female sex (aOR, 1.39; P < .0001), length of stay (LOS) before CAUTI-acquisition (aOR, 1.05; P < .0001), UC DU ratio (aOR, 1.09; P < .0001), public facilities (aOR, 2.24; P < .0001), and neurologic ICUs (aOR, 11.49; P < .0001).
Conclusions:
CAUTI rates are higher in patients with suprapubic catheters, in middle-income countries, in public hospitals, in trauma and neurologic ICUs, and in Eastern European and Asian facilities.
Based on findings regarding risk factors for CAUTI, focus on reducing LOS and UC utilization is warranted, as well as implementing evidence-based CAUTI-prevention recommendations.
Gravitational waves from coalescing neutron stars encode information about nuclear matter at extreme densities, inaccessible by laboratory experiments. The late inspiral is influenced by the presence of tides, which depend on the neutron star equation of state. Neutron star mergers are expected to often produce rapidly rotating remnant neutron stars that emit gravitational waves. These will provide clues to the extremely hot post-merger environment. This signature of nuclear matter in gravitational waves contains most information in the 2–4 kHz frequency band, which is outside of the most sensitive band of current detectors. We present the design concept and science case for a Neutron Star Extreme Matter Observatory (NEMO): a gravitational-wave interferometer optimised to study nuclear physics with merging neutron stars. The concept uses high-circulating laser power, quantum squeezing, and a detector topology specifically designed to achieve the high-frequency sensitivity necessary to probe nuclear matter using gravitational waves. Above 1 kHz, the proposed strain sensitivity is comparable to full third-generation detectors at a fraction of the cost. Such sensitivity changes expected event rates for detection of post-merger remnants from approximately one per few decades with two A+ detectors to a few per year and potentially allow for the first gravitational-wave observations of supernovae, isolated neutron stars, and other exotica.
The migration of dense fluid through a saturated, layered porous medium leads to two end-member examples of buoyancy-driven flow, namely plumes and gravity currents. Herein we develop an integrated theoretical model to study this scenario for the special case where the boundary between the permeable layers, in a two-layered porous medium, is inclined at an angle to the horizontal. Far from being a routine detail, the inclination of the permeability jump leads to a symmetry-breaking: up- and downdip flows have different volume fluxes and travel different distances, possibly substantially different distances, before becoming arrested at the point where plume inflow balances basal draining. Our model predicts these associated run-out lengths and the transient approach thereto. Predictions are validated with measurements from similitude laboratory experiments, in which the upper and lower layers are comprised of glass beads of different diameters. Experiments are conducted for a range of inclination angles and also a range of plume source conditions. The experimental data suggest a complicated structure for the gravity currents, whose boundaries are blurred by dispersion in a manner not captured by our (sharp interface) model. This observation has particular significance in predicting the lateral spread of contaminated fluid through real geological formations, particularly in instances where for example groundwater contamination is of particular concern.
Schools are important settings for increasing reach and uptake of adolescent mental health interventions. There is limited consensus on the focus and content of school-based mental health services (SBMHSs), particularly in low-resource settings. This study elicited the views of diverse stakeholders in two urban settings in India about their priorities and preferences for SBMHSs.
Methods.
We completed semi-structured interviews and focus group discussions with adolescents (n = 191), parents (n = 9), teachers (n = 78), school counsellors (n = 15), clinical psychologists/psychiatrists (n = 7) in two urban sites in India (Delhi and Goa). Qualitative data were obtained on prioritized outcomes, preferred content and delivery methods, and indicated barriers.
Results.
All stakeholders indicated the need for and acceptability of SBMHSs. Adolescents prioritized resolution of life problems and exhibited a preference for practical guidance. Parents and teachers emphasized functional outcomes and preferred to be involved in interventions. In contrast, adolescents' favored limited involvement from parents and teachers, was related to widespread concerns about confidentiality. Face-to-face counselling was deemed to be the most acceptable delivery format; self-help was less frequently endorsed but was relatively more acceptable if blended with guidance or delivered using digital technology. Structured sensitization was recommended to promote adolescent's engagement. Providers endorsed a stepped care approach to address different levels of mental health need among adolescents.
