Impact of Central Venous Catheter Type and Methods on Catheter-Related Colonization and Bacteraemia

A prospective, randomized, controlled, multi-centre clinical trial was performed to test the effectiveness of an antimicrobial central venous catheter (CVC) made of polyurethane integrated with silver, platinum and carbon black (Vantex). Adults expected to require a CVC for more than 60 h were eligible, and were randomized to receive the test or control catheter. All CVCs were inserted with new venipunctures using full aseptic technique. Following catheter removal, the distal tip and an intracutaneous segment were removed and cultured using semiquantitative and quantitative methods. Peripheral blood samples were obtained and cultured to confirm cases of catheter-related bloodstream infection (CRBSI). Bacterial and fungal organisms were identified by standard microbiological methods. Catheter placement was performed primarily in the intensive care unit (50%) or operating theatre (42%). Complete data could be evaluated for 539 patients (77%). The mean duration of CVC placement was 149.3h (six days). There were no significant differences in colonization or bacteraemia rates between the test and control catheters. The overall colonization rate was not particularly low (24.5%), and yet CVC-related bacteraemia occurred in only 1.4% of patients, and CRBSI occurred in only one patient from the control group (0.2%). Insertion site and dressing change frequency were significantly associated with the colonization rate. Although CVCs with antimicrobial features have been associated with a decrease in catheter-related colonization and bacteraemia, this study demonstrated that infection rates may depend more on non-catheter-related factors, such as adherence to infection control standards, selection of insertion site, duration of CVC placement, and dressing change frequency. As microbial resistance increases, clinicians should make maximal use of these processes to reduce catheter-related infections

Impact of Central Venous Catheter Type and Methods on Catheter-Related Colonization and Bacteraemia

A prospective, randomized, controlled, multi-centre clinical trial was performed to test the effectiveness of an antimicrobial central venous catheter (CVC) made of polyurethane integrated with silver, platinum and carbon black (Vantex). Adults expected to require a CVC for more than 60 h were eligible, and were randomized to receive the test or control catheter. All CVCs were inserted with new venipunctures using full aseptic technique. Following catheter removal, the distal tip and an intracutaneous segment were removed and cultured using semiquantitative and quantitative methods. Peripheral blood samples were obtained and cultured to confirm cases of catheter-related bloodstream infection (CRBSI). Bacterial and fungal organisms were identified by standard microbiological methods. Catheter placement was performed primarily in the intensive care unit (50%) or operating theatre (42%). Complete data could be evaluated for 539 patients (77%). The mean duration of CVC placement was 149.3h (six days). There were no significant differences in colonization or bacteraemia rates between the test and control catheters. The overall colonization rate was not particularly low (24.5%), and yet CVC-related bacteraemia occurred in only 1.4% of patients, and CRBSI occurred in only one patient from the control group (0.2%). Insertion site and dressing change frequency were significantly associated with the colonization rate. Although CVCs with antimicrobial features have been associated with a decrease in catheter-related colonization and bacteraemia, this study demonstrated that infection rates may depend more on non-catheter-related factors, such as adherence to infection control standards, selection of insertion site, duration of CVC placement, and dressing change frequency. As microbial resistance increases, clinicians should make maximal use of these processes to reduce catheter-related infections

Impact of mass distribution of insecticide-treated nets in Mozambique, 2012 to 2025: Estimates of child lives saved using the Lives Saved Tool

Malaria was the leading cause of post-neonatal deaths in Mozambique in 2017. The use of insecticide treated nets (ITNs) is recognized as one of the most effective ways to reduce malaria mortality in children. No previous analyses have estimated changes in mortality attributable to the scale-up of ITNs, accounting for provincial differences in mortality rates and coverage of health interventions. Based upon annual provincial ownership coverage of ITNs, the Lives Saved Tool (LiST), a multi-cause mathematical model, estimated under-5 lives saved attributable to increased household ITN coverage in 10 provinces of Mozambique between 2012 and 2018, and projected lives saved from 2019 to 2025 if 2018 coverage levels are sustained. An estimated 14,040 under-5 child deaths were averted between 2012 and 2018. If 2018 coverage levels are maintained until 2025, an additional 33,277 child deaths could be avoided. If coverage reaches at least 85% in all ten provinces by 2022, then a projected 36,063 child lives can be saved. From 2012 to 2018, the estimated number of lives saved was highest in Zambezia and Tete provinces. Increases in ITN coverage can save a substantial number of child lives in Mozambique. Without continued investment, thousands of avoidable child deaths will occur

QRAT+: Generalizing QRAT by a More Powerful QBF Redundancy Property

The QRAT (quantified resolution asymmetric tautology) proof system simulates virtually all inference rules applied in state of the art quantified Boolean formula (QBF) reasoning tools. It consists of rules to rewrite a QBF by adding and deleting clauses and universal literals that have a certain redundancy property. To check for this redundancy property in QRAT, propositional unit propagation (UP) is applied to the quantifier free, i.e., propositional part of the QBF. We generalize the redundancy property in the QRAT system by QBF specific UP (QUP). QUP extends UP by the universal reduction operation to eliminate universal literals from clauses. We apply QUP to an abstraction of the QBF where certain universal quantifiers are converted into existential ones. This way, we obtain a generalization of QRAT we call QRAT+. The redundancy property in QRAT+ based on QUP is more powerful than the one in QRAT based on UP. We report on proof theoretical improvements and experimental results to illustrate the benefits of QRAT+ for QBF preprocessing.Comment: preprint of a paper to be published at IJCAR 2018, LNCS, Springer, including appendi

Retear of anterior cruciate ligament grafts in female basketball players: a case series

