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Background: During the COVID-19 pandemic, rates of central line bloodstream infections (CLABSI) increased nationally. Studies pre-pandemic showed improved CLABSI rates with implementation of a standardized vascular access team (VAT).[PL1] [PL2] [mi3] Varying VAT resources and coverage existed in our 10 acute care facilities (ACF) prior to and during the pandemic. VAT scope also varied in 1) process for line selection during initial placement, 2) ability to place a peripherally inserted central catheter (PICC), midline or ultrasound-guided peripheral IV in patients with difficult vascular access, 3) ownership of daily assessment of central line (CL) necessity, and 4) routine CL dressing changes. We aimed to define and implement the ideal VAT structure and evaluate the impact on CLABSI standardized infection ratios (SIR) and rates prior to and during the pandemic. Methods: A multidisciplinary workgroup including representatives from nursing, infection prevention, and vascular access was formed to understand the current state of VAT responsibilities across all ACFs. The group identified key responsibilities a VAT should conduct to aid in CLABSI prevention. Complete VAT coverage[mi4] was defined as the ability to conduct the identified responsibilities daily. We compared the SIR and CLABSI rates between hospitals who had complete VAT (CVAT) coverage to hospitals with incomplete VAT (IVAT) coverage. Given this work occurred during the pandemic, we further stratified our analysis based on a time frame prior to the pandemic (1/2015 – 12/2019) and intra-pandemic (1/2020 - 12/2022). Results: The multidisciplinary team identified 6 key components of complete VAT coverage: Assessment for appropriate line selection prior to insertion, ability to insert PICC and midlines, daily CL and midline care and maintenance assessments, daily assessment of necessity for CL, and weekly dressing changes for CL and midlines[NA5] . A cross walk of VAT scope (Figure 1) was performed in October 2022 which revealed two facilities (A and E) which met CVAT criteria. Pre-pandemic, while IVAT CLABSI rates and SIR were higher than in CVAT units, the difference was not statistically significant. During the pandemic, however, CLABSI rates and SIR were 40-50% higher in IVAT compared to CVAT facilities (Incident Rate Ratio 1.5, 95% CI 1.1-2.0 and SIR Relative Ratio 1.4, 95% CI1.1-1.9 respectively) (Table 1). Conclusions: CLABSI rates were lower in facilities with complete VAT coverage prior to and during the COVID-19 pandemic suggesting a highly functioning VAT can aid in preventing CLABSIs, especially when a healthcare system is stressed and resources are limited.
To define the incidence of definitive necrotising enterocolitis in term infants with CHD and identify risk factors for morbidity/mortality.
Methods:
We performed a 20-year (2000–2020) single-institution retrospective cohort study of term infants with CHD admitted to the Boston Children’s Hospital cardiac ICU with necrotising enterocolitis (Bell’s stage ≥ II). The primary outcome was a composite of in-hospital mortality and post-necrotising enterocolitis morbidity (need for extracorporeal membrane oxygenation, multisystem organ failure based on the paediatric sequential organ failure assessment score, and/or need for acute gastrointestinal intervention). Predictors included patient characteristics, cardiac diagnosis/interventions, feeding regimen, and severity measures.
Results:
Of 3933 term infants with CHD, 2.1% (n = 82) developed necrotising enterocolitis, with 67% diagnosed post-cardiac intervention. Thirty (37%) met criteria for the primary outcome. In-hospital mortality occurred in 14 infants (17%), of which nine (11%) deaths were attributable to necrotising enterocolitis. Independent predictors of the primary outcome included moderate to severe systolic ventricular dysfunction (odds ratio 13.4,confidence intervals 1.13–159) and central line infections pre-necrotising enterocolitis diagnosis (odds ratio 17.7, confidence intervals 3.21–97.0) and mechanical ventilation post-necrotising enterocolitis diagnosis (odds ratio 13.5, confidence intervals 3.34–54.4). Single ventricle, ductal dependency, and feeding related factors were not independently associated with the primary outcome.
Conclusions:
The incidence of necrotising enterocolitis was 2.1% in term infants with CHD. Adverse outcomes occurred in greater than 30% of patients. Presence of systolic dysfunction and central line infections prior to diagnosis and need for mechanical ventilation after diagnosis of necrotising enterocolitis can inform risk triage and prognostic counseling for families.