Conclusion.
SBMHSs are desired by adolescents and adult stakeholders in this setting where few such services exist. Sensitization activities are required to support implementation. School counsellors have an important role in identifying and treating adolescents with different levels of mental health needs, and a suite of interventions is needed to target these needs effectively and efficiently.
The interaction between droplet dispersion and evaporation in an acetone spray evaporating under ambient conditions is experimentally studied with an aim to understand the physics behind the spatial correlation between the local vapour mass fraction and droplets. The influence of gas-phase turbulence and droplet–gas slip velocity of such correlations is examined, while the focus is on the consequence of droplet clustering on collective evaporation of droplet clouds. Simultaneous and planar measurements of droplet size, velocity and number density, and vapour mass fraction around the droplets, were obtained by combining the interferometric laser imaging for droplet sizing and planar laser induced fluorescence techniques (Sahu et al., Exp. Fluids, vol. 55, 1673, 2014b, pp. 1–21). Comparison with droplet measurements in a non-evaporating water spray under the same flow conditions showed that droplet evaporation leads to higher fluctuations of droplet number density and velocity relative to the respective mean values. While the mean droplet–gas slip velocity was found to be negligibly small, the vaporization Damköhler number ($Da_{v}$) was approximately ‘one’, which means the droplet evaporation time and the characteristic time scale of large eddies are of the same order. Thus, the influence of the convective effect on droplet evaporation is not expected to be significant in comparison to the instantaneous fluctuations of slip velocity, which refers to the direct effect of turbulence. An overall linearly increasing trend was observed in the scatter plot of the instantaneous values of droplet number density ($N$) and vapour mass fraction ($Y_{F}$). Accordingly, the correlation coefficient of fluctuations of vapour mass fraction and droplet number density ($R_{n\ast y}$) was relatively high (${\approx}0.5$) implying moderately high correlation. However, considerable spread of the $N$ versus $Y_{F}$ scatter plot along both coordinates demonstrated the influence on droplet evaporation due to turbulent droplet dispersion, which leads to droplet clustering. The presence of droplet clustering was confirmed by the measurement of spatial correlation coefficient of the fluctuations of droplet number density for different size classes ($R_{n\ast n}$) and the radial distribution function (RDF) of the droplets. Also, the tendency of the droplets to form clusters was higher for the acetone spray than the water spray, indicating that droplet evaporation promoted droplet grouping in the spray. The instantaneous group evaporation number ($G$) was evaluated from the measured length scale of droplet clusters (by the RDF) and the average droplet size and spacing in instantaneous clusters. The mean value of $G$ suggests an internal group evaporation mode of the droplet clouds near the spray centre, while single droplet evaporation prevails near the spray boundary. However, the large fluctuations in the magnitude of instantaneous values of $G$ at all measurement locations implied temporal variations in the mode of droplet cloud evaporation.
Influenza A(H1N1) viruses of the 2009 pandemic (A(H1N1)pdm09) continue to cause outbreaks in the post-pandemic period. During January to May 2015, an upsurge of influenza was recorded that resulted in high fatality in central India. Genetic lineage, mutations in the hemagglutinin (HA) gene and infection by quasi-species are reported to affect disease severity. The objective of this study is to present the molecular and epidemiological trends during the 2015 influenza outbreak in central India. All the referred samples were subjected to qRT–PCR for diagnosis. HA gene sequencing (23 survivors and 24 non-survivors) and cloning were performed and analyzed using Molecular Evolutionary Genomic Analyzer (MEGA 5·05). Of the 3625 tested samples, 1607 (44·3%) were positive for influenza A(H1N1)pdm09, of which 228 (14·2%) individuals succumbed to death. A significant trend was observed in positivity (P = 0·003) and mortality (P < 0·0001) with increasing age. The circulating A(H1N1)pdm09 virus was characterized as belonging to clade-6B. Clinically significant mutations were detected. Patients infected with the quasi-species of the virus had a greater risk of death (P = 0·009). This study proposes a robust molecular and clinical surveillance program for the detection and characterization of the virus, along with prompt treatment protocols to prevent outbreaks.
