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The relative contributions that species assemblages, abiotic variables, and their interactions with one another make to ecosystem properties are recognised but are seldom considered simultaneously, within context, and at the appropriate spatio-temporal scales. Here, we combine fluorescent time-lapse sediment profile imaging (f-SPI) and diffusion gradient thin gels (DGT) to examine, in situ, the link between an important benthic ecosystem process (bioturbation) and the availability (profiles) of Fe and Mn. Whilst the combination of these methodologies (fg-SPI) was successful in gathering high-resolution in situ data of bioturbation activity and Fe/Mn profiles simultaneously, we show that the mechanistic basis of how the infaunal community mediate Fe and Mn is difficult to reconcile because of the spatio-temporal differences between particle and porewater mixing. This mismatch means that the consideration of these mechanistic processes in isolation is likely to limit our interpretative capacity of how infaunal communities mediate various biogeochemical processes in the natural environment. Moreover, the combination of multiple technologies, process based simulation modelling and generalised additive statistical modelling achieved here, emphasises the importance of simultaneously considering additional factors that influence benthic chemistry, in particular bioirrigation and tidal flushing of the sediment profile. Our findings highlight a pressing need to determine how the relative importance of multiple abiotic and biotic factors act in concert to alter major biogeochemical pathways across a variety of contexts and habitats. [ABSTRACT FROM AUTHOR]

The relative contributions that species assemblages, abiotic variables, and their interactions with one another, make to ecosystem properties are recognised but are seldom considered simultaneously, within context, and at the appropriate spatio-temporal scales. Here, we combine fluorescent time-lapse sediment profile imaging (f-SPI) and diffusion gradient thin gels (DGT) to examine, in situ, the link between an important benthic ecosystem process (bioturbation) and ecosystem functioning (trace metal cycling). We show that the mechanistic basis of how the infaunal community mediate Fe and Mn cycles is difficult to reconcile because of the spatio-temporal differences between particle and porewater mixing. This mismatch means that the consideration of these mechanistic processes in isolation is likely to limit our interpretative capacity of how infaunal communities mediate various biogeochemical processes in the natural environment. Moreover, the combination of multiple technologies, process based simulation modelling and generalised additive statistical modelling achieved here, emphasises the importance of simultaneously considering additional factors that influence benthic chemistry, in particular bioirrigation and tidal flushing of the sediment profile. Our findings highlight a pressing need to determine how the relative importance of multiple abiotic and biotic factors act in concert to alter major biogeochemical pathways across a variety of contexts and habitats. [ABSTRACT FROM AUTHOR]

ABSTRACT. Magnetic resonance imaging (MR!) compatible EEG electrodes have been produced and available on the market for the past several years, however, their feasibility from a clinical standpoint remains unknown. Two hundred plus questionnaires were sent out to practicing epilepsy and trauma centers across the United States and Canada to evaluate the advantages and disadvantages of these electrodes as well as their financial feasibility in a clinical setting. 30% of the surveys returned were from clinical sites utilizing MRI compatible EEG recording electrodes. From these results we were able to understand the advantages and disadvantages of utilizing such recording media and their financial feasibility in the workplace. [ABSTRACT FROM AUTHOR]

Flexor tendon injuries require surgical repair. Early repair is optimal, but staged repair may be indicated for delayed presentations. Zone II flexor tendon injuries are the most difficult to achieve acceptable outcomes and require special attention for appropriate repair. Surgical techniques to repair flexor tendons have evolved over the past several decades and principles include core strand repair using at least a 4 strand technique, epitendinous suture to add strength and gliding properties, and pulley venting. Early postoperative active range of motion within the first 3 to 5 days of surgery is essential for optimizing outcomes., Competing Interests: Disclosure The authors have no relevant disclosures to report., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Odontogenic infections are a broad group of head and neck conditions that arise from the teeth and surrounding periodontium. These largely preventable infections disproportionately affect members of ethnic and racial minorities and low-income/uninsured groups, and result in significant costs to our health care system. Left untreated, odontogenic infections can spread to deep spaces of the head and neck and can result in life-threatening complications. The mainstay of treatment includes timely treatment of the affected teeth. These infections are a global public health concern that could be diminished with improved access to routine dental care., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

