Excess length of hospital stay due to healthcare acquired infections. Methodologies evaluation

BACKGROUND: Healthcare acquired infections (HAI) cause an increase of burden and in particular excess length of hospital stay (LOS) accounts for approximately up to 90% of total costs. Therefore accurate estimation of extra hospital stay due to healthcare acquired infections is very important. METHODS: The authors carried out a review comparing the principal methods internationally used for estimating the excess LOS attributable to healthcare acquired infections. RESULTS: The methods described and analysed are: 1) Implicit physician assessment; 2) appropriateness evaluation protocol; 3) unmatched case-control; 4) matched case-control; 5) regression analysis; 6) multistate model. The various methodologies are described underlining advantages and limits which researchers need to know before starting any economic analysis. CONCLUSIONS: Overall, studies taking into account the time-dependent nature of HAI show to give more precise and reliable results

Effect of prophylactic timolol 0.1% gel on intraocular pressure after an intravitreal injection of ranibizumab: a randomized study

Purpose: The purpose of this study is to make a prospective evaluation of the effect of timolol 0.1% eye gel on short-term intraocular pressure (IOP) after an intravitreal injection (IVI) of ranibizumab. Participants and methods: One hundred and fifty eyes of 150 IVI-naïve patients with macular edema caused by various pathological conditions (age-related macular degeneration, central or branch retinal vein occlusion, and diabetic retinopathy) were scheduled to undergo an IVI of ranibizumab (0.5 mg/0.05 cc). The patients were randomly divided into three groups: 50 were not treated with timolol before the IVI (group 1); 50 received an instillation of timolol 0.1% eye gel the evening before the IVI (group 2); and 50 received an instillation of timolol 0.1% eye gel 2 hours before the IVI (group 3). The incidence of clinically significant intraocular hypertensive spikes (>25 mmHg and >40 mmHg) was then assessed. Results: Our findings showed that mean IOP at baseline was significantly higher than at both 5 and 60 minutes after IVI (P25 mmHg were recorded at either time in 27 patients (54%) in group 1, 23 patients (44%) in group 2, and 24 patients (48%) in group 3. None of the between-group differences were significant. Spikes of >40 mmHg (which were only detected 5 minutes after IVI) were recorded in nine (18%), eight (16%), and one patient (2%) in groups 1, 2, and 3, respectively. The only significant difference was between the control and group 3 (P=0.012). Conclusion: An increase in IOP after antivascular endothelial growth factor IVI is a frequent complication. The prophylactic use of timolol 0.1% gel effectively reduced the mean IOP when administered 2 hours before IVI and was also effective in preventing dangerous IOP spikes of >40 mmHg. It is therefore recommended before IVIs as a means of preventing emergency procedures and preserving the health of the optic nerve

Experimental results of crystal-assisted slow extraction at the SPS

The possibility of extracting highly energetic particles from the Super Proton Synchrotron (SPS) by means of silicon bent crystals has been explored since the 1990's. The channelling effect of a bent crystal can be used to strongly deflect primary protons and eject them from the synchrotron. Many studies and experiments have been carried out to investigate crystal channelling effects. The extraction of 120 and 270 GeV proton beams has already been demonstrated in the SPS with dedicated experiments located in the ring. Presently in the SPS, the UA9 experiment is performing studies to evaluate the possibility to use bent silicon crystals to steer particle beams in high energy accelerators. Recent studies on the feasibility of extraction from the SPS have been made using the UA9 infrastructure with a longer-term view of using crystals to help mitigate slow extraction induced activation of the SPS. In this paper, the possibility to eject particles into the extraction channel in LSS2 using the bent crystals already installed in the SPS is presented. Details of the concept, simulations and measurements carried out with beam are presented, before the outlook for the future is discussed.Comment: 4 pages, 7 figures, submitted to to International Particle Accelerator Conference (IPAC) 2017 in Copenhagen, Denmar

Object-based Mapping of the Circumpolar Taiga-Tundra Ecotone with MODIS Tree Cover

