Eye-tracking to observe compliance with hand hygiene in the intensive care unit – a randomised feasibility study

Background: Healthcare-associated infections are associated with increased patient mortality. Hand hygiene is the most effective method to reduce these infections. Despite simplification of this easy intervention, compliance with hand disinfection remains low. Current assessment of hand hygiene is mainly based on observation by hygiene specialists. The aim of this study was to investigate additional benefits of eye-tracking during the analysis of hand hygiene compliance of healthcare professionals in the intensive care unit. Methods: In a simulated, randomised cross-over study conducted at the interdisciplinary intensive care unit of the University Hospital Zurich (Switzerland), doctors and nurses underwent eye-tracking and completed two everyday tasks (injection of 10 micrograms of norepinephrine via a central venous line, blood removal from the central line) in two scenarios where alcoholic dispenser locations differed ("in-sight" and "out-of-sight"). The primary outcomes were dwell time, revisits, first fixation duration and average fixation time on three areas of interest (central venous line, alcohol dispenser, protective glove box) for both scenarios. Compliance with hand hygiene guidelines was analysed. Findings: 49 participants (35 nurses, 14 doctors) were included. Eye-tracking provided additional useful information compared to conventional observations. Dwell time, revisits, first fixation duration and average fixation time did not differ between the two scenarios for all areas of interest. Overall compliance with recommended hand hygiene measures was low in both doctors (mean 20%) and nurses (mean 42.9%). Conclusion: Compared to conventional observations offered additional helpful insights and provided an in-depth analysis of gaze patterns during the recording of hand hygiene compliance in the intensive care unit. Keywords: compliance; eye-tracking; hand hygiene; intensive care unit

Strong partnerships make good partners: Insights about physician-hospital relationships from a study of physician executives

While physicians are likely to respond favorably in concept to hospital-based disease management and other clinical programs, they are less likely to accept their structural and functional characteristics. Because of their role at the hospital-physician interface, hospital physician executives are often tasked with implementing such programs. Given the challenges involved, a deeper understanding of the role of these executives in building the hospital-physician relationship will therefore be an important contribution. To this end, we surveyed senior physician executives at hospitals and health systems (n = 326), to assess their view of the hospital-physician relationship at their institutions, focusing especially on the role of medical staff cohesion. This article presents several of our key findings, in particular that (1) many physician executives identified their medical staff as having relatively low cohesion and (2) the perceived level of medical staff cohesion correlated strongly with the level of physician support for organizational priorities, the degree of constructive physician involvement, and success in improving the physician-hospital relationship. In light of these findings, we conclude by offering concrete recommendations for physician executives and others seeking to build medical staff cohesion in the service of clinical improvement

Monitoring Northern Bobwhite Breeding Populations in the Central Hardwoods Bird Conservation Region