The new mineral tombstoneite (IMA2021-053), (Ca0.5Pb0.5)Pb3Cu2+6Te6+2O6(Te4+O3)6(Se4+O3)2(SO4)2⋅3H2O, occurs at the Grand Central mine in the Tombstone district, Cochise County, Arizona, USA, in cavities in quartz matrix in association with jarosite and rodalquilarite. Tombstoneite crystals are green pseudohexagonal tablets, up to 100 μm across and 20 μm thick. The mineral has a pale green streak and adamantine lustre. It is brittle with irregular fracture and a Mohs hardness of ~2½. It has one perfect cleavage on {001}. The calculated density is 5.680 g cm–3. Optically, the mineral is uniaxial (–) and exhibits pleochroism: O = green, E = light yellow green; O > E. The Raman spectrum exhibits bands consistent with Te6+O6, Te4+O3, Se4+O3 and SO4. Electron microprobe analysis provided the empirical formula (Ca0.51Pb0.49)Σ1.00Pb3.00Cu2+5.85Te6+2.00O6(Te4+1.00O3)6(Se4+0.69Te4+0.24S0.07O3)2(S1.00O4)2⋅3H2O. Tombstoneite is trigonal, P321, a = 9.1377(9), c = 12.2797(9) Å, V = 887.96(18) Å3 and Z = 1. The structure of tombstoneite (R1 = 0.0432 for 1205 I > 2σI) contains thick heteropolyhedral layers comprising Te6+O6 octahedra, Jahn-Teller distorted Cu2+O5 pyramids, Te4+O3 pyramids and Se4+O3 pyramids. Pb2+ cations without stereoactive 6s2 lone-pair electrons are hosted in pockets in the heteropolyhedral layer. Pb2+ cations, possibly with stereoactive 6s2 lone-pair electrons, are located in the interlayer region along with SO4 tetrahedra and H2O groups. Within the heteropolyhedral layer, the Te6+O6 octahedra and the Te4+O3 pyramids form finite Te6+O3(Te4+O3)3 clusters with a pinwheel-like configuration. This is the first known finite complex including both Te4+ and Te6+ polyhedra in any natural or synthetic tellurium oxysalt structure.
Only a small area of the Australian mainland was glaciated during the Pleistocene, whereas periglacial deposits are far more common, indicating that cold environments were extensive and a major influence on landscape evolution. Here we identify representative low-elevation examples of scree slopes and frost action, together with fans and valley fills, indicating pronounced erosion cycles during the Pleistocene. To date the deposits, we explore approaches using radiocarbon, optically stimulated luminescence, and profile dating using the cosmogenic nuclide 10Be. The radiocarbon and optical ages show that screes, alluvial valley fill, and fans were deposited between 66–13 ka during the coldest part of the last glacial cycle, and within the previous glacial cycle. Exposure dating indicates further landscape erosion cycles back to the mid Pleistocene. Together, the deposits indicate the frost cracking limit was ~1300 m lower at 680 ± 10 m and mean winter temperature was 8.2 ± 0.5°C colder than present. Periglacial conditions probably affected much of southeastern Australia. The treeless and dry conditions resulted in widespread erosion and increased run off. Combined with increased snow storage within catchments, rivers were paradoxically larger, with high seasonal discharge and sediment loads.
Microstructures, including crystallographic fabric, within the margin of streaming ice can exert strong control on flow dynamics. To characterize a natural setting, we retrieved three cores, two of which reached bed, from the flank of Jarvis Glacier, eastern Alaska Range, Alaska. The core sites lie ~1 km downstream of the source, with abundant water present in the extracted cores and at the base of the glacier. All cores exhibit dipping layers, a combination of debris bands and bubble-free domains. Grain sizes coarsen on average approaching the lateral margin. Crystallographic orientations are more clustered and with c-axes closer to horizontal nearer the lateral margin. The measured fabric is sufficiently weak to induce little mechanical anisotropy, but the data suggest that despite the challenging conditions of warm ice, abundant water and a short flow distance, many aspects of the microstructure, including measurable crystallographic fabric, evolved in systematic ways.