The effect of entrained air turbulence on dispersion of droplets (with Stokes number based on the Kolmogorov time scale, $St_{{\it\eta}}$, of the order of 1) in a polydispersed spray is experimentally studied through simultaneous and planar measurements of droplet size, velocity and gas flow velocity (Hardalupas et al., Exp. Fluids, vol. 49, 2010, pp. 417–434). The preferential accumulation of droplets at various measurement locations in the spray was examined by two independent methods viz. counting droplets on images by dividing the image in to boxes of different sizes, and by estimating the radial distribution function (RDF). The dimension of droplet clusters (obtained by both approaches) was of the order of Kolmogorov’s length scale of the fluid flow, implying the significant influence of viscous scales of the fluid flow on cluster formation. The RDF of different size classes indicated an increase in cluster dimension for larger droplets (higher $St_{{\it\eta}}$). The length scales of droplet clusters increased towards the outer spray regions, where the gravitational influence on droplets is stronger compared to the central spray locations. The correlation between fluctuations of droplet concentration and droplet and gas velocities were estimated and found to be negative near the spray edge, while it was close to zero at other locations. The probability density function of slip between fluctuating droplet velocity and gas velocity ‘seen’ by the droplets signified presence of considerable instantaneous slip velocity, which is crucial for droplet–gas momentum exchange. In order to investigate different mechanisms of turbulence modulation of the carrier phase, the three correlation terms in the turbulent kinetic energy equation for particle-laden flows (Chen & Wood, Can. J. Chem. Engng, vol. 65, 1985, pp. 349–360) are evaluated conditional on droplet size classes. Based on the comparison of the correlation terms, it is recognized that although the interphase energy transfer due to fluctuations of droplet concentration is low compared to the energy exchange only due to droplet drag (the magnitude of which is controlled by average droplet mass loading), the former cannot be considered negligible, and should be accounted in two phase flow modelling.
We report upon a theoretical and experimental investigation of a porous medium ‘filling box’ flow by specifically examining the details of the laminar descending plume and its outflow in a control volume having an impermeable bottom boundary and sidewalls. The plume outflow initially comprises a pair of oppositely directed gravity currents. The gravity currents propagate horizontally until they reach the lateral sidewalls at $y=\pm L$. The flow then becomes of filling box type, with a vertically ascending ‘first front’ separating discharged plume fluid below from ambient fluid above. The flow details are described analytically by first deriving a new similarity solution for Darcy plumes with $\mathit{Pe}>O(1)$, where $\mathit{Pe}$ is the Péclet number. From the similarity solution so obtained, we then derive expressions for the plume volume flux and mean reduced gravity as functions of the vertical distance from the source. Regarding the plume outflow, a similarity solution adopted from Huppert & Woods (J. Fluid Mech., vol. 292, 1995, pp. 55–69) describes the height and front speed of the gravity currents, whereas a semi-implicit finite difference scheme is used to predict the first front elevation versus time and horizontal distance. As with high-Reynolds-number filling box flows, that studied here is an example of a coupled problem: the gravity current source conditions are prescribed by the plume volume flux and mean reduced gravity. Conversely, discharged plume fluid may be re-entrained into the plume, be it soon or long after reaching the bottom impermeable boundary. To corroborate our model predictions, analogue laboratory experiments are performed with fresh water and salt water as the working fluids. Our experiments consider as independent variables the porous medium bead diameter and the plume source volume flux and reduced gravity. Predictions for the gravity current front position and height compare favourably against analogue measured data. Good agreement is likewise noted when considering either the mean elevation or the profile of the first front. Results from this study may be adopted in modelling geological plumes. For example, our equations can be used to predict the time required for discharged plume fluid to return to the point of injection in the case of aquifers closed on the sides and below by impermeable boundaries.
