Effect of impression pressure and anilox specification on solid and halftone density

Controlling the transfer of ink to the substrate is a key requirement of the flexographicprinting process. Its ability to transfer ink from the image carrier to the substrate at low pressuresenables the process to be used for the production of printed matter using pressure-sensitivematerials. These can range from substrates where high pressures can damage surface structure(e.g. corrugated board), to specialist inks, which can be damaged by the high shearing actionassociated with other volume print processes. This paper evaluates the effect of pressure changeson print quality for different anilox specifications and line rulings on the plate.Data collected from an experimental print trial were used to quantify the effects of aniloxroll specifications, dot pitch, and plate-to-substrate engagement on the reproduction of both acontinuous ink film and the formation of discrete halftone dots.The ink-carrying volume of the cells of the anilox roll was shown to have the greatest influenceon solid density (a parameter used as an indirect measure of ink film thickness) and halftonedot formation; however, the geometrical characteristics of the cells were also shown to havean effect. An initial increase in the pressure within the printing nip resulted in a significantrise in both solid density and tone gain (growth of the halftone dots) due to improved inktransfer from the plate to the substrate. Subsequent increases in pressure produced little furtherincrease of solid density, indicating ink transfer had reached a plateau. The rate of increase ofhalftone density was found to be reduced as pressure increased, which was attributed to the inkapproaching its maximum capability for spreading on the substrate

Impact of Choice of Prophylaxis on the Microbiology of Cardiac Implantable Electronic Device Infections: Insights From the Prevention of Arrhythmia Device Infection Trial (PADIT)

BACKGROUND: The Prevention of Arrhythmia Device Infection Trial (PADIT) investigated whether intensification of perioperative prophylaxis could prevent cardiac implantable electronic device (CIED) infections. Compared with a single dose of cefazolin, the perioperative administration of cefazolin, vancomycin, bacitracin, and cephalexin did not significantly decrease the risk of infection. Our objective was to compare the microbiology of infections between study arms in PADIT. METHODS: This was a post hoc analysis. Differences between study arms in the microbiology of infections were assessed at the level of individual patients and at the level of microorganisms using the Fisher exact test. RESULTS: Overall, 209 microorganisms were reported from 177 patients. The most common microorganisms were coagulase-negative staphylococci (CoNS; 82/209 [39.2%]) and S. aureus (75/209 [35.9%]). There was a significantly lower proportion of CoNS in the incremental arm compared with the standard arm (30.1% vs 46.6%; P = .04). However, there was no significant difference between study arms in the frequency of recovery of other microorganisms. In terms of antimicrobial susceptibility, 26.5% of microorganisms were resistant to cefazolin. CoNS were more likely to be cefazolin-resistant in the incremental arm (52.2% vs 26.8%, respectively; P = .05). However, there was no difference between study arms in terms of infections in which the main pathogen was sensitive to cefazolin (77.8% vs 64.3%; P = .10) or vancomycin (90.8% vs 90.2%; P = .90). CONCLUSIONS: Intensification of the prophylaxis led to significant changes in the microbiology of infections, despite the absence of a decrease in the overall risk of infections. These findings provide important insight on the physiopathology of CIED infections. TRIAL REGISTRATION: NCT01002911

Association of the Timing and Extent of Cardiac Implantable Electronic Device Infections With Mortality.

IMPORTANCE: Cardiac implantable electronic device (CIED) infection is a potentially devastating complication with an estimated 12-month mortality of 15% to 30%. The association of the extent (localized or systemic) and timing of infection with all-cause mortality has not been established. OBJECTIVE: To evaluate the association of the extent and timing of CIED infection with all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS: This prospective observational cohort study was conducted between December 1, 2012, and September 30, 2016, in 28 centers across Canada and the Netherlands. The study included 19 559 patients undergoing CIED procedures, 177 of whom developed an infection. Data were analyzed from April 5, 2021, to January 14, 2023. EXPOSURES: Prospectively identified CIED infections. MAIN OUTCOMES AND MEASURES: Time-dependent analysis of the timing (early [≤3 months] or delayed [3-12 months]) and extent (localized or systemic) of infection was performed to determine the risk of all-cause mortality associated with CIED infections. RESULTS: Of 19 559 patients undergoing CIED procedures, 177 developed a CIED infection. The mean (SD) age was 68.7 (12.7) years, and 132 patients were male (74.6%). The cumulative incidence of infection was 0.6%, 0.7%, and 0.9% within 3, 6, and 12 months, respectively. Infection rates were highest in the first 3 months (0.21% per month), reducing significantly thereafter. Compared with patients who did not develop CIED infection, those with early localized infections were not at higher risk for all-cause mortality (no deaths at 30 days [0 of 74 patients]: adjusted hazard ratio [aHR], 0.64 [95% CI, 0.20-1.98]; P = .43). However, patients with early systemic and delayed localized infections had an approximately 3-fold increase in mortality (8.9% 30-day mortality [4 of 45 patients]: aHR, 2.88 [95% CI, 1.48-5.61]; P = .002; 8.8% 30-day mortality [3 of 34 patients]: aHR, 3.57 [95% CI, 1.33-9.57]; P = .01), increasing to a 9.3-fold risk of death for those with delayed systemic infections (21.7% 30-day mortality [5 of 23 patients]: aHR, 9.30 [95% CI, 3.82-22.65]; P < .001). CONCLUSIONS AND RELEVANCE: Findings suggest that CIED infections are most common within 3 months after the procedure. Early systemic infections and delayed localized infections are associated with increased mortality, with the highest risk for patients with delayed systemic infections. Early detection and treatment of CIED infections may be important in reducing mortality associated with this complication