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To characterize the relationship between chlorhexidine gluconate (CHG) skin concentration and skin microbial colonization.
Design:
Serial cross-sectional study.
Setting/participants:
Adult patients in medical intensive care units (ICUs) from 7 hospitals; from 1 hospital, additional patients colonized with carbapenemase-producing Enterobacterales (CPE) from both ICU and non-ICU settings. All hospitals performed routine CHG bathing in the ICU.
Methods:
Skin swab samples were collected from adjacent areas of the neck, axilla, and inguinal region for microbial culture and CHG skin concentration measurement using a semiquantitative colorimetric assay. We used linear mixed effects multilevel models to analyze the relationship between CHG concentration and microbial detection. We explored threshold effects using additional models.
Results:
We collected samples from 736 of 759 (97%) eligible ICU patients and 68 patients colonized with CPE. On skin, gram-positive bacteria were cultured most frequently (93% of patients), followed by Candida species (26%) and gram-negative bacteria (20%). The adjusted odds of microbial recovery for every twofold increase in CHG skin concentration were 0.84 (95% CI, 0.80–0.87; P < .001) for gram-positive bacteria, 0.93 (95% CI, 0.89–0.98; P = .008) for Candida species, 0.96 (95% CI, 0.91–1.02; P = .17) for gram-negative bacteria, and 0.94 (95% CI, 0.84–1.06; P = .33) for CPE. A threshold CHG skin concentration for reduced microbial detection was not observed.
Conclusions:
On a cross-sectional basis, higher CHG skin concentrations were associated with less detection of gram-positive bacteria and Candida species on the skin, but not gram-negative bacteria, including CPE. For infection prevention, targeting higher CHG skin concentrations may improve control of certain pathogens.
Tight focusing with very small f-numbers is necessary to achieve the highest at-focus irradiances. However, tight focusing imposes strong demands on precise target positioning in-focus to achieve the highest on-target irradiance. We describe several near-infrared, visible, ultraviolet and soft and hard X-ray diagnostics employed in a ∼1022 W/cm2 laser–plasma experiment. We used nearly 10 J total energy femtosecond laser pulses focused into an approximately 1.3-μm focal spot on 5–20 μm thick stainless-steel targets. We discuss the applicability of these diagnostics to determine the best in-focus target position with approximately 5 μm accuracy (i.e., around half of the short Rayleigh length) and show that several diagnostics (in particular, 3$\omega$ reflection and on-axis hard X-rays) can ensure this accuracy. We demonstrated target positioning within several micrometers from the focus, ensuring over 80% of the ideal peak laser intensity on-target. Our approach is relatively fast (it requires 10–20 laser shots) and does not rely on the coincidence of low-power and high-power focal planes.
To assess whether measurement and feedback of chlorhexidine gluconate (CHG) skin concentrations can improve CHG bathing practice across multiple intensive care units (ICUs).
Design:
A before-and-after quality improvement study measuring patient CHG skin concentrations during 6 point-prevalence surveys (3 surveys each during baseline and intervention periods).
Setting:
The study was conducted across 7 geographically diverse ICUs with routine CHG bathing.
Participants:
Adult patients in the medical ICU.
Methods:
CHG skin concentrations were measured at the neck, axilla, and inguinal region using a semiquantitative colorimetric assay. Aggregate unit-level CHG skin concentration measurements from the baseline period and each intervention period survey were reported back to ICU leadership, which then used routine education and quality improvement activities to improve CHG bathing practice. We used multilevel linear models to assess the impact of intervention on CHG skin concentrations.
Results:
We enrolled 681 (93%) of 736 eligible patients; 92% received a CHG bath prior to survey. At baseline, CHG skin concentrations were lowest on the neck, compared to axillary or inguinal regions (P < .001). CHG was not detected on 33% of necks, 19% of axillae, and 18% of inguinal regions (P < .001 for differences in body sites). During the intervention period, ICUs that used CHG-impregnated cloths had a 3-fold increase in patient CHG skin concentrations as compared to baseline (P < .001).
Conclusions:
Routine CHG bathing performance in the ICU varied across multiple hospitals. Measurement and feedback of CHG skin concentrations can be an important tool to improve CHG bathing practice.