We present a multi-wavelength study of a nearby radio loud elliptical galaxy NGC 708, selected from the Bologna B2 sample of radio galaxies. We obtained optical broad band and narrow images from IGO 2m telescope (Pune, India). We supplement the multi-wavelength coverage of the observation by using X-ray data from Chandra, infrared data from 2MASS, Spitzer and WISE and optical image from DSS and HST. In order to investigate properties of interstellar medium, we have generated unsharp-masked, color, residual, quotient, dust extinction, Hα emission maps. From the derived maps it is evident that cool gas, dust, warm ionized Hα and hot X-ray gas are spatially associated with each other. We investigate the inner and outer photometric and kinematic properties of the galaxy using surface brightness profiles. From X-ray 2d beta model, unsharp masking, surface brightness profiles techniques, it is evident that pair of X-ray cavities are present in this system and which are ~5.6 Kpc away from the central X-ray source.
We study the motion of a bubble driven by buoyancy and thermocapillarity in a tube with a non-uniformly heated walls, containing a so-called ‘self-rewetting fluid’; the surface tension of the latter exhibits a parabolic dependence on temperature, with a well-defined minimum. In the Stokes flow limit, we derive the conditions under which a spherical bubble can come to rest in a self-rewetting fluid whose temperature varies linearly in the vertical direction, and demonstrate that this is possible for both positive and negative temperature gradients. This is in contrast to the case of simple fluids whose surface tension decreases linearly with temperature, for which bubble motion is arrested only for negative temperature gradients. In the case of self-rewetting fluids, we propose an analytical expression for the position of bubble arrestment as a function of other dimensionless numbers. We also perform direct numerical simulation of axisymmetric bubble motion in a fluid whose temperature increases linearly with vertical distance from the bottom of the tube; this is done for a range of Bond and Galileo numbers, as well as for various parameters that govern the functional dependence of surface tension on temperature. We demonstrate that bubble motion can be reversed and then arrested only in self-rewetting fluids, and not in linear fluids, for sufficiently small Bond numbers. We also demonstrate that considerable bubble elongation is possible under significant wall confinement, and for strongly self-rewetting fluids and large Bond numbers. The mechanisms underlying the phenomena observed are elucidated by considering how the surface tension dependence on temperature affects the thermocapillary stresses in the flow.
This paper discusses the interaction between droplets and entrained turbulent air flow in the far-downstream locations of a confined polydispersed isothermal spray. Simultaneous and planar measurements of droplet and gas velocities in the spray along with droplet size are obtained with the application of a novel experimental technique, developed by Hardalupas et al. (Exp. Fluids, vol. 49, 2010, pp. 417–434), which combines interferometric laser imaging for droplet sizing (ILIDS) with particle image velocimetry (PIV). These measurements quantified the spatial correlation coefficients of droplet–gas velocity fluctuations ($R_{dg}$) and droplet–droplet velocity fluctuations ($R_{dd}$) conditional on droplet size classes, for various separation distances, and for axial and cross-stream velocity components. At the measurement location close to the spray edge, with increasing droplet size, $R_{dg}$ was found to increase in axial direction and decrease in cross-stream direction. This suggests that as the gas-phase turbulence becomes more anisotropic away from the spray axis, the gravitational influence on droplet–gas correlated motion tends to increase. The effective length scales of the correlated droplet–gas motion were evaluated and compared with that for gas and droplet motion. The role of different turbulent eddies of the gas flow on the droplet–gas interaction was examined. The flow structures were extracted using proper orthogonal decomposition (POD) of the instantaneous gas velocity data, and their contribution on the spatial droplet–gas velocity correlation was evaluated, which quantified the momentum transfer between the two phases at different length scales of the gas flow. The droplets were observed to augment turbulence for the first three POD modes (larger scales) and attenuate it for the rest of the modes (smaller scales). It has been realized that apart from droplet Stokes number and mass loading, the dynamic range of length scales of the gas flow and the relative turbulent kinetic energy content of the flow structures (POD modes) must be considered in order to conclude if the droplets enhance or reduce the carrier-phase turbulence especially at the lower wavenumbers.