Interesterified (IE) fats are widely used to replace partially-hydrogenated fats as hard fats with functional and sensory properties needed for spreads/margarines, baked goods, and confectionary, while avoiding the health hazards of trans fats. Detailed mechanistic work to determine the metabolic effects of interesterification of commonly-consumed hard fats has not yet been done. Earlier studies using fats less commonly consumed have shown either neutral or a lowering effect on postprandial lipaemia. We investigated postprandial lipaemia, lipoprotein remodelling, and triacylglycerol-rich lipoprotein (TRL) fraction apolipoprotein concentrations following a common IE blend of palm oil/kernel fractions versus its non-IE counterpart, alongside a reference monounsaturated (MUFA) oil. A 3-armed, double blind, randomized controlled trial (clinicaltrials.gov NCT03191513) in healthy adults (n = 20; 10 men, 10 women) aged 45–75 y, assessed effects of single meals (897 kcal, 50 g fat, 16 g protein, 88 g carbohydrate) on postprandial plasma triacylglycerol (TAG) concentrations, lipoprotein profiles, and TRL fraction apolipoprotein B48 and TAG concentrations. Test fats were IE 80:20 palm stearin/palm kernel fat, the equivalent non-IE fat, and a high-MUFA reference oil (rapeseed oil, RO). Blood was collected at baseline and hourly for 8 h. Linear mixed modelling was performed, adjusting for treatment order and baseline values (ver. 24.0; SPSS Inc., Chicago, IL, USA). Total 8 h incremental area under the curves (iAUC) for plasma TAG concentrations were lower following IE and non-IE compared with RO (mean difference in iAUC: non-IE vs. RO -1.8 mmol/L.h (95% CI -3.3, -0.2); IE vs. RO -2.6 mmol/L.h (95% CI -5.3, 0.0)), but iAUCs for IE and non-IE were not significantly different. There were no differences between IE and non-IE for chylomicron fraction apoB48 concentrations nor TAG:apoB48 ratio. No differences were observed between IE and non-IE for lipoprotein (VLDL, HDL, LDL) particle size or sub-class particle concentrations. However, LDL particle diameters were reduced at 5 and 6 h following IE vs RO (P < 0.05). XXL- (including chylomicron remnants and VLDL particles), XL- and L-VLDL particle concentrations (average diameters > 75, 64, and 53.6 nm respectively) were higher following IE and non-IE vs. RO at 6 h (P < 0.05) and 8 h postprandially (P < 0.005–0.05). In conclusion, both IE and non-IE palmitic acid-rich fats generated a greater preponderance of pro-atherogenic large TRL remnant particles in the late postprandial phase relative to an oleic acid-rich oil. However, the process of interesterification did not modify postprandial TAG response or lipoprotein metabolism.
Ga proverbial wisdom holds that “hate has no medicine,” but there is a sacred court in Accra where people can calm the animosity that emerges from social conflicts. A unique form of vernacular jurisprudence has emerged at the Nae We Shrine Tribunal, which manages the consequences of civil, criminal, and supernatural crimes without raising the ire of human rights activists. Using records from this shrine court, the authors of this article demonstrate how the Tribunal offers social and spiritual wellbeing in a manner that cannot be provided by the chiefly and state judicial systems.
Hagstromite, Pb8Cu2+(Te6+O6)2(CO3)Cl4, (IMA2019-093) is a new tellurate mineral from Otto Mountain near Baker, California, USA. It occurs on quartz in association with cerussite, fuettererite and thorneite. It is a secondary oxidation zone mineral and is presumed to have formed by oxidation of earlier formed tellurides, chalcopyrite and galena. Hagstromite occurs as light yellow–green blades, up to ~100 μm long. Crystals are transparent with adamantine to silky lustre. The mineral is brittle with two cleavages providing splintery fracture; the Mohs hardness is probably between 2 and 3. The calculated density is 7.062 g cm–3. Hagstromite is optically biaxial (+), with calculated indices of refraction for α = 2.045, β = 2.066 and γ = 2.102; 2Vmeas = 76(1)°; and optical orientation X = b, Y = a and Z = c. The Raman spectrum of hagstromite exhibits similarities with those of agaite and thorneite and confirms the presence of CO32–. The electron microprobe analyses provided the empirical formula Pb8.07Cu2+0.98Te6+1.96C1.17Cl3.83O15.34. Hagstromite is orthorhombic, space group Ibam, with a = 23.688(17), b = 9.026(8), c = 10.461(8) Å, V = 2237(3) Å3 and Z = 4. The crystal structure of hagstromite (R1 = 0.0659 for 284 I > 2σI reflections) contains a novel Cu2+Te6+2O12 chain assembled of corner-sharing Cu2+O4 squares and Te6+O6 octahedra. The O atoms in the chains form bonds with Pb2+ cations, which in turn bond to Cl– and CO32– anions, thereby creating a framework structure.
