Promoting quality through measurement of performance and response: prevention success stories.

Successful efforts to prevent health-care acquired infections occur daily in U.S. hospitals. However, few of these "success stories" are presented in the medical literature or discussed at professional meetings. Key components of successful prevention efforts include multidisciplinary teams, appropriate educational interventions, and data dissemination to clinical staff

Emission pathways to achieve 2.0°C and 1.5°C climate targets

We investigated the feasibilities of 2.0°C and 1.5°C climate targets by considering the abatement potentials of a full suite of greenhouse gases, pollutants, and aerosols. We revised the inter-temporal dynamic optimization model DICE-2013R by introducing three features as follows. First, we applied a new marginal abatement cost curve derived under moderate assumptions regarding future socioeconomic development—the Shared Socioeconomic Pathways 2 (SSP2) scenario. Second, we addressed emission abatement for not only industrial CO2 but also land-use CO2, CH4, N2O, halogenated gases, CO, volatile organic compounds, SOx, NOx, black carbon and organic carbon. Third, we improved the treatment of the non-CO2 components in the climate module based on MAGICC 6.0. We obtained the following findings: (1) It is important to address the individual emissions in an analysis of low stabilization scenarios because abating land-use CO2, non-CO2 and aerosol emissions also contributes to maintaining a low level of radiative forcing and substantially affects the climate costs. (2) The 2.0°C target can be efficiently reached under the assumptions of the SSP2 scenario. (3) The 1.5°C target can be met with early deep cuts under the assumption of a temperature overshoot, and it will triple the carbon price and double the mitigation cost compared with the 2.0°C case

Cystatins as calpain inhibitors: Engineered chicken cystatin- and stefin B-kininogen domain 2 hybrids support a cystatin-like mode of interaction with the catalytic subunit of μ-calpain

Within the cystatin superfamily, only kininogen domain 2 (KD2) is able to inhibit μ- and m-calpain. In an attempt to elucidate the structural requirements of cystatins for calpain inhibition, we constructed recombinant hybrids of human stefin B (an intracellular family 1 cystatin) with KD2 and Delta L110 deletion mutants of chicken cystatin-KD2 hybrids. Substitution of the N-terminal contact region of stefin B by the corresponding KD2 sequence resulted in a calpain inhibitor of K-i = 188 nM. Deletion of L110, which forms a beta -bulge in family 1 and 2 cystatins but is lacking in KD2, improved inhibition of mu -calpain 4- to 8-fold. All engineered cystatins were temporary inhibitors of calpain due to slow substrate-like cleavage of a single peptide bond corresponding to Gly9-Ala10 in chicken cystatin. Biomolecular interaction analysis revealed that, unlike calpastatin, the cystatin-type inhibitors do not bind to the calmodulin-like domain of the small subunit of calpain, and their interaction with the mu -calpain heterodimer is completely prevented by a synthetic peptide comprising subdomain B of calpastatin domain 1. Based on these results we propose that (i) cystatin-type calpain inhibitors interact with the active site of the catalytic domain of calpain in a similar cystatin-like mode as with papain and (ii) the potential for calpain inhibition is due to specific subsites within the papain-binding regions of the general cystatin fold

Feeding back surveillance data to prevent hospital-acquired infections.

We describe the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance system. Elements of the system critical for successful reduction of nosocomial infection rates include voluntary participation and confidentiality; standard definitions and protocols; identification of populations at high risk; site-specific, risk- adjusted infection rates comparable across institutions; adequate numbers of trained infection control professionals; dissemination of data to health-care providers; and a link between monitored rates and prevention efforts

Bidirectional light-scattering image processing method for high-concentration jet sprays

In order to study the distributions of droplet size and volume density in high-concentration jet sprays, a new technique is developed, which combines the forward and backward light scattering method and an image processing method. A pulsed ruby laser is used as the light source. The Mie scattering theory is applied to the results obtained form image processing on the scattering photographs. The time history is obtained for the droplet size and volume density distributions, and the method is demonstrated by diesel fuel sprays under various injecting conditions. The validity of the technique is verified by a good agreement in the injected fuel volume distributions obtained by the present method and by injection rate measurements.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25819/1/0000382.pd

