Sterile Tubing Changes to Prevent CLABSIs in the NICU

Purpose Statement: NICU patients have a decreased risk of CLABSI infections when two-person sterile central line changes are implemented into central line maintenance bundles compared to bundles that only use one-person clean line change techniques. Background: Neonates admitted to the neonatal care intensive care unit (NICU) often require the placement of central lines for the administration of medications, fluids, parental nutrition, and hemodynamic monitoring. Despite their many advantages, central lines can lead to serious infections, known as cental line associated bloodstream infections (CLABSI). These infections are not related to an infection from another site and develop within forty-eight hours of removal. CLABSIs are a major contributor to morbidity and mortality in the NICU population and are costly to hospital systems. According to Mobley & Bizzarro, infants who develop CLABSIs can cost up to an additional $50,000 and add as many as ten days to their hospital stay when compared to other infants without CLABSIs (2017). An evidence-based approach that has shown to improve patient outcomes and reduce CLABSIs is the use of a bundle, which is utilized upon insertion and during maintenance of the central line. Based on the available research, the most common CLASBI bundle elements include: using maximum standard barrier precautions, using a specific skin preparation & line dressing protocol, daily central line need assessments, a two-person line change technique, specific education and training for staff, and quarterly audits (Payne et al., 2018). The St. Cloud Hospital NICU currently utilizes these practices expect for a two-person line change with sterile technique.https://digitalcommons.centracare.com/nursing_posters/1162/thumbnail.jp

Impacto do Programa de educação nutricional “Nutriamigos®” nos níveis de conhecimento sobre alimentação saudável em crianças escolares

 Introduction: With the increase of childhood obesity, early intervention in nutrition education becomes necessary. Therefore, during the school period, the school becomes the best place for implementation of a nutritional education program. Objective: The current study was carried out in a public and in a private school, with the objective of evaluating and comparing the results of the "Nutriamigos®" Program on food and nutrition knowledge of children with different socioeconomic levels, sex, age and Body Mass Index (BMI). Method: Comparative longitudinal study, before and after educational intervention. To evaluate the intervention, a public (school 1) and a private school (school 2) were selected. This was a random, convenience sample comparing students from different social and economic levels, consisting of 242 (school 1) and 99 children (school 2), respectively, totaling 341 children, from 6 to 10 years of age. The Body Mass Index was used to measure nutritional status. Knowledge about food and nutrition was evaluated through a questionnaire, applied before and after intervention. The nutritional intervention consisted of 12 classes of 50 minutes each. Results: The improvement in knowledge on food and nutrition between the pre and post intervention stages was statistically significant. Conclusion: The "Nutriamigos®" Program reached its goal, demonstrating that it is effective in public and private schools and should not be differentiated for boys or girls, or for children with normal or excessive weight. Introdução: Com o aumento da obesidade infantil, torna-se necessária intervenção educacional nutricional desde a infância. Durante o período escolar, a escola se torna, portanto, o melhor local para a implementação de um programa de educação nutricional. Objetivo: O presente estudo foi realizado em uma escola pública e uma particular, com o objetivo de avaliar e comparar o resultado da intervenção do Programa “Nutriamigos®” no conhecimento sobre alimentação e nutrição, de crianças de diferentes níveis socioeconômicos, sexo, idade e Índice de Massa Corporal (IMC). Método:  Estudo longitudinal comparativo, antes e após intervenção educacional. Para a avaliação da intervenção foram selecionadas uma escola pública (escola 1) e uma particular (escola 2). Esta foi uma amostra de conveniência aleatória, comparando alunos de diferentes níveis sociais e econômicos, consistindo de 242 (escola 1) e 99 crianças (escola 2), respectivamente, totalizando 341 crianças, de 6 a 10 anos de idade. O Índice de Massa Corporal foi utilizado para mensurar o estado nutricional. O conhecimento sobre nutrição e alimentação foi avaliado por meio de um questionário de conhecimento, aplicado pré e pós intervenção. A intervenção nutricional constou de 12 aulas de 50 minutos cada. Resultados: A melhora no conhecimento sobre alimentação e nutrição entre os estágios de pré e pós intervenção foi estatisticamente significante. Conclusão: O Programa “Nutriamigos®” atingiu o objetivo proposto, comprovando que é efetivo em escolas públicas e particulares e não deve ser diferenciado para meninos ou meninas, ou para crianças com peso normal ou excessivo

Nitrogen fixation and transfer in open ocean diatom–cyanobacterial symbioses

Many diatoms that inhabit low-nutrient waters of the open ocean live in close association with cyanobacteria. Some of these associations are believed to be mutualistic, where N2-fixing cyanobacterial symbionts provide N for the diatoms. Rates of N2 fixation by symbiotic cyanobacteria and the N transfer to their diatom partners were measured using a high-resolution nanometer scale secondary ion mass spectrometry approach in natural populations. Cell-specific rates of N2 fixation (1.15–71.5 fmol N per cell h−1) were similar amongst the symbioses and rapid transfer (within 30 min) of fixed N was also measured. Similar growth rates for the diatoms and their symbionts were determined and the symbiotic growth rates were higher than those estimated for free-living cells. The N2 fixation rates estimated for Richelia and Calothrix symbionts were 171–420 times higher when the cells were symbiotic compared with the rates estimated for the cells living freely. When combined, the latter two results suggest that the diatom partners influence the growth and metabolism of their cyanobacterial symbionts. We estimated that Richelia fix 81–744% more N than needed for their own growth and up to 97.3% of the fixed N is transferred to the diatom partners. This study provides new information on the mechanisms controlling N input into the open ocean by symbiotic microorganisms, which are widespread and important for oceanic primary production. Further, this is the first demonstration of N transfer from an N2 fixer to a unicellular partner. These symbioses are important models for molecular regulation and nutrient exchange in symbiotic systems

