Risk factors for central venous catheter-related infections in surgical and intensive care units. The Central Venous Catheter-Related Infections Study Group.

To identify avoidable risk factors for central venous catheter (CVC) infections in patients undergoing short-term catheterization

FOAM FORMATION IN THE SALTSTONE PRODUCTION FACILITY: EVALUATION OF SOURCES AND MITIGATION

The Saltstone Production Facility receives waste from Tank 50H for treatment. Influents into Tank 50H include the Effluent Treatment Project waste concentrate, H-Canyon low activity waste and General Purpose Evaporator bottoms, Modular Caustic Side Solvent Extraction Unit decontaminated salt solution, and salt solution from the Deliquification, Dissolution and Adjust campaign. Using the Waste Characterization System (WCS), this study tracks the relative amounts of each influent into Tank 50H, as well as the total content of Tank 50H, in an attempt to identify the source of foaming observed in the Saltstone Production Facility hopper. Saltstone has been using antifoam as part of routine processing with the restart of the facility in December 2006. It was determined that the maximum admix usage in the Saltstone Production Facility, both antifoam and set retarder, corresponded with the maximum concentration of H-Canyon low activity waste in Tank 50H. This paper also evaluates archived salt solutions from Waste Acceptance Criteria analysis for propensity to foam and the antifoam dosage required to mitigate foaming. It was determined that Effluent Treatment Project contributed to the expansion factor (foam formation) and General Purpose Evaporator contributed to foaminess (persistence). It was also determined that undissolved solids contribute to foam persistence. It was shown that additions of Dow Corning Q2-1383a antifoam reduced both the expansion factor and foaminess of salt solutions. The evaluation of foaming in the grout hopper during the transition from water to salt solution indicated that higher water-to-premix ratios tended to produce increased foaming. It was also shown that additions of Dow Corning Q2-1383a antifoam reduced foam formation and persistence

Fire in the Operating Room During Hypospadias Repair

Fire in the operating room (OR) is a very distressful and shocking occurrence with potential dramatic consequences. Despite safety rules and rigorous recommendations, such unintentional events do occur every so often. Notably, the vast majority of cases have been reported in the adult population, with very few pediatric cases described to date. Herein, we report on a 16-month-old boy undergoing reconstructive surgery for penoscrotal hypospadias, who experienced an OR fire most likely related to the use of alcohol-based solution ignited by monopolar electrocautery

Price discrimination in the Italian medical device industry: an empirical analysis

In this paper we ascertain that the Italian market for medical devices is characterized by significant price dispersion. We have, therefore, carried out an econometric analysis, as well as a Bayesian network analysis to verify if price dispersion is due to price discrimination. We have found that ASLs (Aziende Sanitarie Locali) incur higher procurement costs than AOs (Aziende Ospedaliere), which purchase larger quantities as Centralized purchasing agencies do. Consequently, second-degree price discrimination may be one of the causes of price differences. Price levels are also inversely related to product age because of intense innovative activity, making product differentiation more likely than price discrimination. Public procurement agents located in Southern Italy pay higher prices than those located in Northern or Central Italy. This is due to the higher probability for Southern procurement agents to purchase from independent wholesalers, rather than from producers, implying a double marginalization effect which raises final prices. It is also more likely that obsolete medical devices are sold to Southern health care providers

Phase-averaged characterization of turbulent isothermal free swirling jet after vortex breakdown

This work mainly focused on the near-exit region of a round isothermal free swirling jet to characterize the effect of swirl on the flow field and to identify large coherent structures. 3C-2D PIV was employed to capture the instantaneous flow field close to the nozzle exit for non-swirling (S=0) and a high swirling jets (S=1.26) both with a Reynolds number of 21800. At swirl level of 1.26 the pressure fluctuations measured by a capacitive microphone indicate the existence of periodic instability, the so called precessing vortex core (PVC). A three-component proper orthogonal decomposition (POD) applied to the instantaneous velocity fields allow to identify the dominant flow structure associated to the PVC. The time coefficients of the two first most energetic POD modes were used to reconstruct the phase of the oscillatory motion in the swirling flow. The phase information was then used to conditionally average the instantaneous velocity field s, this allowed the 3D structure of the PVC to be reconstructed. The instantaneous minima of negative swirling strength values calculated from the instantaneous velocity field revealed the presence of two helical structures located in the inner and outer shear layers. By phase averaging the instantaneous swirling strength maps, the 3D helical vortex structure was reconstructed . The two co-winding counter-rotating helical structure fade out at an axial location of approximately z/ D = 1.5. The findings evidence that the combined application of PIV, POD and frequency analysis using capacitive microphone can provide detailed observations of coherent fluctuations ind uced by vortex precession

Optical coherence tomography and optical coherence tomography angiography in uveitis : a review

Optical coherence tomography (OCT) has dramatically changed the understanding and management of uveitis and other ocular conditions. Currently, OCT angiography (OCTA) combines structural information with the visualization of blood flow within the imaged area. The aim of this review is to present the basic principles of OCT and OCTA interpretation and to investigate the role of these imaging techniques in the diagnosis and management of uveitis. Common complications of intraocular inflammation such as macular oedema and inflammatory choroidal neovascularization are often diagnosed and followed with OCT/OCTA scans. However, uveitis specialists can obtain much more information from tomographic scans. This review provides a comprehensive description of typical OCT/OCTA findings characterizing different ocular structures in uveitis, proceeding from the cornea to the choroid. A careful interpretation of OCT/OCTA images can help in the differential diagnosis, the prediction of clinical outcomes, and the follow-up of patients with uveitis

Signals were broadly positive for months, but never definitive: the tocilizumab story

BACKGROUND: Most COVID-19 treatment guidelines currently recommend tocilizumab in combination with dexamethasone in critically ill patients who are exhibiting rapid respiratory decompensation. OBJECTIVES: To produce a critical review and summary of the pathway which led to the repurposing of tocilizumab for COVID-19 treatment, from in vitro observations to guidelines recommendations. SOURCES: All studies evaluating the effectiveness of tocilizumab to treat COVID-19 disease published over July 2020-July 2021. CONTENT: Two large methodologically well conducted observational studies, the TESEO and the STOP COVID cohorts, showed a reduction in the risk of invasive mechanical ventilation or death in patients treated with tocilizumab as compared to standard of care in 2020. Concomitantly and up to February 2021 a number of small sample size randomized trials (RCTs) were showing discrepant results. These RCTs had a number of issues: small sample size, various designs and inclusion criteria and different dosages of tocilizumab used. The confidence interval of the meta-analytic estimate for the RCT results was consistent with the hypothesis of no efficacy of tocilizumab. In our opinion, this was mainly because the meta-analysis included small and heterogeneous studies. These results led to a delay in the inclusion of tocilizumab in guidelines which occurred only in the summer of 2021. IMPLICATIONS: Although observational studies are unable to control for unmeasured confounding, they can be put together quickly during a pandemic and promptly provide important information. The large sample size allows us to investigate effect measure modifiers and better target interventions. It is key that the effect size is somewhat large (RR>2), all sources of bias are properly accounted for and the direct evidence is weighted against these factors. It appears to us that for tocilizumab, not having dismissed the results of carefully designed and analysed observational studies in 2020 could have prevented many deaths over those months