Clinical Enterobacteriacae isolates with a colistin minimum inhibitory concentration (MIC) ≥4 mg/L from a United States hospital were screened for the mcr-1 gene using real-time polymerase chain reaction (RT-PCR) and confirmed by whole-genome sequencing. Four colistin-resistant Escherichia coli isolates contained mcr-1. Two isolates belonged to the same sequence type (ST-632). All subjects had prior international travel and antimicrobial exposure.
Recent commercialization of auxin herbicide–based weed control systems has led to increased off-target exposure of susceptible cotton cultivars to auxin herbicides. Off-target deposition of dilute concentrations of auxin herbicides can occur on cotton at any stage of growth. Field experiments were conducted at two locations in Mississippi from 2014 to 2016 to assess the response of cotton at various growth stages after exposure to a sublethal 2,4-D concentration of 8.3 g ae ha−1. Herbicide applications occurred weekly from 0 to 14 weeks after emergence (WAE). Cotton exposure to 2,4-D at 2 to 9 WAE resulted in up to 64% visible injury, whereas 2,4-D exposure 5 to 6 WAE resulted in machine-harvested yield reductions of 18% to 21%. Cotton maturity was delayed after exposure 2 to 10 WAE, and height was increased from exposure 6 to 9 WAE due to decreased fruit set after exposure. Total hand-harvested yield was reduced from 2,4-D exposure 3, 5 to 8, and 13 WAE. Growth stage at time of exposure influenced the distribution of yield by node and position. Yield on lower and inner fruiting sites generally decreased from exposure, and yield partitioned to vegetative or aborted positions and upper fruiting sites increased. Reductions in gin turnout, micronaire, fiber length, fiber-length uniformity, and fiber elongation were observed after exposure at certain growth stages, but the overall effects on fiber properties were small. These results indicate that cotton is most sensitive to low concentrations of 2,4-D during late vegetative and squaring growth stages.
The crystal structure of tlapallite has been determined using single-crystal X-ray diffraction and supported by electron probe micro-analysis, powder diffraction and Raman spectroscopy. Tlapallite is trigonal, space group P321, with a = 9.1219(17) Å, c = 11.9320(9) Å and V = 859.8(3) Å3, and was refined to R1 = 0.0296 for 786 reflections with I > 2σ(I). This study resulted from the discovery of well-crystallised tlapallite at the Wildcat prospect, Utah, USA. The chemical formula of tlapallite has been revised to (Ca,Pb)3CaCu6[Te4+3Te6+O12]2(Te4+O3)2(SO4)2·3H2O, or more simply (Ca,Pb)3CaCu6Te4+8Te6+2O30(SO4)2·3H2O, from H6(Ca,Pb)2(Cu,Zn)3(TeO3)4(TeO6)(SO4). The tlapallite structure consists of layers containing distorted Cu2+O6 octahedra, Te6+O6 octahedra and Te4+O4 disphenoids (which together form the new mixed-valence phyllotellurate anion [Te4+3Te6+O12]12−), Te4+O3 trigonal pyramids and CaO8 polyhedra. SO4 tetrahedra, Ca(H2O)3O6 polyhedra and H2O groups fill the space between the layers. Tlapallite is only the second naturally occurring compound containing tellurium in both the 4+ and 6+ oxidation states with a known crystal structure, the other being carlfriesite, CaTe4+2Te6+O8. Carlfriesite is the predominant secondary tellurium mineral at the Wildcat prospect. We also present an updated structure for carlfriesite, which has been refined to R1 = 0.0230 for 874 reflections with I > 2σ(I). This updated structural refinement improves upon the one reported previously by refining all atoms anisotropically and presenting models of bond valence and Te4+ secondary bonding.
