A Multifaceted Approach using Implementation Science Methods to Increase CHG Bathing Compliance and Reduce Central Line Associated Blood Stream Infections on a Non-ICU unit

BACKGROUND or RATIONALE: The Acute Care Surgery unit (ACS) is a General and Progressive level of care post-operative unit at VCU Health system. Between quarter four 2021 and quarter one of 2023, five Central line associated blood stream infections (CLABSIs) occurred. NDNQI data revealed ACS had a higher CLABSI rate per 1,000 patient days than the national average of other similar type units in other magnet hospitals. STATEMENT OF THE PROBLEM: A GAP analysis revealed ACS did not achieve the 80% CHG compliance goal set by VCU Health’s Infection Prevention Department in all six quarters that these five CLABSIs occurred. This goal was set based on evidence that higher CHG bathing compliance reduces hospital acquired infections, including CLABSIs. A quality improvement (QI) project was developed to improve and sustain CHG compliance to 80% or greater and reduce/prevent CLABSIs. METHODOLOGY: A literature review revealed several implementation science methods may be effective in improving CHG compliance. Methods for this QI project were selected to address gaps in knowledge of staff and patients contributing to higher patient refusals and less opportunities for patients to comply. Implementation Science methods used for this project included: Staff education outreach, printed educational material, daily and bimonthly Audit and Feedback, Patient education through providing and framing information. A quality improvement project was developed and implemented using Plan-Do-Study-Act (PDSA) format. Three PDSA cycles were completed between February 13- April 30, 2023 RESULTS: Goal CHG compliance was exceeded in PDSA cycles 2 and 3. ACS has met or exceeded 80% CHG compliance for seven months in a row since PDSA cycle 2. ACS has had no CLABSIs since January 2023, before the PDSA project began. CONCLUSIONS: Using multifaceted implementation science interventions was effective in changing the knowledge, beliefs, and practice of non-ICU staff from being a barrier into a facilitator to achieving and sustaining goal CHG compliance to prevent CLABSI

Building health: an epidemiological study of "sick building syndrome" in the Whitehall II study

Objectives: Sick building syndrome (SBS) is described as a group of symptoms attributed to the physical environment of specific buildings. Isolating particular environmental features responsible for the symptoms has proved difficult. This study explores the role and significance of the physical and psychosocial work environment in explaining SBS. Methods: Cross sectional data on the physical environment of a selection of buildings were added to individual data from the Whitehall II study—an ongoing health survey of office based civil servants. A self-report questionnaire was used to capture 10 symptoms of the SBS and psychosocial work stress. In total, 4052 participants aged 42–62 years working in 44 buildings were included in this study. Results: No significant relation was found between most aspects of the physical work environment and symptom prevalence, adjusted for age, sex, and employment grade. Positive (non-significant) relations were found only with airborne bacteria, inhalable dust, dry bulb temperature, relative humidity, and having some control over the local physical environment. Greater effects were found with features of the psychosocial work environment including high job demands and low support. Only psychosocial work characteristics and control over the physical environment were independently associated with symptoms in the multivariate analysis. Conclusions: The physical environment of office buildings appears to be less important than features of the psychosocial work environment in explaining differences in the prevalence of symptoms

Monitoring RXTE Observations of Markarian 348: the origin of the column density variations

We analyze 37 RXTE observations of the type 2 Seyfert galaxy Mrk348 obtained during a period of 14 months. We confirm the spectral variability previous reported by Smith et al., in the sense that thecolumn density decreases by a factor of ~3 as the count rate increases. Column density variations could possibly originate either due to the random drift of clouds within the absorption screen, or due to photoionization processes. Our modeling of the observed variations implies that the first scenario is more likely. These clouds should lie in a distance of >2 light years from the source, having a diameter of a few light days and a density of >10^7 cm^(-3), hence probably residing outside the Broad Line Region.Comment: 6 pages, 3 figures, to appear in MNRA

