Healthcare-Associated Infections in Australia: Tackling the \u27Known Unknowns\u27

Australia does not have a national healthcare-associated infection (HAI) surveillance program. Without national surveillance, we do not understand the burden of HAIs, nor can we accurately assess the effects of national infection prevention initiatives. Recent research has demonstrated disparity between existing jurisdictional-based HAI surveillance activity while also identifying broad key stakeholder support for the establishment of a national program. A uniform surveillance program will also address growing concerns about hospital performance measurements and enable public reporting of hospital data

Quantum Steering Algorithm for Estimating Fidelity of Separability

Quantifying entanglement is an important task by which the resourcefulness of a state can be measured. Here we develop a quantum algorithm that tests for and quantifies the separability of a general bipartite state, by making use of the quantum steering effect. Our first separability test consists of a distributed quantum computation involving two parties: a computationally limited client, who prepares a purification of the state of interest, and a computationally unbounded server, who tries to steer the reduced systems to a probabilistic ensemble of pure product states. To design a practical algorithm, we replace the role of the server by a combination of parameterized unitary circuits and classical optimization techniques to perform the necessary computation. The result is a variational quantum steering algorithm (VQSA), which is our second separability test that is better suited for the capabilities of quantum computers available today. This VQSA has an additional interpretation as a distributed variational quantum algorithm (VQA) that can be executed over a quantum network, in which each node is equipped with classical and quantum computers capable of executing VQA. We then simulate our VQSA on noisy quantum simulators and find favorable convergence properties on the examples tested. We also develop semidefinite programs, executable on classical computers, that benchmark the results obtained from our VQSA. Our findings here thus provide a meaningful connection between steering, entanglement, quantum algorithms, and quantum computational complexity theory. They also demonstrate the value of a parameterized mid-circuit measurement in a VQSA and represent a first-of-its-kind application for a distributed VQA. Finally, the whole framework generalizes to the case of multipartite states and entanglement.Comment: v1: 19 pages, 10 figures, all source code available as arXiv ancillary file

Stakeholders’ perceptions of digital health platform ecosystem generativity

This paper discusses findings from a study of healthcare stakeholders’ perceptions of the enablers and barriers of core-periphery systems and solutions in the digital platform of a Private Tertiary Health Service (PTHS). Using critical realism as a lens, the study involved an embedded case study of three departments in PTHS. The findings show that the platformisation of digital health infrastructure enhanced generativity, including innovation, adoption, and scaling. Further, the research identified platform governance as the area that requires enhancements. This research adds to the limited literature on digital health platform ecosystems by revealing healthcare stakeholders’ perceptions. Our findings can inform strategy for health organisations seeking platformisation of their digital infrastructures. Further, state and national digital healthcare policymakers can use this research to address digital health platform ecosystems challenges, especially in the private sector

Agostini v. Felton and the Delivery of Title I Services in Catholic Schools

The Supreme Court’s recent decision in Agostini v. Felton is its most important case involving Catholic schools since the landmark 1971 ruling in Lemon v. Kurtzman. In Agostini, a closely divided Court took the unusual step of overturning its 1985 decision in Aguilar v. Felton, which prohibited the on-site delivery of Title I services to students enrolled in religiously affiliated nonpublic schools. In light of the potential ramifications of Agostini, this article reviews the Court’s rationale in detail before reflecting on how Agostini might affect the delivery of educational services under Title I and the Individuals with Disabilities Educational Act to students in Catholic schools

The Burden of Healthcare-Associated Infection in Australian Hospitals: A Systematic Review of the Literature

Introduction: Central to all efforts to control and prevent healthcare associated infections (HAIs) is the inherent need to measure the burden of infection and disease, classically referred to as surveillance. Australia does not have a national HAI surveillance system making it very difficult to systematically assess and report on the burden of hospital-acquired HAIs. This systematic review reports the incidence burden of HAIs in Australian hospitals as reported in the peer-reviewed literature from 2010 to 2016. Methods: Systematic review of the peer-reviewed literature reporting the incidence of HAIs in Australian hospitals between from 2010 to 2016 was identified using MEDLINE and CINAHL databases. The study protocol is registered with PROSPERO (registration number: CRD42016052997). Results: Of the 844 articles identified in the search, 24 articles were included in this review. Overall, these data suggest 83,096 HAIs per year in Australia, comprising 71,186 urinary tract infections, 4902 Clostridium difficile infections, 3946 surgical site infections, 1962 respiratory infections in acute stroke patients and 1100 hospital-onset Staphylococcus aureus bacteraemia. This is very large underestimate given the lack of or incomplete data on common infections such as pneumonia, gastroenterological and bloodstream infection, thus potentially missing up to 50% 60% of infections. If that is the case, the incidence of HAIs in Australia may be closer to 165,000 per year. Conclusion: There is a dearth of peer-reviewed literature reporting the incidence of HAIs in Australian hospitals, making it very difficult to an accurate burden of infection. On the eve of a global ‘post antibiotic era’, the need for national consensus on definitions, surveillance methodology and reporting is paramount

