Reducing the Incidence of CLABSI through Hand Hygiene

Practice Problem: Central line-associated bloodstream infections (CLABSI) account for most hospital-associated preventable infections in the United States and globally. Implementation of effective hand hygiene practices is considered to be highly effective in preventing CLABSIs if performed during insertion and every handling instance. PICOT: The PICOT question guiding this project is as follows: Among intensive care unit employees (P), implementation of hand hygiene awareness program and practice (I) compared to current practices (C) in reducing CLABSI incidences (O) among adult inpatients in 10 weeks (T)? Evidence: The evidence from a rigorous literature review showed that the appropriate education promotes hand hygiene, direct observation of peer’s hand hygiene practice promotes hand hygiene, and various campaigns on hand hygiene improve compliance and implementation of the appropriate guideline. Intervention: The intervention for the change project included developing ICU staff nurses\u27 competency and compliance in hand hygiene before and after handling patients with central lines. The intervention implemented was WHO’s five moments of hand hygiene technique for effective hand hygiene. The project manager directly monitored and remediated employees for hand hygiene breaches. Outcome: There was no statistical significance in the intervention but there was noted clinical significance. There was a slight change in CLABSI rates after implementing the WHO\u27s five moments of hand hygiene technique. Reported CLABSI incidence before project implementation was 1 compared to zero incidences in the post-implementation period. However, the intervention was unable to yield hand hygiene compliance of 90% showing no positive effects on the compliance rates and hence deemed unsuccessful. Conclusion: The project outcome warrants additional monitoring with additional champions to audit the hand hygiene process. The outcome also warrants additional monitoring on larger sample over longer duration to yield more statistically significant data. Further staff education and training paired with periodic audits and evaluation of the practice change over time may add insights to more evidence of clinical significance

Severity and Clinical Outcome of COVID-19 Patients Admitted at a Provincial Infectious and Communicable Disease Hospital of Nepal: A Cross-Sectional Study

Background: This study provides information regarding severity and clinical outcome of people admitted with the diagnosis of COVID-19 infection during the global pandemic at a provincial infectious disease hospital in Gandaki Province in Nepal. The evidence from this study will be helpful to compare the clinical outcome of people admitted with COVID-19 during the outbreak. Methods: Cross-sectional study was conducted from March 2023 to August 2023 after approval from NHRC (ref. no. 1448) with sample size of 1366 at the hospital. Structured questionnaire was used to collect secondary data (electronic and paper records) retrospectively from hospital records with a diagnosis of COVID-19 infection. Total enumeration technique was used with enlisting of all cases of COVID-19 to the hospital. The collected data was analyzed using SPSS version 11.5. Results: The hospital admitted the highest number of cases between April to September 2021. Among the 1366 admitted cases, 791 (57.91%) were males and 575 (42.09%) were females, the most common age group affected was 31 to 40 years (22.99%); 1092 (79.94%) were from Kaski district. As per disease severity, 884 (64.71%) were moderate cases followed by 391 (28.62%) mild cases and 91 (6.67%) severe cases. A total of 1205 (88.21%) patients were discharged, 105(7.69%) patients were referred and 56 (4.10%) patients died of COVID -19. Conclusions: Almost 3/4th of the admitted cases came from same district, majority had moderate disease and the hospital cure rate was almost 8/9th. As the majority of cases are from active age group (21 years to 60 years old), public health measures can be targeted to these groups including surrounding population to stop transmission and spread of COVID-19 or similar infectious diseases. The information from this study can guide for the preparation and planning of in-patient and isolation departments of similar other provincial infectious disease hospitals

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

U.S. Consumers\u27 Acceptance and Willingness to Pay for Genetically Modified and Genome-edited Foods

Even though genetically modified (GM) crops have a lot of economic potential for producers and consumers, they have not been widely accepted due to increasing concerns related to food safety, human, animal, and environmental health. Unlike GM technology, genome-editing technology does not involve the transfer of genetic materials. It is simpler, cheaper, more precise, and faster relative to GM technology and has immense potential for incorporating producer and consumer traits. Genome-editing technology, as a novel process, not has been explored much from the consumer’s side. This study uses a nationally representative survey of 1,573 U.S. consumers to examine their acceptance and willingness to pay for genome-edited foods and GM foods. We used discrete choice experiments to estimate consumers’ willingness to pay for genome-edited foods and GM foods. To evaluate the effects of information, we included a control and two versions of information treatments. In treatment 1 (T1) we provided information on technological details, whereas in treatment 2 (T2) we provided the information on both technological details and their health and environmental benefits. We employed a random parameter logit model to estimate consumers’ willingness to pay (WTP) for genome-edited food products. We used cluster analysis to identify consumer segments based on their attitudinal indices. The consumer characteristics and willingness to consume GM and genome edited foods are assessed within the identified clusters. Further, we used multivariate probit model to examine differences between and similarities among the determinants of the current consumption of GM foods and the future consumption of GM and genome-edited foods. Findings from the study show that consumers’ WTP for GM and genome-edited foods are similar, but lower than the WTP for conventionally bred food. WTP for genome-edited foods differ based on food types. Provision of information with specific health and environmental benefits has a significant effect on WTP for genome-edited foods. Consumers’ perceptions and acceptance of GM and genome-edited foods are similar to one another. Consumer were divided in three categories: uncertainty-loving, uncertainty-neutral and uncertainty-averse. Uncertainty-loving consumers were found to have positive attitudes toward future consumption of GM and genome-edited foods. Unlike WTP, willingness to consume for GM and genome-edited foods do not vary by food type. Information provision has no effect on the likelihood of acceptance of genome-edited foods, it reduces the likelihood of accepting GM foods. Consumers trust domestic start-ups and universities more than multinational firms as technology developers