Variability in antidepressant response is due to genetic and environmental factors. Among genetic factors, the ones controlling for availability of the drug at the target site are interesting candidates. Rs6295C/G SNP for 5-HT1A gene (HTR1A) has been found to effect the expression and function of HTR1A In fact rs6295C/G was in strong linkage disequilibrium with other polymorphisms of HTR1A suggesting that those functional effects could be associated with polymorphisms other than the synonymous rs6295C/G. In the present study we examine the possible association of a panel of markers in strong linkage disequilibrium of the HTR1A with SSRI/SNRI response in 137 Japanese major depression sample followed for 6 weeks. We observed the significant association of better response to antidepressant with rs10042486C/C (p<0.0001), rs6295G/G (p<0.0001) and rs1364043T/T (p=0.018) genotype carriers, that is mutant allele homozygote, independently from clinical variables. Furthermore mutant allele homozygote carriers in all these 3 SNPs was associated more solidly with treatment response by various assessment such as HAM-D score change over time (p=0.001), week 2 (p<0.0001), 4(p=0.007), and 6(p=0.048) as well as response rate (p=0.0005) and remission rate (p=0.004).
In conclusion, this is the first study that reports the significant association of antidepressant response with rs10042486C/T and rs1364043G/T variants of HTR1A and also with rs10042486-rs6295-rs1364043 combination. This finding adds an important piece of information for the pathway of detecting the genetics of antidepressant response even if results must be verified on larger samples.
In this study, direct numerical simulation of the flow around a rotating sphere at high Mach and low Reynolds numbers is conducted to investigate the effects of rotation rate and Mach number upon aerodynamic force coefficients and wake structures. The simulation is carried out by solving the three-dimensional compressible Navier–Stokes equations. A free-stream Reynolds number (based on the free-stream velocity, density and viscosity coefficient and the diameter of the sphere) is set to be between 100 and 300, the free-stream Mach number is set to be between 0.2 and 2.0, and the dimensionless rotation rate defined by the ratio of the free-stream and surface velocities above the equator is set between 0.0 and 1.0. Thus, we have clarified the following points: (1) as free-stream Mach number increased, the increment of the lift coefficient due to rotation was reduced; (2) under subsonic conditions, the drag coefficient increased with increase of the rotation rate, whereas under supersonic conditions, the increment of the drag coefficient was reduced with increasing Mach number; and (3) the mode of the wake structure becomes low-Reynolds-number-like as the Mach number is increased.
Infrared spectroscopy was performed on a thin section of a chalcedonic quartz at high temperature in order to investigate the states and diffusivity of intergranular water. The sample contained 0.3 wt.% of silanol (Si—OH) and 0.3 wt.% of molecular H2O, located mainly at intergranular regions but also as fluid inclusions. We monitored the diffusion of molecular H2O associated with dehydration by in situ analyses at 350—500°C and determined the bulk-diffusion coefficients as expressed by an Arrhenius relationship: Dbulk (m2 sec—1) = 10—4.5 exp(—107±17/RT), where R is the gas coefficient and T the temperature. The activation energy for our sample is similar to those previously reported for diffusion in quartz aggregates with incompletely-connected grain boundaries. This result and our previous measurements of electrical conductivity imply that diffusion of molecular H2O at incompletely- connected intergranular regions is the main mechanism for the dehydration. The diffusion coefficients in chalcedony are larger than those previously reported for rhyolitic glass and other granular aggregates. Intergranular regions, inherent larger pores and cracks created during heating can act as efficient diffusion paths within the chalcedony.
The interaction of femtosecond ultra-intense laser pulses with clusters increases absorption of the incident laser light compared with the interaction with solid targets and leads to enhanced generation of different quantum beams with unique parameters. Future investigations of such interaction urgently need detailed modeling and optimization of cluster parameters, for instance, in order to obtain the clusters with desired size, or some specific spatial configuration of the target etc. A numerical model of gas-cluster targets production by the nozzle flows of gases and binary mixtures is presented. Some previous results of the model utilization are summarized, and some new results are given. Techniques of experimental verification of the numerical results are discussed.
