A regional informatics platform for coordinated antibiotic resistant infection tracking, alerting and prevention

Background. We developed and assessed the impact of a patient registry and electronic admission notification system relating to regional antimicrobial resistance (AMR) on regional AMR infection rates over time. We conducted an observational cohort study of all patients identified as infected or colonized with methicillin-resistant Staphylococcus aureus (MRSA) and/or vancomycin-resistant enterococci (VRE) on at least 1 occasion by any of 5 healthcare systems between 2003 and 2010. The 5 healthcare systems included 17 hospitals and associated clinics in the Indianapolis, Indiana, region. Methods. We developed and standardized a registry of MRSA and VRE patients and created Web forms that infection preventionists (IPs) used to maintain the lists. We sent e-mail alerts to IPs whenever a patient previously infected or colonized with MRSA or VRE registered for admission to a study hospital from June 2007 through June 2010. Results. Over a 3-year period, we delivered 12 748 e-mail alerts on 6270 unique patients to 24 IPs covering 17 hospitals. One in 5 (22%–23%) of all admission alerts was based on data from a healthcare system that was different from the admitting hospital; a few hospitals accounted for most of this crossover among facilities and systems. Conclusions. Regional patient registries identify an important patient cohort with relevant prior antibiotic-resistant infection data from different healthcare institutions. Regional registries can identify trends and interinstitutional movement not otherwise apparent from single institution data. Importantly, electronic alerts can notify of the need to isolate early and to institute other measures to prevent transmission

Geometric modeling of 3D woven preforms in composite T-joints

A common method to fabricate net-shaped three-dimensional (3D) woven preforms for composite T-joints is to weave flat 3D preforms via a standard weaving machine with variation in binder yarn path and then separate the preform in the form of a bifurcation. Folding introduces fiber architecture deformation at the 3D woven bifurcation area. In this paper, a geometric modeling approach is proposed to represent the realistic fiber architecture, as a preprocessor for finite element analyses to predict composite structural performance. Supported by X-ray micro-computed tomography (mCT), three important deformation mechanisms are observed including yarn stack shifting, cross-section bending, and cross-section flattening resulting from the folding process. Furthermore, a set of mathematical formulae for simulation of the deformations in the junction region are developed and satisfactory agreement is observed when compared with mCT scan results

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Confluent 3D-assembly of fibrous structures

The ability to independently control fiber alignments and structural geometry is critical for design of optimal three-dimensional (3D) fibrous structures. We present a novel method to 3D-assemble carbon fiber structures, containing no seams or adhesive joints, using a confluence of several textile methodologies. A variety of complex structural shapes with tailored fiber topologies are demonstrated to be achievable. These optimized structures are shown to have unprecedented static and dynamic strength as well as damage tolerance and ductility. For example, the energy absorption capacity of a 3D-assembled carbon fiber prismatic sandwich structure is shown to be 300% greater than a high performance metallic counterpart