<p>Abstract</p> <p>Background</p> <p>Incidence of anterior cruciate ligament (ACL) injuries in young female basketball players is higher than that in male basketball players. Graft retears are more frequent with the increasing number of ACL reconstructions. The present study aimed to examine the incidence of retears in competitive female basketball players.</p> <p>Methods</p> <p>Sixty-four female basketball players (aged 12 to 29 years) who underwent primary anatomic double-bundle ACL reconstruction using hamstring grafts participated in the study. We investigated incidence, mechanism, and patient characteristics of ACL graft retears. Mann-Whitney <it>U </it>test was used for statistical analysis, and the level of significance was determined at <it>P </it>< 0.05.</p> <p>Results</p> <p>Six patients suffered from ACL graft retear (9.4%). Mean duration between primary ACL reconstruction and incidence of retears was 11.7 months. However, there were no other postoperative graft ruptures after 24 months. Primary injury and retear mechanisms varied by patient. At six months after the primary ACL reconstruction surgery, mean quadriceps and hamstring strengths were 81% and 87%, respectively, indicating favorable recovery of muscle strength. However, preoperative quadriceps and hamstring strength in the retear group were 65% and 71%, respectively. In particular, preoperative quadriceps strength in the retear group demonstrated a lower value than that in the uninjured group (<it>P </it>< 0.05).</p> <p>Conclusions</p> <p>We observed a high incidence of ACL graft retears in competitive female basketball players, as previously reported. Considering the timing of graft retear occurrences, an early return to playing basketball should be avoided following ACL reconstruction. Closer attention should be paid to player preoperative condition, as well as muscle strength and postoperative status.</p

Relativistic Nucleus-Nucleus Collisions: from the BEVALAC to RHIC

I briefly describe the initial goals of relativistic nuclear collisions research, focusing on the LBL Bevatron/Bevalac facility in the 1970's. An early concept of high hadronic density fireball formation, and subsequent isentropic decay (preserving information as to the high density stage) led to an outline of physics observables that could determine the nuclear matter equation of state at several times nuclear ground state matter density. With the advent of QCD the goal of locating, and characterizing the hadron-parton deconfinement phase transformation suggested the need for higher $\sqrt{s}$, the research thus moving to the BNL AGS and CERN SPS, finally to RHIC at BNL. A set of physics observables is discussed where present data span the entire $\sqrt{s}$ domain, from Bevalac and SIS at GSI, to top RHIC energy. Referring, selectively, to data concerning bulk hadron production, the overall $\sqrt{s}$ evolution of directed and radial flow observables, and of pion pair Bose-Einstein correlation are discussed. The hadronization process is studied in the grand canonical statistical model. The resulting hadronization points in the plane T vs. $\mu_B$ converge onto the parton-hadron phase boundary predicted by finite $\mu_B$ lattice QCD, from top SPS to RHIC energy. At lower SPS and top AGS energy a steep strangeness maximum occurs at which the Wroblewski parameter $\lambda_s \approx$ 0.6; a possible connection to the QCD critical point is discussed. Finally the unique new RHIC physics is addressed: high $p_T$ hadron suppression and jet "tomography".Comment: 19 pages, 11 figure

Parton coalescence at RHIC

Using a covariant coalescence model, we study hadron production in relativistic heavy ion collisions from both soft partons in the quark-gluon plasma and hard partons in minijets. Including transverse flow of soft partons and independent fragmentation of minijet partons, the model is able to describe available experimental data on pion, kaon, and antiproton spectra. The resulting antiproton to pion ratio is seen to increase at low transverse momenta and reaches a value of about one at intermediate transverse momenta, as observed in experimental data at RHIC. A similar dependence of the antikaon to pion ratio on transverse momentum is obtained, but it reaches a smaller value at intermediate transverse momenta. At high transverse momenta, the model predicts that both the antiproton to pion and the antikaon to pion ratio decrease and approach those given by the perturbative QCD. Both collective flow effect and coalescence of minijet partons with partons in the quark-gluon plasma affect significantly the spectra of hadrons with intermediate transverse momenta. Elliptic flows of protons, Lambdas, and Omegas have also been evaluated from partons with elliptic flows extracted from fitting measured pion and kaon elliptic flows, and they are found to be consistent with available experimental data.Comment: 12 pages, 11 figure

Inclusive production of charged pions in p+C collisions at 158 GeV/c beam momentum

The production of charged pions in minimum bias p+C interactions is studied using a sample of 377000 inelastic events obtained with the NA49 detector at the CERN SPS at 158 GeV/c beam momentum. The data cover a phase space area ranging from 0 to 1.8 GeV/c in transverse momentum and from -0.1 to 0.5 in Feynman x. Inclusive invariant cross sections are given on a grid of 270 bins per charge thus offering for the first time a dense coverage of the projectile hemisphere and of the cross-over region into the target fragmentation zone.Comment: 31 pages, 30 figures, submitted to European Journal of Physic

System size dependence of strange particle yields and spectra at sqrt(s)=17.3 GeV

Yields and spectra of strange hadrons (K+, K-, phi, Lambda and Antilambda) as well as of charged pions were measured in near central C+C and Si+Si collisions at 158 AGeV beam energy with the NA49 detector. Together with earlier data for p+p, S+S and Pb+Pb reactions the system size dependence can be studied. Relative strangeness production rises fast and saturates at about 60 participating nucleons; the net hyperon spectra show an increasing shift towards midrapidity for larger colliding nuclei. An interpretation based on the formation of coherent systems of increasing volume is proposed. The transverse mass spectra can be described by a blast wave ansatz. Increasing flow velocity is accompanied by decreasing temperatures for both kinetic and chemical freeze out. The increasing gap between inelastic and elastic decoupling leaves space for rescattering.Comment: 8 pages, 6 figures, Proceedings of the Hot Quarks 2004 worksho