Tpeak-Tend, Tpeak-Tend/QT ratio and Tpeak-Tend dispersion for risk stratification in Brugada Syndrome:A systematic review and meta-analysis

Background: Brugada syndrome is an ion channelopathy that predisposes affected subjects to ventricular tachycardia/fibrillation (VT/VF), potentially leading to sudden cardiac death (SCD). Tpeak-Tend intervals, (Tpeak-Tend)/QT ratio and Tpeak-Tend dispersion have been proposed for risk stratification, but their predictive values in Brugada syndrome have been challenged recently. Methods: A systematic review and meta-analysis was conducted to examine their values in predicting arrhythmic and mortality outcomes in Brugada Syndrome. PubMed and Embase databases were searched until 1 May 2018, identifying 29 and 57 studies. Results: Nine studies involving 1740 subjects (mean age 45 years old, 80% male, mean follow-up duration was 68 ± 27 months) were included. The mean Tpeak-Tend interval was 98.9 ms (95% CI: 90.5-107.2 ms) for patients with adverse events (ventricular arrhythmias or SCD) compared to 87.7 ms (95% CI: 80.5-94.9 ms) for those without such events, with a mean difference of 11.9 ms (95% CI: 3.6-20.2 ms, P = 0.005; I2 = 86%). Higher (Tpeak-Tend)/QT ratios (mean difference = 0.019, 95% CI: 0.003-0.036, P = 0.024; I2 = 74%) and Tpeak-Tend dispersion (mean difference = 7.8 ms, 95% CI: 2.1-13.4 ms, P = 0.007; I2 = 80%) were observed for the event-positive group. Conclusion: Tpeak-Tend interval, (Tpeak-Tend)/QT ratio and Tpeak-Tend dispersion were higher in high-risk than low-risk Brugada subjects, and thus offer incremental value for risk stratification

Simulation of cell-substrate traction force dynamics in response to soluble factors

Finite element (FE) simulations of contractile responses of vascular muscular thin films (vMTFs) and endothelial cells resting on an array of micro-posts under stimulation of soluble factors were conducted in comparison with experimental measurements reported in literature. Two types of constitutive models were employed in the simulations, i.e. smooth muscle cell type and non-smooth muscle cell type. The time histories of the effects of soluble factors were obtained via calibration against experimental measurements of contractile responses of tissues or cells. The numerical results for vMTFs with micropatterned tissues suggest that the radius of curvature of vMTFs under stimulation of soluble factors is sensitive to width of the micropatterned tissue, i.e. the radius of curvature increases as the tissue width decreases. However, as the tissue response is essentially isometric, the time history of the maximum principal stress of the micropatterned tissues is not sensitive to tissue width. Good agreement has been achieved for predictions of the vasoconstrictor endothelin-1 (ET-1) induced contraction stress between the FE numerical simulation and the experiment based approach of Alford, et al. (2011) for the vMTFs with 40, 60, 80 and 100 μm width patterns. This may suggest the contraction stress is weakly sensitive to the tissue width for these patterns. However, for 20 μm width tissue patterning, the numerical simulation result for contraction stress is less than the average value of experimental measurements, which may suggest the thinner and more elongated spindle-like cells within the 20 μm width tissue patterning have higher contractile output. The constitutive model for non-smooth muscle cells was used to simulate the contractile response of the endothelial cells. The substrate was treated as an effective continuum. For agonists such as Lysophosphatidic acid (LPA) and vascular endothelial growth factor (VEGF), the deformation of the cell diminishes from edge to centre and the central part of the cell is essentially under isometric state. Numerical studies demonstrated the scenarios that cell polarity can be triggered via manipulation of the effective stiffness and Possion’s ratio of the substrate