The circumpolar taiga-tundra ecotone was delineated using an image segmentation based mapping approach with multi-annual MODIS Vegetation Continuous Fields (VCF) tree cover data. Circumpolar tree canopy cover (TCC) throughout the ecotone was derived by averaging MODIS VCF data from 2000 - 2005 and adjusting the averaged values using linear equations relating MODIS TCC to Quickbird-derived tree cover estimates. The adjustment helped mitigate VCF's overestimation of tree cover in lightly forested regions. An image segmentation grouped pixels representing similar tree cover into polygonal features (objects) that form the map of the transition zone. Eachfeature represents an area much larger than the 500m MODIS pixel to characterize thepatterns of sparse forest patches on a regional scale. Comparisons of the adjusted average tree cover data were made with (1) two existing tree line definitions aggregated for each 1deg longitudinal interval in North America and Eurasia and (2) Landsat-derived Canadianproportion of forest cover for Canada. The adjusted TCC from MODIS VCF shows, on average, greater than 12% TCC for all but one regional zone at the intersection with independently delineated tree lines. Adjusted values track closely with Canadian proportion of forest cover data in areas of low tree cover. Those polygons near the boreal/tundra interface with either (1) mean adjusted TCC values between 5-20% , or (2) mean adjusted TCC values 5% were used to identify the ecotone

Biodiversity of vegetable crops, a living heritage

Biodiversity is the natural heritage of the planet and is one of the key factors of sustainable development, due to its importance not only for the environmental aspects of sustainability but also for the social and economic ones. The purpose of this Special Issue is to publish high-quality research papers addressing recent progress and perspectives while focusing on different aspects related to the biodiversity of vegetable crops. Original, high-quality contributions that have not yet been published, or that are not currently under review by other journals, have been gathered. A broad range of aspects such as genetic, crop production, environments, customs and traditions were covered. All contributions are of significant relevance and could stimulate further research in this area

Effects of municipal solid waste- and sewage sludge-compost-based growing media on the yield and heavy metal content of four lettuce cultivars

Compost has been recently suggested as an alternative to peat for the preparation of growing substrates in soilless cultivation systems. However, some physico-chemical properties of compost may reduce plant performance and endanger the quality of productions, in particular for possible heavy metal accumulation in edible parts. This study aims at evaluating the suitability of a municipal solid waste compost (MSWC) and a sewage sludge compost (SSC) as components of growing media for the soilless cultivation of lettuce (Lactuca sativa L.). Heavy metal content of SSC complied with legislation limits but, in MSWC, it exceeded (Cu, Pb) or was very close (Cd, Zn) to safe limits. A greenhouse experiment was carried out by cultivating four lettuce cultivars (“Maximus,” “Murai,” “Patagonia,” and “Aleppo”) in pots containing a mixture of MSWC and perlite (MSWC + P), SSC and perlite (SSC + P), or peat and perlite (peat + P), the latter used as control. Plant biometric parameters measured after 72 days of growth revealed that the yield of plants cultivated on SSC + P was similar to control plants, independently of the cultivar. Conversely, MSWC + P suppressed in general the biomass production, especially for Murai and Patagonia cultivars. Compared to peat + P, both compost-based substrates reduced the leaf accumulation of heavy metals, with a major effect in Maximus plants. The levels of Cd and Pb in the edible part were always below the safe limits imposed by European regulation. Therefore, risks of heavy metal intake in food chain associated with the replacement of peat with compost in the growing media are negligible, even when a compost with a significant amount of heavy metals is used. Besides compost quality monitoring, also an appropriate varietal choice is crucial to obtain good yields and safe products

Commissioning and operation of the Cherenkov detector for proton Flux Measurement of the UA9 Experiment

The UA9 Experiment at CERN-SPS investigates channeling processes in bent silicon crystals with the aim to manipulate hadron beams. Monitoring and characterization of channeled beams in the high energy accelerators environment ideally requires in-vacuum and radiation hard detectors. For this purpose the Cherenkov detector for proton Flux Measurement (CpFM) was designed and developed. It is based on thin fused silica bars in the beam pipe vacuum which intercept charged particles and generate Cherenkov light. The first version of the CpFM is installed since 2015 in the crystal-assisted collimation setup of the UA9 experiment. In this paper the procedures to make the detector operational and fully integrated in the UA9 setup are described. The most important standard operations of the detector are presented. They have been used to commission and characterize the detector, providing moreover the measurement of the integrated channeled beam profile and several functionality tests as the determination of the crystal bending angle. The calibration has been performed with Lead (Pb) and Xenon (Xe) beams and the results are applied to the flux measurement discussed here in detail.Comment: 25 pages, 14 figure

