Statin Use and Risk of Sepsis After Percutaneous Nephrolithotomy

Purpose: To examine the association between statin medication use and sepsis risk after percutaneous nephrolithotomy (PCNL). Materials and Methods: Using medical claims data, we identified working-age adults with urinary stone disease who were treated with PCNL. Among this cohort, we determined which patients had a prescription fill for a statin agent that encompassed their surgery date. We then fitted logistic regression models to examine for differences in rates of postoperative sepsis between statin users and nonusers. In addition, we evaluated the frequency of nonfebrile urinary tract infections (UTIs) and intensive care unit (ICU) services utilization and hospital length of stay (LOS) as a function of statin use. Results: During the study period, at total of 2046 patients underwent PCNL, 382 (18.7%) of whom had a prescription fill for a statin agent preceding their surgery. The overall rate of sepsis in this population was 3.8%. After adjusting for patient health status and sociodemographic factors, the rate of postoperative sepsis was comparable between statin users and nonusers (5.3% vs 3.5%, respectively; P=0.105). In addition, UTI and ICU utilization rates did not relate to statin use (P>0.05 for all associations). Adjusted hospital LOS was shorter among statin users, but the difference was clinically trivial (3.6 vs 4.1 days; P=0.007). Conclusions: Statin use is not associated with reductions in postoperative sepsis, nonfebrile UTIs, ICU utilization, or hospital LOS after PCNL. To increase the safety of PCNL, urologists will have to consider other processes of care (e.g., clinical care pathways).Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140081/1/end.2015.0042.pd

High resolution x-ray characterization of periodically domain-inverted nonlinear optical crystals

A high-resolution triple-axis diffractometer has been used for the structural characterization of periodically domain-inverted nonlinear optical crystals of KTiOPO4 and LNbO3. Striations have been revealed in high strain-sensitivity multiple-crystal topographs of the domain-inverted regions of both these samples and these are dominated by orientation contrast. The combination of high-resolution reciprocal-space mapping and topography has shown that the extended diffraction streak in the q[210] direction for domain-inverted LiNbO3 originates from the "minutely misoriented structure" which is related to the original configuration of dislocations. The reason for the generation of the structural imperfections via the domain-inversion processing is interpreted in terms of the converse piezoelectric effect

A systematic review of different models of home and community care services for older persons

<p>Abstract</p> <p>Background</p> <p>Costs and consumer preference have led to a shift from the long-term institutional care of aged older people to home and community based care. The aim of this review is to evaluate the outcomes of case managed, integrated or consumer directed home and community care services for older persons, including those with dementia.</p> <p>Methods</p> <p>A systematic review was conducted of non-medical home and community care services for frail older persons. MEDLINE, PsycINFO, CINAHL, AgeLine, Scopus and PubMed were searched from 1994 to May 2009. Two researchers independently reviewed search results.</p> <p>Results</p> <p>Thirty five papers were included in this review. Evidence from randomized controlled trials showed that case management improves function and appropriate use of medications, increases use of community services and reduces nursing home admission. Evidence, mostly from non-randomized trials, showed that integrated care increases service use; randomized trials reported that integrated care does not improve clinical outcomes. The lowest quality evidence was for consumer directed care which appears to increase satisfaction with care and community service use but has little effect on clinical outcomes. Studies were heterogeneous in methodology and results were not consistent.</p> <p>Conclusions</p> <p>The outcomes of each model of care differ and correspond to the model's focus. Combining key elements of all three models may maximize outcomes.</p

Mixing potential of a surface-mounted solar-powered water mixer (SWM) for controlling cyanobacterial blooms

Cyanobacterial blooms continue to be a serious nuisance to water quality managers, and remedial measures that are ecologically sound, economically feasible, and efficient in responding to the scale and intensity of the problem are required for their control. Here, we evaluated the potential of a new technique to adequately mix the water column and control cyanobacterial blooms, employing a surface-mounted solar-powered water mixer (SWM). Flow dynamics, thermal structure of the water column and phytoplankton photo-physiology were compared before and during operation of the SWM in Falling Creek Reservoir to determine whether the device helps weaken thermal stratification, deepen surface mixed layer, and entrain surface cyanobacteria into deeper water to light-limit their growth. Water circulation generated by the SWM resulted in weak velocity fields to a lateral distance of 5. m from the device, to a depth of 1.5. m from the surface. Moreover, the mixing minimized the surface water temperatures by approximately 2. °C and deepened the surface mixed layer by 1. m up to a lateral distance of 3. m from the SWM, but little change occurred beyond this distance even after continuous operation of the device for more than a week. Photo-physiological observations also suggested light-limitation in cyanobacterial growth up to a lateral distance of 5. m from SWM during intense sunlight conditions. The results showed that the SWM has limited zone of influence and is unable to adequately mix lakes and reservoirs to effectively control cyanobacterial blooms. © 2013 Elsevier B.V.Sanjina Upadhyay, Kevin A. Bierlein, John C. Little, Michael D. Burch, Kevin P. Elam, Justin D. Brooke

Report (Battelle Memorial Institute. Columbus Laboratories)

Quarterly progress report on a project to test the radiation effects on metallurgy