Monitoring northern bobwhite (Colinus virginianus) breeding populations is an important component of the National Bobwhite Conservation Initiative as a means of evaluating success of achieving population goals. Northern bobwhite populations declined by 3.8% from 1980 to 2006 in the Central Hardwoods Bird Conservation Region (CHBCR). Northern bobwhite research in the CHBCR is limited and population trend estimates are based on North American Breeding Bird Survey (BBS) data. Monitoring northern bobwhite populations and developing accurate population estimates by incorporating detection functions and occupancy estimates are important components of the conservation initiative in this region. We documented northern bobwhite abundance throughout the CHBCR via a roadside-based removal and distance sampling survey method, and assessed differences in detection with respect to observer, northern bobwhite relative abundance, and land cover. We also addressed the potential for a roadside survey bias to ascertain if there was a seasonal, or site effect on northern bobwhite detection and occupancy through repeated surveys. Finally, we measured northern bobwhite calling rates by time of day and day of the breeding season to assess bobwhite availability for detection with radiotelemetry data. The spatially-balanced, roadside, monitoring strategy used counties as basic sampling units within bobwhite focal areas in the CHBCR (n 1⁄4 37 counties). We randomly located 5, 15-km monitoring routes in each focal county along secondary roads. We conducted 5-min unlimited distance point counts along each route (30 counts/route) from May through July, 2008–2011. We conducted off-road and radiotelemetry surveys on Peabody Wildlife Management Area (PWMA), and additional off-road surveys on Fort Campbell Military Base, Tennessee-Kentucky and on private lands in Livingston County, Kentucky from May through July, 2010–2011.We detected 6,440 individual northern bobwhite on roadside survey routes; .95% of the survey routes had at least 1 northern bobwhite detection. We developed a suite of 17 a priori removal models in Program MARK to estimate roadside survey detection probabilities. The best model included differences in time interval detection, observer, and 3 covariates: distance from the observer, number of individuals aurally detected, and percent forested habitat within a 100-m radius of the point count. Detection probabilities were greatest during the first minute of detection, and then decreased. Detection probabilities (6 SD) decreased as distance from the observer (b 1⁄4 0.0020 6 0.0005, n 1⁄4 6,440) increased, but increased as the number of individuals detected at a point (b 1⁄4 0.15 6 0.04, n 1⁄4 6,440) increased. We used the most parsimonious model and mean covariate values to generate overall parameter estimates, which differed between observers and time intervals. We detected 637 individual northern bobwhite on 90 off-road transects across 4 sites from 2010 to 2011. We developed a suite of 10 a priori occupancy models in Program MARK to estimate off-road survey detection probabilities and site occupancy. Detection probabilities were greater (.26%) during the second point count visit (q 1⁄4 0.69 6 0.03) versus first (q 1⁄4 0.51 6 0.04) and third (q 1⁄4 0.47 6 0.04) visits (n 1⁄4 270). Detection probability increased as relative abundance increased (b 1⁄4 2.90 6 0.22, n 1⁄4 270). Occupancy was held constant and was not affected by any covariates evaluated. Peak northern bobwhite detection probabilities occurred from 1 to 25 June, an important consideration for population models that use breeding season survey data. Distance from road was not a significant grouping variable in any of the models, suggesting that roadside bias may not be an important consideration in designing bobwhite monitoring strategies. We located 295 radio-marked male bobwhites from 2010 to 2011. Marked males called on 115 of 295 points (39.0%). The furthest distance a radio-marked male moved during the survey period was 60 m, and movement distances were generally small (x ̄ 1⁄4 4.2 6 10.3 m, n 1⁄4 295). We compared 8 a priori time-of-detection models in Program MARK to estimate radiotelemetry survey detection probabilities. We grouped surveys based on year and included time-of-day, and day- of-year as additional temporal covariates. Detection probability was inversely related to time of day (b 1⁄4 0.04 6 0.10, n 1⁄4 105), but positively related to day of year (b 1⁄4 0.010 6 0.008, n 1⁄4 105); b estimates overlapped 0 suggested weak relationships. Our results documented the first attempt to explicitly model differences in northern bobwhite detection related to spatial (potential roadside biases, habitat parameters, northern bobwhite distances), temporal (seasonality, annual fluctuations), and behavioral (observer, northern bobwhite relative abundance) variables. We used a combination of 3 methodologies to estimate detection parameters and will adjust indices of relative abundance and density estimates across a broad spatial extent. Our spatially-balanced roadside survey can be effectively used to monitor northern bobwhite populations across broad spatial extents and incorporates the components of detection to improve estimates of northern bobwhite relative abundance

The importance of intravenous immunoglobulin treatment in critically ill patients with necrotizing soft tissue infection: a retrospective cohort study.