We present multiwavelength study of a sample of radio loud early-type galaxies chosen from the B2 sample. We performed surface photometry in BVR broad band filters and Hα narrow band filter on CCD images of sample galaxies using IGO 2m telescope, Pune (INDIA), to get radial profiles of various photometric and geometrical parameters that describe elliptical isophotes fitted to the 2D light distribution of the galaxies. The analysis of radial profiles of quantities such as the (local) surface brightness, the ellipticity, and the deviations from elliptical isophotes parametrized by the Fourier coefficients are main focus of our study. We generated color maps, residual maps, and dust extinction maps, Hα emission maps of the galaxies to study the morphology of the dust and ionized gas content present in the galaxies. We carried out detailed analysis of the properties of the dust present in our sample galaxies. Additionaly, we investigated properties of the dust in the central ~10 arcsec region of our sample galaxies using optical images available from the HST (WFPC2) data archive. We estimated mass and temperature of the dust, molecular gas mass, in the sample galaxies using FIR fluxes of the galaxies obtained from IRAS.
We used spectroscopic data available from the SDSS (DR7) to get an estimate of the mass of the central super massive black-hole for B2 1257+28 (NGC 4874). We plotted rotation curve for coma cluster (Abell 1656), which indicates the presence of dark matter halo around the galaxy B2 1257+28.
We report on the effect of the International Nosocomial Infection Control Consortium's (INICC) multidimensional approach for the reduction of ventilator-associated pneumonia (VAP) in adult patients hospitalized in 21 intensive-care units (ICUs), from 14 hospitals in 10 Indian cities. A quasi-experimental study was conducted, which was divided into baseline and intervention periods. During baseline, prospective surveillance of VAP was performed applying the Centers for Disease Control and Prevention/National Healthcare Safety Network definitions and INICC methods. During intervention, our approach in each ICU included a bundle of interventions, education, outcome and process surveillance, and feedback of VAP rates and performance. Crude stratified rates were calculated, and by using random-effects Poisson regression to allow for clustering by ICU, the incidence rate ratio for each time period compared with the 3-month baseline was determined. The VAP rate was 17·43/1000 mechanical ventilator days during baseline, and 10·81 for intervention, showing a 38% VAP rate reduction (relative risk 0·62, 95% confidence interval 0·5–0·78, P = 0·0001).
The X-ray diffraction data for the single phase UAl4 are reported. The data were obtained with a Huber–Guinier diffractometer with MoKα1 radiation. The unit cell of UAl4 is orthorhombic (space group Imma) with lattice parameters a=4.396 Å, b=6.251 Å, and c=13.699 Å.
Forest birds were surveyed on the islands of Flores and Sumbawa, Indonesia, in July-September 1993. Assessments were made of the conservation status and habitat requirements of the restricted-range, threatened, and near-threatened species. Semi-evergreen rainforest was found to be more important than moist deciduous monsoon forest for the conservation of these species, but such habitat is being rapidly degraded at mid-altitudes and in the lowlands. Moist deciduous monsoon forest is still widespread in the lowlands but it is also being degraded by human activities. Only one significant protected area exists in the region: Taman Nasional Komodo. This harbours an important population of Yellow-crested Cockatoo Cacatua sulphurea but it is too dry o t support any semi-evergreen rainforest. Ten of the 24 restricted-range species found on these islands are of particular conservation importance mainly because of combinations of intolerance of degraded habitat, dependence on semi-evergreen rainforest, restriction to the lowlands, and low population densities. The highest priority species are Flores Monarch Monarcha sacerdotum and Wallace's Hanging-parrot Loriculus flosculus, which were only found in semi-evergreen rainforest at about 450-950 m at one site in the Tanjung Kerita Mese proposed protected area in south-west Flores. Effective protection of this site is urgently required in order to help secure the future of these species. Recommendations are presented for the protection of further areas on Flores and Sumbawa.