The introduction of auxin herbicide weed control systems has led to increased occurrence of crop injury in susceptible soybeans and cotton. Off-target exposure to sublethal concentrations of dicamba can occur at varying growth stages, which may affect crop response. Field experiments were conducted in Mississippi in 2014, 2015, and 2016 to characterize cotton response to a sublethal concentration of dicamba equivalent to 1/16X the labeled rate. Weekly applications of dicamba at 35 g ae ha−1 were made to separate sets of replicated plots immediately following planting until 14 wk after emergence (WAE). Exposure to dicamba from 1 to 9 WAE resulted in up to 32% visible injury, and exposure from 7 to 10 WAE delayed crop maturity. Exposure from 8 to 10 and 13 WAE led to increased cotton height, while an 18% reduction in machine-harvested yield resulted from exposure at 6 WAE. Cotton exposure at 3 to 9 WAE reduced the seed cotton weight partitioned to position 1 fruiting sites, while exposure at 3 to 6 WAE also reduced yield in position 2 fruiting sites. Exposure at 2, 3, and 5 to 7 WAE increased the percent of yield partitioned to vegetative branches. An increase in percent of yield partitioned to plants with aborted terminals occurred following exposure from 3 to 7 WAE and corresponded with reciprocal decreases in yield partitioned to positional fruiting sites. Minimal effects were observed on fiber quality, except for decreases in fiber length uniformity resulting from exposure at 9 and 10 WAE.
The crystal structure of burckhardite from the type locality, Moctezuma, Sonora, Mexico, has been refined to R1 = 0.0362 and wR2 = 0.0370 for 215 reflections with I > 2σ(I). Burckhardtite is trigonal, space group P1m, with the unit-cell parameters a = 5.2566(5) Å , c = 13.0221(10) Å , V = 311.62(5) Å3 and Z = 1 for the ideal formula unit Pb2(Fe3+Te6+)[AlSi3O8]O6. There is no long-range order of (Fe3+, Te6+) or (Al3+, Si4+). New microprobe data were used to estimate site scattering factors, and Raman spectroscopic data showed no evidence of O–H stretching bands. Burckhardtite is not closely related to the micas, as supposed previously, but is a double-sheet silicate in which the aluminosilicate anion resembles that of minerals such as cymrite and kampfite. The [(Fe3+Te6+)O6]3– part of the structure is not bonded directly to the aluminosilicate layer, but forms a discrete anionic phyllotellurate layer that alternates with the [AlSi3O8]– double sheets. Similar phyllotellurate layers are known from several synthetic phases. In burckhardtite, Pb2+ cations intercalate between phyllosilicate and phyllotellurate layers, forming a Pb2[FeTeO6] module that is topologically similar to a slab of the structure of rosiaite, Pb[Sb2O6]. The crystal symmetry, structure, classification as a double-sheet silicate and chemical formula, including the determination of the 6+ valence of Te and absence of essential H2O, are all new findings for the mineral.
GET MEDIEVAL. This now infamous phrase derives from a scene embedded in Quentin Tarantino's Pulp Fiction, which premiered a few months after Derek Jarman's death in 1994. Raped in a sadomasochistic dungeon and rescued by the man he has been chasing (Butch Coolidge, played by Bruce Willis), the criminal boss Marsellus Wallace (Ving Rhames) shoots in the groin the individual who had earlier sodomised him at gunpoint, threatens him with a pair of pliers and a blow torch, and declares: “Hear me talkin’ hillbilly boy?! I ain't through with you by a damn sight. I'm gonna git Medieval on your ass.” Wallace's announcement that he is going to inflict some medieval-style torment on his attacker-turned-victim calls on the very visceral associations that the word “medieval” popularly evokes: barbaric, brutal, bloody and dark.
Getting Medieval is also the title of an influential book by the medievalist Carolyn Dinshaw. Working against Tarantino's reductive (and implicitly homophobic) sense of medieval as a space of abjection and otherness, Dinshaw looks instead to a series of contemporary writers and thinkers for whom the medieval period offers up desirable alternatives to aspects of modernity: “Getting medieval: not undertaking brutal private vengeance in a triumphal and unregulated bloodbath, as Marsellus Wallace threatens in Pulp Fiction … but using ideas of the past, creating relations with the past, touching in this way the past in our efforts to build selves and communities now and into the future.”
This chapter presents an overview of Jarman's encounters with the medieval in his filmmaking, art and writings, bringing his own efforts to “touch” the past into focus. While Jarman's “medieval” occasionally conforms to Tarantino's perception of it as an abject other, my argument is that the way Jarman gets medieval conforms more closely to Dinshaw's definition. By taking a journey into these so-called “Middle Ages” – their art and architecture, their religious and literary cultures, and their portrayals of time and space – Jarman was able to imagine a vision of the future that bypassed some of the straitjackets of modernity. First, I consider Jarman's attitudes to religion, with particular reference to the institutions of medieval Christianity.