BACKGROUND Necrotizing soft-tissue infections are infections with high mortality. The use of immunoglobulins within a combination therapy including broad-spectrum antibiotics has been debated. We assessed potential benefits of immunoglobulins and hypothesized that they were associated with a treatment benefit in a high-resource setting. METHODS Patients with necrotizing soft-tissue infection hospitalized in the tertiary intensive care unit of the University Hospital of Zurich, Switzerland, between 2008 and 2020 were included retrospectively. The association between immunoglobulin administration and in-hospital survival, intensive care unit length of stay, the incidences of acute renal failure, acute respiratory distress syndrome and septic shock were analyzed. RESULTS After adjustment for confounders, no difference for in-hospital survival (hazard ratio 2.20, 95% confidence interval [CI] 0.24-20.20, p = 0.5), intensive care unit length of stay (subhazard ratio [SHR] 0.90, CI 0.41-1.98, p = 0.8) and the development of acute respiratory distress syndrome (SHR 1.2, CI 0.36-4.03, p = 0.77) was observed in patients with or without immunoglobulin treatment. The Simplified Acute Physiology Score II, the risk of developing acute renal failure (SHR 2.86, CI 1.33-6.15, p = 0.01) and septic shock (SHR 1.86, CI 1.02-3.40, p = 0.04) was higher in patients treated with immunoglobulins, possibly reflecting a higher disease severity beyond measured confounders. CONCLUSIONS No clear evidence for a benefit of immunoglobulins in our cohort with consistent antibiotic use was found. Patients receiving immunoglobulins appeared more severely ill. Complementary to high treatment standards and appropriate antibiotics including beta lactams and protein synthesis inhibitors, immunoglobulins should be administered on a case-to-case basis, at least while more evidence from larger randomized controlled trials is missing

Coagulation side effects of enzymatic debridement in burned patients

Objectives Bromelain-based enzymatic debridement has emerged as a valuable option to the standard surgical intervention for debridement in burn injuries. Adverse effects on coagulation parameters after enzymatic debridement have been described. The purpose of this study was to compare the effect of enzymatic and surgical debridement on coagulation. Methods Between 03/2017 and 02/2021 patients with burn injuries with a total body surface area (TBSA) ≥ 1% were included in the study. Patients were categorized into two groups: the surgically debrided group and the enzymatically debrided group. Coagulation parameters were assessed daily for the first seven days of hospitalization. Results In total 132 patients with a mean TBSA of 17% were included in this study, of which 66 received enzymatic debridement and 66 received regular surgical-debridement. Patients receiving enzymatic debridement presented significantly higher factor-V concentration values over the first seven days after admission (p = 0.05). Conclusion Enzymatic debridement in burned patients does not appear to increase the risk of coagulation abnormalities compared with the regular surgical approach

Sub-Nanometer Channels Embedded in Two-Dimensional Materials

Two-dimensional (2D) materials are among the most promising candidates for next-generation electronics due to their atomic thinness, allowing for flexible transparent electronics and ultimate length scaling. Thus far, atomically-thin p-n junctions, metal-semiconductor contacts, and metal-insulator barriers have been demonstrated. While 2D materials achieve the thinnest possible devices, precise nanoscale control over the lateral dimensions is also necessary. Here, we report the direct synthesis of sub-nanometer-wide 1D MoS2 channels embedded within WSe2 monolayers, using a dislocation-catalyzed approach. The 1D channels have edges free of misfit dislocations and dangling bonds, forming a coherent interface with the embedding 2D matrix. Periodic dislocation arrays produce 2D superlattices of coherent MoS2 1D channels in WSe2. Using molecular dynamics simulations, we have identified other combinations of 2D materials where 1D channels can also be formed. The electronic band structure of these 1D channels offer the promise of carrier confinement in a direct-gap material and charge separation needed to access the ultimate length scales necessary for future electronic applications.Comment: 22 pages main manuscript and methods, 4 main figures, 30 pages supplementary materials, 16 extended figure

Multiple plumage traits convey information about age and within-age-class qualities of a canopy-dwelling songbird, the Cerulean Warbler

Colorful plumage traits in birds may convey multiple, redundant, or unreliable messages about an individual. Plumage may reliably convey information about disparate qualities such as age, condition, and parental ability because discrete tracts of feathers may cause individuals to incur different intrinsic or extrinsic costs. Few studies have examined the information content of plumage in a species that inhabits forest canopies, a habitat with unique light environments and selective pressures. We investigated the information content of four plumage patches (blue-green crown and rump, tail white, and black breast band) in a canopy-dwelling species, the Cerulean Warbler (Setophaga cerulea), in relation to age, condition, provisioning, and reproduction. We found that older males displayed wider breast bands, greater tail white, and crown and rump feathers with greater blue-green (435–534 nm) chroma and hue than males in their first potential breeding season. In turn, older birds were in better condition (short and long term) and were reproductively superior to younger birds. We propose that these age-related plumage differences (i.e. delayed plumage maturation) were not a consequence of a life history strategy but instead resulted from constraints during early feather molts. Within age classes, we found evidence to support the multiple messages hypothesis. Birds with greater tail white molted tails in faster, those with more exaggerated rump plumage (lower hue, greater blue-green chroma) provisioned more, and those with lower rump blue-green chroma were in better condition. Despite evidence of reliable signaling in this species, we found no strong relationships between plumage and reproductive performance, potentially because factors other than individual differences more strongly influenced fecundity

