A Man’s Home Is His Castle, But It Has a Secret Dungeon: Domestic Violence Victims Need An Amendment to Florida’s All-Party Consent Law

Domestic violence is an epidemic that is occurring at alarming rates throughout the state of Florida and across the nation. Much of that abuse occurs behind closed doors inside the home where there are no witnesses. Because Florida law does not allow a person to record communications without the consent of everyone else involved, victims are forced to rely on uncorroborated verbal accusations when they report their abuse. Unfortunately, it is difficult to prosecute these cases because they turn into credibility contests where the abuser often has an unfair advantage and has learned how to manipulate the system. If the abuse was serious enough, the victim can rely on visible physical injuries to support her allegations. That is also problematic because it forces victims to use their bodies as evidence when far more effective substitutes are available. This Note demonstrates that, although we claim domestic violence is no longer a private matter, we are effectively keeping it hidden behind closed doors by refusing to let victims record their abuse and then making it exceedingly difficult to prove their allegations without corroboration. The abuser’s right to privacy has become a priority over the victim’s safety. This Note argues that domestic violence victims need the ability to record the abuse they suffer inside the homes they share with their abusers. Finally, this Note proposes a statutory amendment to Florida’s all-party consent law that would achieve this goal

Steel and Composite Beams With Web Openings

Three design methods, osiginally deveIoped by Donahey and Darwin (19861, for dewmining the maximum shear capacity of composite beams with unreinforced web openings are extended to include steel and composite beams with or without reinforcement at the opening. The three design methods incorporate sirnplirylng assumptions that pennit closed-form sofutions for maximum shear capacity. The first method assumes that the neutral axes for secondary knding lie in the flanges of the top and bottom tees and defines the interaction of shear and normal stresses by a linear approximation of the von Mises yield function. The second method ignores the contribution of the flanges to secondary bending moments and employs the von Mises yield function to define the interaction of shear and normal stresses. The third method ignores the contribution of the flanges to secondary bending moments and defines the interaction between shear and normal smsses with a linear approximation of the von Mises yield function. Simplified design expressions for the maximum moment capacity of steel and composite beams with web openings are presented. Six refinements of the design methods are investigated to determine their significance in predicting member strengths. Simplified design expressions developed by Darwin (1990) for determining the maximum moment capacity of steel and composite kams at web openings are surnmarjzed. The accuracy and ease of application of the design methods presented in this report (Methods I, TI, and JJI) and applicable procedures proposed by Redwood and Shrivastava (1980), Redwood and Poumboums (19841, and Redwood and Cho (1986) are compared with experimental results of fifty steel beams and thirty-five composite beams. Resistance factors are- calculated for use in LRFD of structural steel buiIdings. The simplest of the design methods presented in this coupled with moment-shear interaction procedures proposed by Donahey and Darwin (19861, provides excellent agreement with test results and a superior approach in terms of accuracy and ease of application. Resistance factors of 0.90 and 0.85, applied to both shear and bending, are suitable for steel and composite beams, respectively

Impact of time to appropriate therapy on mortality in patients with vancomycin-intermediate Staphylococcus aureus infection

Despite the increasing incidence of vancomycin-intermediate Staphylococcus aureus (VISA) infections, few studies have examined the impact of delay in receipt of appropriate antimicrobial therapy on outcomes in VISA patients. We examined the effects of timing of appropriate antimicrobial therapy in a cohort of patients with sterile-site methicillin-resistant S. aureus (MRSA) and VISA infections. In this single-center, retrospective cohort study, we identified all patients with MRSA or VISA sterile-site infections from June 2009 to February 2015. Clinical outcomes were compared according to MRSA/VISA classification, demographics, comorbidities, and antimicrobial treatment. Thirty-day all-cause mortality was modeled with Kaplan-Meier curves. Multivariate logistic regression analysis (MVLRA) was used to determine odds ratios for mortality. We identified 354 patients with MRSA (n = 267) or VISA (n = 87) sterile-site infection. Fifty-five patients (15.5%) were nonsurvivors. Factors associated with mortality in MVLRA included pneumonia, unknown source of infection, acute physiology and chronic health evaluation (APACHE) II score, solid-organ malignancy, and admission from skilled care facilities. Time to appropriate antimicrobial therapy was not significantly associated with outcome. Presence of a VISA infection compared to that of a non-VISA S. aureus infection did not result in excess mortality. Linezolid use was a risk for mortality in patients with APACHE II scores of ≥14. Our results suggest that empirical vancomycin use in patients with VISA infections does not result in excess mortality. Future studies should (i) include larger numbers of patients with VISA infections to confirm the findings presented here and (ii) determine the optimal antibiotic therapy for critically ill patients with MRSA and VISA infections