The JWST Early Release Science Program for Direct Observations of Exoplanetary Systems IV: NIRISS Aperture Masking Interferometry Performance and Lessons Learned

We present a performance analysis for the aperture masking interferometry (AMI) mode on board the James Webb Space Telescope Near Infrared Imager and Slitless Spectrograph (JWST/NIRISS). Thanks to self-calibrating observables, AMI accesses inner working angles down to and even within the classical diffraction limit. The scientific potential of this mode has recently been demonstrated by the Early Release Science (ERS) 1386 program with a deep search for close-in companions in the HIP 65426 exoplanetary system. As part of ERS 1386, we use the same dataset to explore the random, static, and calibration errors of NIRISS AMI observables. We compare the observed noise properties and achievable contrast to theoretical predictions. We explore possible sources of calibration errors, and show that differences in charge migration between the observations of HIP 65426 and point-spread function calibration stars can account for the achieved contrast curves. Lastly, we use self-calibration tests to demonstrate that with adequate calibration, NIRISS AMI can reach contrast levels of $\sim9-10$ mag. These tests lead us to observation planning recommendations and strongly motivate future studies aimed at producing sophisticated calibration strategies taking these systematic effects into account. This will unlock the unprecedented capabilities of JWST/NIRISS AMI, with sensitivity to significantly colder, lower mass exoplanets than ground-based setups at orbital separations inaccessible to JWST coronagraphy.Comment: 20 pages, 12 figures, submitted to AAS Journal

The \textit{JWST} Early Release Science Program for Direct Observations of Exoplanetary Systems III: Aperture Masking Interferometric Observations of the star HIP\,65426 at 3.8 μm\boldsymbol{3.8\,\rm{\mu m}}

We present aperture masking interferometry (AMI) observations of the star HIP 65426 at $3.8\,\rm{\mu m}$ as a part of the \textit{JWST} Direct Imaging Early Release Science (ERS) program obtained using the Near Infrared Imager and Slitless Spectrograph (NIRISS) instrument. This mode provides access to very small inner working angles (even separations slightly below the Michelson limit of ${}0.5\lambda/D$ for an interferometer), which are inaccessible with the classical inner working angles of the \textit{JWST} coronagraphs. When combined with \textit{JWST}'s unprecedented infrared sensitivity, this mode has the potential to probe a new portion of parameter space across a wide array of astronomical observations. Using this mode, we are able to achieve a contrast of $\Delta m_{F380M}{\sim }7.8$\,mag relative to the host star at a separation of {\sim}0.07\arcsec but detect no additional companions interior to the known companion HIP\,65426\,b. Our observations thus rule out companions more massive than 10{-}12\,\rm{M\textsubscript{Jup}} at separations ${\sim}10{-}20\,\rm{au}$ from HIP\,65426, a region out of reach of ground or space-based coronagraphic imaging. These observations confirm that the AMI mode on \textit{JWST} is sensitive to planetary mass companions orbiting at the water frost line, even for more distant stars at $\sim$100\,pc. This result will allow the planning and successful execution of future observations to probe the inner regions of nearby stellar systems, opening essentially unexplored parameter space.Comment: 15 pages, 9 figures, submitted to ApJ Letter

The JWST Early Release Science Program for Direct Observations of Exoplanetary Systems. IV. NIRISS Aperture Masking Interferometry Performance and Lessons Learned

We present a performance analysis for the aperture masking interferometry (AMI) mode on board the James Webb Space Telescope Near Infrared Imager and Slitless Spectrograph (JWST/NIRISS). Thanks to self-calibrating observables, AMI accesses inner working angles down to and even within the classical diffraction limit. The scientific potential of this mode has recently been demonstrated by the Early Release Science (ERS) 1386 program with a deep search for close-in companions in the HIP 65426 exoplanetary system. As part of ERS 1386, we use the same data set to explore the random, static, and calibration errors of NIRISS AMI observables. We compare the observed noise properties and achievable contrast to theoretical predictions. We explore possible sources of calibration errors and show that differences in charge migration between the observations of HIP 65426 and point-spread function calibration stars can account for the achieved contrast curves. Lastly, we use self-calibration tests to demonstrate that with adequate calibration NIRISS F380M AMI can reach contrast levels of ∼9–10 mag at ≳λ/D. These tests lead us to observation planning recommendations and strongly motivate future studies aimed at producing sophisticated calibration strategies taking these systematic effects into account. This will unlock the unprecedented capabilities of JWST/NIRISS AMI, with sensitivity to significantly colder, lower-mass exoplanets than lower-contrast ground-based AMI setups, at orbital separations inaccessible to JWST coronagraphy