Sustainable commercial use of native wildlife is an alternative economic means of land use by Indigenous people in remote rural areas. This situation applies within large tracts of land owned by Indigenous people across northern Australia. The commercial use of saltwater crocodiles Crocodylus porosus is a growing industry in Australia's Northern Territory. Although Indigenous people sell crocodile eggs and hatchlings, the majority of harvesting and incubation is done by non-indigenous people from less remote areas. One Indigenous community has been heavily involved in this industry and now manages its own harvest and incubation programme. We present a case study of this programme, which has transitioned from outside agencies managing the harvest, to complete local ownership and management. Egg harvests and incubation success rates declined by 40% following the switch to local management. Income increased, as did production costs; in particular, royalty payments made to Indigenous landowners. The declines reflect the community's motives for engaging in the industry, which have been socially rather than commercially driven, and damage to nesting habitat by feral animals. The increase in royalties reflects the need to compete with non-indigenous harvesters from outside the township, who are strictly commercially driven. Harvesting, incubation and trade in crocodile eggs and hatchlings can form a viable and sustainable enterprise for remote Indigenous communities. However, efficiency needs to be improved to fulfil the need for a reliable and dependable supply chain, and regulatory institutions should give Indigenous harvesters sufficient freedom to pursue innovative and viable livelihood options.
This study aimed to predict eosinophilic chronic rhinosinusitis prognosis by investigating changes in the blood eosinophil count and other disease biomarkers after surgery.
Methods:
Blood eosinophil numbers and serum interleukin-5 levels were measured in 22 eosinophilic chronic rhinosinusitis patients before and after functional endoscopic sinus surgery, and compared with equivalent measures in non-eosinophilic chronic rhinosinusitis patients and chronic rhinosinusitis without polyps patients. Differences between well-controlled eosinophilic chronic rhinosinusitis patients and those who experienced recurrence were also assessed.
Results:
Blood eosinophil numbers and serum interleukin-5 level decreased after surgery in eosinophilic chronic rhinosinusitis patients. In this patient group, blood eosinophil counts before surgery were significantly higher in patients who experienced recurrence (825.7 ± 26.1 vs 443.9 ± 76.6 cells/μl, p < 0.05), and decreased significantly after surgery (825.7 ± 26.1 vs 76.7 ± 25.8 cells/μl, p < 0.05).
Conclusion:
Blood eosinophil numbers may reflect disease severity in eosinophilic chronic rhinosinusitis patients and their prognosis after surgery.
This paper describes an overview of our recent discovery – clear
demonstration that LiF crystals can be efficiently used as a high-performance neutron
imaging detector based on optically stimulated luminescence of color centers
generated by neutron irradiation. It is shown that the neutron images we have
obtained are almost free from granular noise, have a spatial resolution of ${\sim}5.4~{\rm\mu}\text{m}$ and a linear response with a dynamic range of at least $10^{3}$. The high contrast and good sensitivity of LiF crystals allow us to
distinguish two holes with less than 2% transmittance difference. We propose to use
such detectors in areas where high spatial resolution with high image gradation
resolution is needed, including diagnostics of different plasma sources such as laser
and z-pinch produced plasmas.
The superbubble (SB) 30 Dor C with the strong non-thermal X-ray emission is one of the best targets for study of the cosmic-ray (CR) acceleration. We investigated X-ray spectral properties of the SB with a high spatial resolution of ~10 pc. Consequently, the spectra in the east regions can be described with a combination of absorbed thermal and non-thermal models while the spectra in the west regions can be fitted with an absorbed non-thermal model. We found that the observed photon index and intensity in 2-10 keV show variations of 2.0-3.5 and (0.6-8.0) × 10−7 erg s−1 cm−2 str−1, respectively. The results are possibly caused by the spatial variation of the CR acceleration efficiency and/or the circumstellar environment.
It is shown that various spectroscopic methods based on measurements of X-ray spectra radiated from cluster targets can be used for estimation of the destruction degree of clusters by laser prepulses. These methods allow insight to be gained regarding the important issue of preservation of the dense cluster core at the moment of the arrival of the main laser pulse. In addition, they can be used for quantitative estimation of the size of the undestroyed parts of the clusters and also for measuring the temperature and density of the preplasmas produced by the laser prepulses.
The Dielectric Barrier Discharge (DBD) is composed of many Filamentary Discharges (FDs), and it can be applied to ozone generation, gaseous pollution control, etc. In our laboratory, we investigated efficient cleaning methods of diesel exhaust gas by DBD. From the results of numerical simulation of chemical reactions, a homogeneous DBD was expected to improve the efficiency of pollution control and also the ozone yield. Recently, we found that a DBD device using alumina as barrier material can generate an Atmospheric Pressure Townsend Discharge (APTD) in air. In this research, we setup two ozonizers with different discharge modes of FD and APTD, and compared the ozone yield. The experimental results showed that the ozone yield was higher by the FD mode than by the APTD mode in lower Specific Input Energy (SIE) region. However in the region that the SIE is larger than 420J/L, the APTD mode showed higher ozone yield than FD mode.