Deep Underground Neutrino Experiment (DUNE), Far Detector Technical Design Report, Volume I Introduction to DUNE

International audienceThe preponderance of matter over antimatter in the early universe, the dynamics of the supernovae that produced the heavy elements necessary for life, and whether protons eventually decay—these mysteries at the forefront of particle physics and astrophysics are key to understanding the early evolution of our universe, its current state, and its eventual fate. The Deep Underground Neutrino Experiment (DUNE) is an international world-class experiment dedicated to addressing these questions as it searches for leptonic charge-parity symmetry violation, stands ready to capture supernova neutrino bursts, and seeks to observe nucleon decay as a signature of a grand unified theory underlying the standard model. The DUNE far detector technical design report (TDR) describes the DUNE physics program and the technical designs of the single- and dual-phase DUNE liquid argon TPC far detector modules. This TDR is intended to justify the technical choices for the far detector that flow down from the high-level physics goals through requirements at all levels of the Project. Volume I contains an executive summary that introduces the DUNE science program, the far detector and the strategy for its modular designs, and the organization and management of the Project. The remainder of Volume I provides more detail on the science program that drives the choice of detector technologies and on the technologies themselves. It also introduces the designs for the DUNE near detector and the DUNE computing model, for which DUNE is planning design reports. Volume II of this TDR describes DUNE's physics program in detail. Volume III describes the technical coordination required for the far detector design, construction, installation, and integration, and its organizational structure. Volume IV describes the single-phase far detector technology. A planned Volume V will describe the dual-phase technology

Deep Underground Neutrino Experiment (DUNE), Far Detector Technical Design Report, Volume II: DUNE Physics

The preponderance of matter over antimatter in the early universe, the dynamics of the supernovae that produced the heavy elements necessary for life, and whether protons eventually decay -- these mysteries at the forefront of particle physics and astrophysics are key to understanding the early evolution of our universe, its current state, and its eventual fate. DUNE is an international world-class experiment dedicated to addressing these questions as it searches for leptonic charge-parity symmetry violation, stands ready to capture supernova neutrino bursts, and seeks to observe nucleon decay as a signature of a grand unified theory underlying the standard model. The DUNE far detector technical design report (TDR) describes the DUNE physics program and the technical designs of the single- and dual-phase DUNE liquid argon TPC far detector modules. Volume II of this TDR, DUNE Physics, describes the array of identified scientific opportunities and key goals. Crucially, we also report our best current understanding of the capability of DUNE to realize these goals, along with the detailed arguments and investigations on which this understanding is based. This TDR volume documents the scientific basis underlying the conception and design of the LBNF/DUNE experimental configurations. As a result, the description of DUNE's experimental capabilities constitutes the bulk of the document. Key linkages between requirements for successful execution of the physics program and primary specifications of the experimental configurations are drawn and summarized. This document also serves a wider purpose as a statement on the scientific potential of DUNE as a central component within a global program of frontier theoretical and experimental particle physics research. Thus, the presentation also aims to serve as a resource for the particle physics community at large

Deep Underground Neutrino Experiment (DUNE) Near Detector Conceptual Design Report

International audienceThe Deep Underground Neutrino Experiment (DUNE) is an international, world-class experiment aimed at exploring fundamental questions about the universe that are at the forefront of astrophysics and particle physics research. DUNE will study questions pertaining to the preponderance of matter over antimatter in the early universe, the dynamics of supernovae, the subtleties of neutrino interaction physics, and a number of beyond the Standard Model topics accessible in a powerful neutrino beam. A critical component of the DUNE physics program involves the study of changes in a powerful beam of neutrinos, i.e., neutrino oscillations, as the neutrinos propagate a long distance. The experiment consists of a near detector, sited close to the source of the beam, and a far detector, sited along the beam at a large distance. This document, the DUNE Near Detector Conceptual Design Report (CDR), describes the design of the DUNE near detector and the science program that drives the design and technology choices. The goals and requirements underlying the design, along with projected performance are given. It serves as a starting point for a more detailed design that will be described in future documents

DUNE Offline Computing Conceptual Design Report

This document describes Offline Software and Computing for the Deep Underground Neutrino Experiment (DUNE) experiment, in particular, the conceptual design of the offline computing needed to accomplish its physics goals. Our emphasis in this document is the development of the computing infrastructure needed to acquire, catalog, reconstruct, simulate and analyze the data from the DUNE experiment and its prototypes. In this effort, we concentrate on developing the tools and systems thatfacilitate the development and deployment of advanced algorithms. Rather than prescribing particular algorithms, our goal is to provide resources that are flexible and accessible enough to support creative software solutions as HEP computing evolves and to provide computing that achieves the physics goals of the DUNE experiment

Reconstruction of interactions in the ProtoDUNE-SP detector with Pandora

International audienceThe Pandora Software Development Kit and algorithm libraries provide pattern-recognition logic essential to the reconstruction of particle interactions in liquid argon time projection chamber detectors. Pandora is the primary event reconstruction software used at ProtoDUNE-SP, a prototype for the Deep Underground Neutrino Experiment far detector. ProtoDUNE-SP, located at CERN, is exposed to a charged-particle test beam. This paper gives an overview of the Pandora reconstruction algorithms and how they have been tailored for use at ProtoDUNE-SP. In complex events with numerous cosmic-ray and beam background particles, the simulated reconstruction and identification efficiency for triggered test-beam particles is above 80% for the majority of particle type and beam momentum combinations. Specifically, simulated 1 GeV/$c$ charged pions and protons are correctly reconstructed and identified with efficiencies of 86.1$\pm0.6$% and 84.1$\pm0.6$%, respectively. The efficiencies measured for test-beam data are shown to be within 5% of those predicted by the simulation