Evaluation of exposure-specific risks from two independent samples: A simulation study

<p>Abstract</p> <p>Background</p> <p>Previous studies have proposed a simple product-based estimator for calculating exposure-specific risks (ESR), but the methodology has not been rigorously evaluated. The goal of our study was to evaluate the existing methodology for calculating the ESR, propose an improved point estimator, and propose variance estimates that will allow the calculation of confidence intervals (CIs).</p> <p>Methods</p> <p>We conducted a simulation study to test the performance of two estimators and their associated confidence intervals: 1) current (simple product-based estimator) and 2) proposed revision (revised product-based estimator). The first method for ESR estimation was based on multiplying a relative risk (RR) of disease given a certain exposure by an overall risk of disease. The second method, which is proposed in this paper, was based on estimates of the risk of disease in the unexposed. We then multiply the updated risk by the RR to get the revised product-based estimator. A log-based variance was calculated for both estimators. Also, a binomial-based variance was calculated for the revised product-based estimator. 95% CIs were calculated based on these variance estimates. Accuracy of point estimators was evaluated by comparing observed relative bias (percent deviation from the true estimate). Interval estimators were evaluated by coverage probabilities and expected length of the 95% CI, given coverage. We evaluated these estimators across a wide range of exposure probabilities, disease probabilities, relative risks, and sample sizes.</p> <p>Results</p> <p>We observed more bias and lower coverage probability when using the existing methodology. The revised product-based point estimator exhibited little observed relative bias (max: 4.0%) compared to the simple product-based estimator (max: 93.9%). Because the simple product-based estimator was biased, 95% CIs around this estimate exhibited small coverage probabilities. The 95% CI around the revised product-based estimator from the log-based variance provided better coverage in most situations.</p> <p>Conclusion</p> <p>The currently accepted simple product-based method was only a reasonable approach when the exposure probability is small (< 0.05) and the RR is ≤ 3.0. The revised product-based estimator provides much improved accuracy.</p

An evaluation and comparison of conservation guidelines for an at-risk migratory songbird

For at-risk wildlife species, it is important to consider conservation within the process of adaptive management. Golden-winged Warblers (Vermivora chrysoptera) are Neotropical migratory songbirds that are experiencing long-term population declines due in part to the loss of early-successional nesting habitat. Recently-developed Golden-winged Warbler habitat management guidelines are being implemented by USDA: Natural Resource Conservation Service (2014) and its partners through the Working Lands For Wildlife (WLFW) program. During 2012–2014, we studied the nesting ecology of Golden-winged Warblers in managed habitats of the eastern US that conformed to WLFW conservation practices. We evaluated five NRCS “management scenarios” with respect to nesting success and attainment of recommended nest site vegetation conditions outlined in the Golden-winged Warbler breeding habitat guidelines. Using estimates of territory density, pairing rate, nest survival, and clutch size, we also estimated fledglingproductivity (number of fledglings/ha) for each management scenario. In general, Golden-winged Warbler nest survival declined as each breeding season advanced, but nest survival was similar across management scenarios. Within each management scenario, vegetation variables had little influence on nest survival. Still, percent Rubus cover and density of \u3e2 m tall shrubs were relevant in some management scenarios. All five management scenarios rarely attained recommended levels of nest site vegetation conditions for Golden-winged, yet nest survival was high. Fledgling productivity estimates for each management scenario ranged from 2.1 to 8.6 fledglings/10 hectares. Our results indicate that targeted habitat management for Golden-winged Warblers using a variety of management techniques on private lands has the capability to yield high nest survival and fledgling productivity, and thus have the potential to contribute to the species recovery