Solitary Fibrous Tumor of the Lower Leg: A Rare and Difficult Diagnosis

Solitary fibrous tumor (SFT) is a rare neoplasm that commonly originates in the pleura. Extrapleural locations are rare and for this reason sometimes difficult to diagnose. Malignant forms with local recurrence or distant metastases have been reported, also as a consequence of inappropriate treatment. In this article, we report the case of an SFT of the lower leg in a 37-year-old man. Leg SFT is a rare occurrence, and differential diagnosis may be difficult because they can mimic a variety of benign and malignant mesenchymal tumors; immunohistochemical analysis for CD34, CD99, vimentin, and Bcl-2 is necessary. Misdiagnosis carries a significant risk of inadequate removal with subsequent increased risk of recurrence and distant metastases

Molecular Networking: A Useful Tool for the Identification of New Psychoactive Substances in Seizures by LC–HRMS

New Psychoactive Substances (NPS) are a global concern since they are spreading at an unprecedented rate. Despite their commerce still being limited compared to traditional illicit drugs, the identification of NPS in seizures may represent a challenge because of the variety of possible structures. In this study we report the successful application of molecular networking (MN) to identify unexpected fentanyl analogs in two seizures. The samples were extracted with 1 mL of methanol and analyzed with an untargeted data-dependent acquisition approach by LC–HRMS. The obtained data were examined using the MN workflow within the Global Natural Product Search (GNPS). A job was submitted to GNPS by including both seizures and standard mixtures containing synthetic cannabinoids and fentanyls raw files; spectra obtained from standards were used to establish representative networks for both molecular classes. All synthetic cannabinoids in the mixture were linked together resulting in a molecular network despite their different fragmentation spectra. Looking at fentanyls, all the molecules with the typical 188.143 and 105.070 fragments were combined in a representative network. By exploiting the standard networks two unexpected fentanyls were found in the analyzed seizures and were putatively annotated as para-fluorofuranylfentanyl and (iso)butyrylfentanyl. The identity of these two fentanyl analogs was confirmed by NMR analysis. Other m/z ratios in the seizures were compatible with fentanyl derivatives; however, they appeared to be minor constituents, probably impurities or synthetic byproducts. The latter might be of interest for investigations of common fingerprints among different seizures

Two-year visual field outcomes of the treatment for advanced glaucoma study (TAGS)

PURPOSE: to compare visual field (VF) progression between the two arms of the Treatment of Advanced Glaucoma Study (TAGS) DESIGN: post-hoc analysis of VF data from a two-arm multicenter randomized controlled clinical trial METHODS: 453 patients with newly diagnosed advanced open-angle glaucoma in at least one eye from 27 centers in the United Kingdom were randomized to either trabeculectomy (N = 227) or medications in their index eye (N = 226) and followed-up for two years with two 24-2 VF tests at baseline, 4, 12 and 24 months. We analyzed data for participants with a reliable VF (False positive rate < 15%) at baseline and at least two other time-points. MAIN OUTCOME MEASURES: Average difference in rate of progression (RoP) was analyzed using a hierarchical Bayesian model. Time for each eye to progress from baseline beyond specific cut-offs (0.5, 1, 1.5 and 2 dB) was compared using survival analysis. RESULTS: 211 eyes in the trabeculectomy-first arm and 203 eyes in the medications-first arm were analyzed. The average RoPs (Estimate [95% Credible Intervals]) were -0.59 [-0.88, -0.31] dB/year in the medications-first arm and -0.40 [-0.67, -0.13] dB/year in the trabeculectomy-first arm. The difference was not significant (Bayesian p-value = 0.353). More eyes progressed in the medications-first arm: ≥0.5 dB (p = 0.001), ≥1dB (p = 0.014), ≥1.5dB (p = 0.071) and ≥2dB (p = 0.061). CONCLUSIONS: there was no significant difference in the average RoP at two years. Initial trabeculectomy significantly reduced the proportion of progressing eyes