XPS analysis of Fe2O3-TiO2-Au nanocomposites prepared by a plasma-assisted route

Fe2O3 nanodeposits have been grown on fluorine-doped tin oxide (FTO) substrates by plasma enhanced-chemical vapor deposition (PE-CVD). Subsequently, the obtained systems have been functionalized through the sequential introduction of TiO2 and Au nanoparticles (NPs) by means of radio frequency (RF)-sputtering. The target nanocomposites have been specifically optimized in view of their ultimate functional application in solar-driven H2 generation. In the present study, our attention is focused on a detailed X-ray photoelectron spectroscopy (XPS) characterization of the surface composition for a representative Fe2O3-TiO2-Au specimen. In particular, this report provides a detailed discussion of the analyzed C 1s, O 1s, Fe 2p, Ti 2p, and Au 4f regions. The obtained results point to the formation of pure Fe2O3-TiO2-Au composites, with gold present only in its metallic state and each of the constituents maintaining its chemical identity

A study of Pt-/alpha-Fe2O3 nanocomposites by XPS

alpha-Fe2O3 matrices were deposited on Fluorine-doped Tin Oxide (FTO) substrates by Plasma Enhanced- Chemical Vapor Deposition (PE-CVD) from Fe(hfa)_2TMEDA (hfa = 1,1,1,5,5,5-hexafluoro-2,4-pentanedionate; TMEDA = N,N,N’,N’-tetramethylethylenediamine). The obtained nanosystems were subsequently functionalized by platinum nanoparticles (NPs) via Radio Frequency (RF)-sputtering, exposing samples either to a pre- or post-sputtering thermal treatment at 650°C for one hour in air. Interestingly, Pt oxidation state in the final composite systems strongly depended on the adopted processing conditions. In this work, a detailed X-ray Photoelectron Spectroscopy (XPS) analysis was carried out in order to investigate the material chemical composition, with particular regard to the relative Pt(0)/Pt(II)/Pt(IV) content. The obtained results evidenced that, when annealing is performed prior to sputtering, only PtO and PtO2 are revealed in the final Pt/alpha-Fe2O3 nanocomposite. In a different way, annealing after sputtering results in the co-presence of Pt(0), Pt(II) and Pt(IV) species, the former arising from the thermal decomposition of PtO2 to metallic platinum

The feasibility of oligogenic combined segregation and linkage analysis in CEPH pedigrees

The CEPH samples are an invaluable resource for mapping genes that contribute to traits that can be measured in cell lines. With the many markers that have already been genotyped for the Centre d'Etude du Polymorphisme Humain (CEPH) pedigrees and are readily available, one need only obtain phenotypes to conduct a linkage analysis. For Genetic Analysis Workshop 15 (GAW15), over 3000 expression levels of genes in lymphoblastoid cells in 14 of the CEPH pedigrees were provided. For this study, eight of these expression levels were selected to obtain a spectrum of heritabilities, three were selected based on linkage results with traditional LOD scores >3, and one trait was selected at random. A Bayesian Monte Carlo Markov chain oligogenic segregation and linkage analysis was conducted on each of these 12 traits using the genome-wide single-nucleotide polymorphism linkage markers provided for GAW15. Our goal was to assess the ability of these methods to map genes in the CEPH pedigrees. Surprisingly, positive linkage signals were found for all 12 traits, even those with a very small traditionally calculated heritability. However, the portion of the variance attributed to genetic sources by the oligogenic segregation analysis differed substantially in some cases from the traditional heritability. It appears that genetic variance estimated from oligogenic segregation analysis may be a better indicator of whether genes can be mapped for complex traits than traditional heritability

Suverenitet na prodaju? Hvatanje u koštac s marginalnošću u Južnom Pacifiku – primjer otoka Niuea

This paper examines the case of Niue, a small raised atoll with a population of under 1500 that is self-governing in free association with New Zealand. Its marginality in terms of physical and economic isolation, small size and harsh environment is pronounced. However, it has survived with relatively high living standards and a range of livelihood options for its population. The paper assesses Niue’s marginality and analyses its strategies for survival and development, focusing on the manner in which it has negotiated sovereignty.Rad se bavi primjerom otoka Niuea, malenoga izdignutog atola s manje od 1500 stanovnika, koji ima status samouprave u slobodnom savezu s Novim Zelandom. Marginalnost otoka Niuea u obliku fizičke i ekonomske izolacije te veličine i negostoljubivog okoliša vrlo je naglašena. No otok uspijeva održati relativno visok životni standard te ponuditi svom stanovništvu niz raznolikih opcija privređivanja. U radu se analizira marginalnost Niuea te njegova strategija preživljavanja i razvoja, s naglaskom na način na koji je otok dogovorio svoju neovisnost