Interrater reliability of surveillance for ventilator-associated events and pneumonia

OBJECTIVETo compare interrater reliabilities for ventilator-associated event (VAE) surveillance, traditional ventilator-associated pneumonia (VAP) surveillance, and clinical diagnosis of VAP by intensivists.DESIGNA retrospective study nested within a prospective multicenter quality improvement study.SETTINGIntensive care units (ICUs) within 5 hospitals of the Centers for Disease Control and Prevention Epicenters.PATIENTSPatients who underwent mechanical ventilation.METHODSWe selected 150 charts for review, including all VAEs and traditionally defined VAPs identified during the primary study and randomly selected charts of patients without VAEs or VAPs. Each chart was independently reviewed by 2 research assistants (RAs) for VAEs, 2 hospital infection preventionists (IPs) for traditionally defined VAP, and 2 intensivists for any episodes of pulmonary deterioration. We calculated interrater agreement using κ estimates.RESULTSThe 150 selected episodes spanned 2,500 ventilator days. In total, 93–96 VAEs were identified by RAs; 31–49 VAPs were identified by IPs, and 29–35 VAPs were diagnosed by intensivists. Interrater reliability between RAs for VAEs was high (κ, 0.71; 95% CI, 0.59–0.81). Agreement between IPs using traditional VAP criteria was slight (κ, 0.12; 95% CI, −0.05–0.29). Agreement between intensivists was slight regarding episodes of pulmonary deterioration (κ 0.22; 95% CI, 0.05–0.39) and was fair regarding whether episodes of deterioration were attributable to clinically defined VAP (κ, 0.34; 95% CI, 0.17–0.51). The clinical correlation between VAE surveillance and intensivists’ clinical assessments was poor.CONCLUSIONSProspective surveillance using VAE criteria is more reliable than traditional VAP surveillance and clinical VAP diagnosis; the correlation between VAEs and clinically recognized pulmonary deterioration is poor.Infect Control Hosp Epidemiol 2017;38:172–178</jats:sec

OPTIMIZATION STUDIES ON PASTE-FUELED FAST REACTORS

The reference design is an unmoderated, sodium-cooled reactor using a paste fuel of uranium monocarbide in sodium. The core is a cylinder 5 ft in diameter and 5 ft in height. An 18-in. thick breeding blanket surrounds the core, and an 18-in. thick graphite reflector surrounds the blanket. Various changes were made in the reference core to uncover any possible modifications for cost reductions and to evaluate the consequences of certain design modifications which might occur. Cases were studied for variations in: fuel volume fraction in the core from 0.2 to 0.6; fertile material volume fraction in the blanket from 0.2 to 0.6; blanket thickness 3 in. to 24 in.; fuel materials of UC, U metal, UC/ sub 2/, PuC-- UC, Pu-- U metal, and PuO/sub 2/-- UC/sub 2/; and liquid carrier in the paste of Na, Sn, or Pb. (auth

Μελέτη επιπτώσεων συνδρομολόγησηςεφαρμογών σε πολυπύρηνες αρχιτεκτονικές

Understanding viral transmission dynamics within populations of reservoir hosts can facilitate greater knowledge of the spillover of emerging infectious diseases. While bat-borne viruses are of concern to public health, investigations into their dynamics have been limited by a lack of longitudinal data from individual bats. Here, we examine capture-mark-recapture (CMR) data from a species of Australian bat (Myotis macropus) infected with a putative novel Alphacoronavirus within a Bayesian framework. Then, we developed epidemic models to estimate the effect of persistently infectious individuals (which shed viruses for extensive periods) on the probability of viral maintenance within the study population. We found that the CMR data analysis supported grouping of infectious bats into persistently and transiently infectious bats. Maintenance of coronavirus within the study population was more likely in an epidemic model that included both persistently and transiently infectious bats, compared with the epidemic model with non-grouping of bats. These findings, using rare CMR data from longitudinal samples of individual bats, increase our understanding of transmission dynamics of bat viral infectious diseases

Computer automation of ultrasonic testing

Report describes a prototype computer-automated ultrasonic system developed for the inspection of weldments. This system can be operated in three modes: manual, automatic, and computer-controlled. In the computer-controlled mode, the system will automatically acquire, process, analyze, store, and display ultrasonic inspection data in real-time. Flaw size (in cross-section), location (depth), and type (porosity-like or crack-like) can be automatically discerned and displayed. The results and pertinent parameters are recorded

AI in Production: Video Analysis and Machine Learning for Expanded Live Events Coverage

In common with many industries, TV and video production is likely to be transformed by Artificial Intelligence (AI) and Machine Learning (ML), with software and algorithms assisting production tasks that, conventionally, could only be carried out by people. Expanded coverage of a diverse range of live events is particularly constrained by the relative scarcity of skilled people, and is a strong use case for AI-based automation. This paper describes recent BBC research into potential production benefits of AI algorithms, using visual analysis and other techniques. Rigging small, static UHD cameras, we have enabled a one-person crew to crop UHD footage in multiple ways and cut between the resulting shots, effectively creating multi-camera HD coverage of events that cannot accommodate a camera crew. By working with programme makers to develop simple deterministic rules and, increasingly, training systems using advanced video analysis, we are developing a system of algorithms to automatically frame, sequence and select shots, and construct acceptable multicamera coverage of previously untelevised types of event

Improvement in Chronic Hepatocerebral Degeneration Following Liver Transplantation

Chronic progressive hepatocerebral degeneration with spastic paraparesis, dementia, dysarthria, ataxia, tremor, and neuropsychiatric symptoms follows long-standing portal-systemic shunting, is associated with structural changes in the central nervous system, and does not respond to conventional therapy for hepatic encephalopathy. A case of advanced chronic liver disease with severe, progressive hepatocerebral degeneration after 23 yr of portal-systemic shunting is reported in whom there was significant objective improvement in intellectual function and in the chronic neurological signs 3 mo after orthotopic liver transplantation and further improvement 12 mo after transplantation

Together forever? Explaining exclusivity in party-firm relations

Parties and firms are the key actors of representative democracy and capitalism respectively and the dynamic of attachment between them is a central feature of any political economy. This is the first article to systematically analyse the exclusivity of party-firm relations. We consider exclusivity at a point in time and exclusivity over time. Does a firm have a relationship with only one party at a given point in time, or is it close to more than one party? Does a firm maintain a relationship with only one party over time, or does it switch between parties? Most important, how do patterns of exclusivity impact on a firm’s ability to lobby successfully? We propose a general theory, which explains patterns of party-firm relations by reference to the division of institutions and the type of party competition in a political system. A preliminary test of our theory with Polish survey data confirms our predictions, establishing a promising hypothesis for future research

An exploratory study on the potential of social enterprise to act as the institutional glue of network governance

This study combines two topics of contemporary salience for public administration: social enterprise and governance networks. While operating at different levels, both are institutions which attempt to draw together the three pillars of state, market, and civil society. Nevertheless, the respective literatures focus on particular aspects of the three pillars. We connect the two concepts and suggest that some social enterprises can act as the institutional glue of networks due to their ability to benefit organizations in each of the three sectors. This requires social enterprises to have the managerial capacity to diffuse social know-how, and is facilitated by the trust of other organizations and a supportive policy framework. The links are explicated at the conceptual level before providing evidence from South Korea and the UK. Finally, research propositions are offered, which suggest new avenues for future research

Social Enterprise in Europe: At the Crossroads of Market, Public Policies and Third Sector

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