Prevalence and predictors of postdischarge antibiotic use following mastectomy

OBJECTIVESurvey results suggest that prolonged administration of prophylactic antibiotics is common after mastectomy with reconstruction. We determined utilization, predictors, and outcomes of postdischarge prophylactic antibiotics after mastectomy with or without immediate breast reconstruction.DESIGNRetrospective cohort.PATIENTSCommercially insured women aged 18–64 years coded for mastectomy from January 2004 to December 2011 were included in the study. Women with a preexisting wound complication or septicemia were excluded.METHODSPredictors of prophylactic antibiotics within 5 days after discharge were identified in women with 1 year of prior insurance enrollment; relative risks (RR) were calculated using generalized estimating equations.RESULTSOverall, 12,501 mastectomy procedures were identified; immediate reconstruction was performed in 7,912 of these procedures (63.3%). Postdischarge prophylactic antibiotics were used in 4,439 procedures (56.1%) with immediate reconstruction and 1,053 procedures (22.9%) without immediate reconstruction (P&lt;.001). The antibiotics most commonly prescribed were cephalosporins (75.1%) and fluoroquinolones (11.1%). Independent predictors of postdischarge antibiotics were implant reconstruction (RR, 2.41; 95% confidence interval [CI], 2.23–2.60), autologous reconstruction (RR, 2.17; 95% CI, 1.93–2.45), autologous reconstruction plus implant (RR, 2.11; 95% CI, 1.92–2.31), hypertension (RR, 1.05; 95% CI, 1.00–1.10), tobacco use (RR, 1.07; 95% CI, 1.01–1.14), surgery at an academic hospital (RR, 1.14; 95% CI, 1.07–1.21), and receipt of home health care (RR, 1.11; 95% CI, 1.04–1.18). Postdischarge prophylactic antibiotics were not associated with SSI after mastectomy with or without immediate reconstruction (bothP&gt;.05).CONCLUSIONSProphylactic postdischarge antibiotics are commonly prescribed after mastectomy; immediate reconstruction is the strongest predictor. Stewardship efforts in this population to limit continuation of prophylactic antibiotics after discharge are needed to limit antimicrobial resistance.Infect Control Hosp Epidemiol2017;38:1048–1054</jats:sec

Variability in Fluoroscopic X-Ray Exposure in Contemporary Cardiac Catheterization Laboratories

ObjectivesThis study sought to assess fluoroscopic exposure rates in contemporary cardiac catheterization laboratories (CCL).BackgroundIncreasing attention is being focused on X-ray exposure during diagnostic and therapeutic cardiovascular procedures.MethodsWe measured fluoroscopic exposure rates (R/min) in 41 systems using a standardized methodology (National Electrical Manufacturers Association XR21 phantom). Measurements were obtained at 2 different phantom thicknesses to simulate varying patient body habitus.ResultsFluoroscopic exposure rates under medium (median 3.0 R/min, interquartile range 1.4 R/min) and large (median 12.5 R/min, interquartile range 4.8 R/min) habitus conditions showed substantial variation. Fluoroscopic exposure was associated with simulated patient habitus, X-ray system type, vendor, and geographic region. Under medium habitus conditions, only 25% of systems operated within a zone of lower than average exposure rates and satisfactory image quality; this frequency diminished to 7% under large habitus conditions (p < 0.001).ConclusionsThere is substantial variation (4- to 6-fold) in fluoroscopic exposure rates. This variation was not consistently associated with improved image quality. In the absence of a predictable benefit of higher (or lower) than average exposure rates, CCL quality improvement programs must minimize such potentially harmful variability in X-ray exposure

Inpatient urine cultures are frequently performed without urinalysis or microscopy: Findings from a large academic medical center

OBJECTIVETo describe the frequency of urine cultures performed in inpatients without additional testing for pyuriaDESIGNRetrospective cohort studySETTINGA 1,250-bed academic tertiary referral centerPATIENTSHospitalized adultsMETHODSThis study included urine cultures drawn on 4 medical and 2 surgical wards from 2009 to 2013 and in the medical and surgical intensive care units (ICUs) from 2012 to 2013. Patient and laboratory data were abstracted from the hospital’s medical informatics database. We identified catheter-associated urinary tract infections (CAUTIs) in the ICUs by routine infection prevention surveillance. Cultures without urinalysis or urine microscopy were defined as “isolated.” The primary outcome was the proportion of isolated urine cultures obtained. We used multivariable logistic regression to assess predictors of isolated cultures.RESULTSDuring the study period, 14,743 urine cultures were obtained (63.5 cultures per 1,000 patient days) during 11,820 patient admissions. Of these, 2,973 cultures (20.2%) were isolated cultures. Of the 61 CAUTIs identified, 31 (50.8%) were identified by an isolated culture. Predictors for having an isolated culture included male gender (adjusted odds ratio [aOR], 1.22; 95%; confidence interval [CI], 1.11–1.35], urinary catheterization (aOR, 2.15; 95% CI, 1.89–2.46), ICU admission (medical ICU aOR, 1.72; 95% CI, 1.47–2.00; surgical ICU aOR, 1.82; 95% CI, 1.51–2.19), and obtaining the urine culture ≥1 calendar day after admission (1–7 days aOR, 1.91; 95% CI. 1.71–2.12; &gt;7 days after admission aOR, 2.81; 95% CI, 2.37–3.34).CONCLUSIONSIsolated urine cultures are common in hospitalized patients, particularly in patients with urinary catheters and those in ICUs. Interventions targeting inpatient culturing practices may improve the diagnosis of urinary tract infections.Infect Control Hosp Epidemiol2017;38:455–460</jats:sec