An investigation is made of the role of hollow atoms in the spectra of an ultrashort-pulse-laser-driven Ar cluster target. Experimental measurements are presented from an Ar cluster-gas target using short-pulse lasers with various intensities, durations, and contrasts. Calculations in support of these measurements have been performed using a detailed atomic kinetics model with the ion distributions found from solution of the time-dependent rate equations. The calculations are in good agreement with the measurements and the role of hollow atoms in the resulting complicated spectra is analyzed. It is demonstrated that, although the presence of hollow atoms is estimated to add only around 2% to the total line emission, signatures of hollow atom spectra can be identified in the calculations, which are qualitatively supported by the experimental measurements.
We used X-ray spectroscopy as a diagnostic tool for investigating the properties of laser-cluster interactions at the stage in which non-adiabatic cluster expansion takes place and a quasi-homogeneous plasma is produced. The experiment was carried out with a 10 TW, 65 fs Ti:Sa laser focused on CO2 cluster jets. The effect of different laser-pulse contrast ratios and cluster concentrations was investigated. The X-ray emission associated to the Rydberg transitions allowed us to retrieve, through the density and temperature of the emitting plasma, the time after the beginning of the interaction at which the emission occurred. The comparison of this value with the estimated time for the “homogeneous” plasma formation shows that the degree of adiabaticity depends on both the cluster concentration and the pulse contrast. Interferometric measurements support the X-ray data concerning the plasma electron density.
Background and objective: The degradation of the cytoskeletal protein microtubule-associated protein 2 (MAP2), by calpain has been known to occur following traumatic brain injury. We examined the therapeutic potential of calpain inhibitor 2, compared with that of moderate hypothermia in traumatic brain injury produced by weight drop in rats.
Methods: An inhibitor treated group (n = 8) received calpain inhibitor 2 intravenously (i.v.) for 5 min before and for 6 h after injury (total 2 μmol); a hypothermic (HT) group (n = 8) was maintained at 30°C (temporalis muscle temperature) for 45 min prior to and 60 min after injury; an untreated (UT) group (n = 8) received an infusion of inactive vehicle. Eight rats (sham group) underwent surgery without brain injury. Histopathological (haematoxylin and eosin staining) and MAP2 (immunohistchemistry and western blotting) evaluations were performed at 6 h after injury.
Results: Ipsilateral cortical damage was marked in the injured groups. In the hippocampus, marked pyramidal neuronal damage was observed in the UT and calpain inhibitor treated (CI) groups, while these neurons were better preserved in the HT group. The hippocampal MAP2 levels in the UT, CI and HT groups were significantly decreased to 13 ± 9%, 28 ± 33% and 62 ± 25% of the sham control, respectively. MAP2 concentration in the HT group was significantly higher than in UT and CI groups (P < 0.05).
Conclusion: The results suggest that moderate hypothermia, but not calpain inhibitor 2 with the tested regime, attenuates cytoskeletal damage in the ipsilateral hippocampus at 6 h after traumatic brain injury.
High-resolution K-shell spectra of a plasma created by
superintense laser irradiation of micron-sized Ar clusters have been
measured with an intensity above 1019 W/cm2
and a pulse duration of 30 fs. The total photon flux of 2 ×
108 photons/pulse was achieved for Heα1
resonant line of Ar (λ = 3.9491 Å, 3.14 keV). In parallel
with X-ray measurements, energy distributions of emitted ions have been
measured. The multiply charged ions with kinetic energies up to 800 keV
were observed. It is found that hot electrons produced by high contrast
laser pulses allow the isochoric heating of clusters and shift the ion
balance toward the higher charge states, which enhances both the X-ray
line yield of the He-like argon ion and the ion kinetic energy.
To investigate the directional dependence of the Faraday effect in terbium–scandium–aluminum garnet (TSAG) single crystals, grown by the Czochralski method, the Verdet constant was measured at 〈111〉, 〈110〉, and 〈100〉 orientations. Extinction ratio and magnetic susceptibility were measured. From the linear dependence of the Verdet constant and inverse wavelength square 1/λ2, 〈111〉 direction shows the highest value of Verdet constant (for λ⋅ = 649.1 nm, Vav = 8.256 × 10−3 deg · Oe−1 · cm−1). Significant anisotropy of magnetic susceptibility was not observed. The extinction ratio of TSAG shows the highest value for 〈111〉 orientation 38.7 dB, which implies that it can be used as an optical isolator.