The Prevalence of Healthcare Associated Infections Among Adult Inpatients at Nineteen Large Australian Acute-care Public Hospitals: A Point Prevalence Survey

Background Australia does not have a national healthcare associated infection (HAI) surveillance program. Only one HAI point prevalence study has been undertaken in 1984. The objective of this study was to estimate the burden of healthcare associated infection (HAI) in acute adult inpatients in Australia. Methods A cross sectional point prevalence study (PPS) was conducted in a sample of large acute care hospitals. All data were collected by two trained Research Assistants. Surveillance methodology was based on the European Centre for Disease Prevention and Control (ECDC) PPS Protocol with variation in the sampling method in that only acute inpatients ≥ 18 years old were included. ECDC HAI definitions were applied. Results Data was collected between August and November 2018. A total of 2767 patients from 19 hospitals were included in the study. The median age of patients was 67, and 52.9% of the sample were male. Presence of a multi-drug resistant organism was documented for 10.3% of the patients. There were 363 HAIs present in 273 patients. The prevalence of patients with a HAI was 9.9% (95%CI: 8.8–11.0). Hospital prevalence rates ranged from 5.7% (95%CI:2.9–11.0) to 17.0% (95%CI:10.7–26.1). The most common HAIs were surgical site infection, pneumonia and urinary tract infection, comprising 64% of all HAIs identified. Conclusion This is the first HAI PPS to be conducted in Australia in 34 years. The prevalence rate is higher than the previous Australian study and that reported by the ECDC, however differences in methodology limit comparison. Regular, large scale HAI PPS should be undertaken to generate national HAI data to inform and drive national interventions

Establishing the Prevalence of Healthcare-associated Infections in Australian Hospitals: Protocol for the Comprehensive Healthcare Associated Infection National Surveillance (CHAINS) Study

Introduction A healthcare-associated infection (HAI) data point prevalence study (PPS) conducted in 1984 in Australian hospitals estimated the prevalence of HAI to be 6.3%. Since this time, there have been no further national estimates undertaken. In the absence of a coordinated national surveillance programme or regular PPS, there is a dearth of national HAI data to inform policy and practice priorities. Methods and analysis A national HAI PPS study will be undertaken based on the European Centres for Disease Control method. Nineteen public acute hospitals will participate. A standardised algorithm will be used to detect HAIs in a two-stage cluster design, random sample of adult inpatients in acute wards and all intensive care unit patients. Data from each hospital will be collected by two trained members of the research team. We will estimate the prevalence of HAIs, invasive device use, single room placement and deployment of transmission-based precautions

Reducing Urinary Catheter Use: A Protocol for a Mixed Methods Evaluation of an Electronic Reminder System in Hospitalised Patients in Australia

Introduction: Despite advances in infection prevention and control, catheter-associated urinary tract infections (CAUTIs) are common and remain problematic. Prolonged urinary catheterisation is the main risk factor for development of CAUTIs; hence, interventions that target early catheter removal warrant investigation. The study’s objectives are to examine the efficacy of an electronic reminder system, the CATH TAG, in reducing urinary catheter use (device utilisation ratio) and to determine the effect of the CATH TAG on nurses’ ability to deliver patient care. Methods and analysis: This study uses a mixed methods approach in which both quantitative and qualitative data will be collected. A stepped wedge randomised controlled design in which wards provide before and after observations will be undertaken in one large Australian hospital over 24 weeks. The intervention is the use of the CATH TAG. Eligible hospital wards will receive the intervention and act as their own control, with analysis undertaken of the change within each ward using data collected in control and intervention periods. An online survey will be administered to nurses on study completion, and a focus group for nurses will be conducted 2 months after study completion. The primary outcomes are the urinary catheter device utilisation ratio and perceptions of nurses about ease of use of the CATH TAG. Secondary outcomes include a reduced number of cases of catheter-associated asymptomatic bacteriuria, a reduced number of urinary catheters inserted per 100 patient admissions, perceptions of nurses regarding effectiveness of the CATH TAG, changes in ownership/interest by patients in catheter management, as well as possible barriers to successful implementation of the CATH TAG

Simulation of solute transport in a heterogeneous vadose zone describing the hydraulic properties using a multistep stochastic approach

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95612/1/wrcr10619.pd