A microplot experiment was conducted for two consecutive years, 1978–9 and 1979–80, on alkaline calcareous soils of Chittor, Kapasan, Nimbaheda and Chhotisadari blocks at the Department of Agronomy, College of Agriculture, Udaipur (India). It was found that soil application of 250 kg S/ha both of elemental sulphur and gypsum significantly increased chlorophyll a and b and concentrations of N, K and S of plants. Leaf sap pH and P and Fe concentrations were, however, significantly reduced by sulphur treatments. Foliar application of 0·2% Fe-EDDHA increased chlorophyll a and b and caused marginal increase in N concentration of plants. K and S concentrations remained unaffected but P and Fe concentrations underwent significant reduction. Leaf sap pH was not at all affected by this treatment.
Failure of metabolic translocation of iron and hence its inactivation inside the plant is suggested to be the most probable cause for the incidence of chlorosis despite high tissue Fe concentration. Sulphur application created a balanced nutritional environment and thus kept iron physiologically active for chlorophyll synthesis. Reduced efficacy of Fe-EDDHA might be due to high P concentration in the plant.
In 2004 a deep sequence of HST images of the Bulge was used to identify sixteen transiting extrasolar planet candidates (the SWEEPS candidates; Sahu et al. 2006), of which at least seven are likely to be true planets. Of these, SWEEPS-4 is almost certainly in the disk, and was shown through radial velocity followup to contain a planetary companion; the identification of the remaining fifteen candidates was left undetermined.
We have used a repeat visit in 2006 to attach proper motions to some 180,000 objects, including all sixteen SWEEPS candidates. This has allowed us to build a sample of bulge stars to unprecedented purity. A population of more than 13,000 bulge objects is kinematically isolated, with fewer than thirty disk contaminants. We use the mean bulge and disk populations to test the balance of kinematic associations for the sixteen SWEEPS candidates. Assuming both the detectability and the astrophysical false-positive fraction to be similar for disk and bulge, we find the fraction of stars with planets in the bulge to be consistent with that in the disk.
The SWEEPS (Sagittarius Window Eclipsing Extrasolar Planet Search) program was aimed at detecting planets around stars in the Galactic bulge, not only to determine their physical properties, but also to determine whether the properties of planets found in the solar neighborhood, such as their frequency and the metallicity dependence, also hold for the planets in the Galactic bulge. We used the Hubble Space Telescope to monitor 180,000 F, G, K, and M dwarfs in the Galactic bulge continuously for 7 days in order to look for transiting planets. We discovered 16 candidate transiting extrasolar planets with periods of 0.6 to 4.2 days, including a possible new class of ultra-short period planets (USPPs) with P < 1 day. The facts that (i) the coverage in the monitoring program is continuous, (ii) most of the stars are at a known distance (in the Galctic bulge), (iii) monitoring was carried out in 2 passbands, and (iv) the images have high spatial resolution, were crucial in minimizing and estimating the false positive rates. We estimate that at least 45% of the candidates are genuine planets. Radial velocity observations of the two brightest host stars further support the planetary nature of the transiting companions. These results suggest that the planet frequency in the Galactic bulge is similar to that in the solar neighborhood. They also suggest that higher metallicity favors planet formation even in the Galactic bulge. The USPPs occur only around low-mass stars which may suggest that close-in planets around higher-mass stars are irradiately evaporated, or that planets are able to migrate to and survive in close-in orbits only around such old and low-mass stars.
In 2004 the Sagittarius Window Eclipsing Extrasolar Planet Search (SWEEPS) project undertook a very deep ACS/WFC exposure-set of the Sgr-I low-reddening window in the Galactic Bulge, with repeat observations 2.04 years later. The combination of superb first-epoch sampling, wide field of view and high PSF stability of ACS/WFC on Hubble allows proper motions to be extracted for more than 137,000 objects, over 85,000 to accuracy better than 0.3 mas yr−1. We present these proper motions and outline some of the uses to which they have been put, including the separation of a pure-Bulge sample and the inner Galactic rotation curve.