As part of a central line-associated bloodstream infections prevention initiative, our academic medical center formed a dedicated nursing team to assist with central line insertions and provide support with caring for difficult lines and dressings. During the program's first 3 years, the proportion of insertion-related central line-associated bloodstream infections occurring in areas within the team's scope declined overall by 47%., (Copyright © 2023 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Objective: Determine the food(s) most likely contaminated by Salmonella Javiana associated with a salmonellosis outbreak involving 2 hospitals in North Carolina that were within 50 miles of each other in November 2021., Methods: A 2:1 matched case-control study was conducted. Food histories were obtained from hospital food orders and potential confounder covariates were collected from patient medical records. Attack rates and conditional logistic regression odds ratios (OR) were estimated at the 80% confidence interval (CI) for each food exposure and salmonellosis., Results: There were 21 cases and 42 controls included. Fruit cups had the strongest association with salmonellosis (matched and adjusted OR = 7.9 80% CI: 2.7, 23.6). Hospital-specific ORs varied for several food items, but attack rates analyses provided additional evidence that fruit cups were a likely common source., Conclusion: Our analyses implicated fruit cups in an outbreak of salmonellosis in 2 hospitals. Other methodologic challenges included selection of controls among sick patients, heterogeneity of food exposures, reliance on food orders rather than foods consumed, and retention of food history records. Understanding and anticipating these challenges through changes to policies and operational procedures is critical for conducting efficient and effective case-control studies in the hospital setting., (Copyright © 2023. Published by Elsevier Inc.)

This paper describes the creation of outpatient monoclonal antibody (mAb) infusion centers for COVID-19 patients in a large academic medical center. It shows how the early and consistent partnership between infection prevention and the clinical and operational teams to establish and implement policies and procedures led to efficient and safe workflows., (Copyright © 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Objective: An estimated 3.8% of the global population experiences depression, according to the [2019] WHO report. Evidence supports the efficacy of exercise training (EX) for depression; however, its comparative efficacy to conventional, evidence-supported psychotherapies remains understudied. Therefore, we conducted a network meta-analysis to compare the efficacy of exercise training (EX), behavioral activation therapy (BA), cognitive-behavioral therapy (CBT), and non-directive supportive therapy (NDST)., Methods: Our search was performed in seven relevant databases (inception to March 10, 2020) and targeted randomized trials comparing psychological interventions head-to-head and/or to a treatment as usual (TAU) or waitlist (WL) control for the treatment of adults (18 years or older) with depression. Included trials assessed depression using a validated psychometric tool., Results: From 28,716 studies, 133 trials with 14,493 patients (mean age of 45.8 years; 71.9% female) were included. All treatment arms significantly outperformed TAU (standard mean difference [SMD] range, -0.49 to -0.95) and WL (SMD range, -0.80 to -1.26) controls. According to surface under the cumulative ranking (SUCRA) probabilities, BA was mostly likely to have the highest efficacy (1.6), followed by CBT (1.9), EX (2.8), and NDST (3.8). Effect size estimates between BA and CBT (SMD = -0.09, 95% CI [-0.50 to 0.31]), BA and EX (-0.22, [-0.68 to 0.24]), and CBT and EX (-0.12, [-0.42 to 0.17]) were very small, suggesting comparable treatment effects of BA, CBT, and EX. With individual comparisons of EX, BA, and CBT to NDST, we found small to moderate effect sizes (0.09 to 0.46), suggesting EX, BA, and CBT may equally outperform NDST., Conclusions: Findings provide preliminary yet cautionary support for the clinical use of exercise training for adult depression. High study heterogeneity and lack of sound investigations of exercise must be considered. Continued research is needed to position exercise training as an evidence-based therapy., Competing Interests: Conflicts of Interest None of the authors have any potential conflict of interests.

Background: The COVID-19 pandemic has had a substantial effect on the delivery of psychiatric health care. Inpatient psychiatric health care facilities have experienced outbreaks of COVID-19, making these areas particularly vulnerable., Methods: Our facility used a multidisciplinary approach to implement enhanced infection prevention and control (IPC) interventions in our psychiatric health care areas., Results: In a 16-month period during the COVID-19 pandemic, our 2 facilities provided >29,000 patient days of care to 1,807 patients and identified only 47 COVID-19 positive psychiatric health inpatients (47/1,807, or 2.6%). We identified the majority of these cases by testing all patients at admission, preventing subsequent outbreaks. Twenty-one psychiatric health care personnel were identified as COVID+ during the same period, with 90% linked to an exposure other than a known positive case at work., Discussion: The IPC interventions we implemented provided multiple layers of safety for our patients and our staff. Ultimately, this resulted in low SARS-CoV-2 infection rates within our facilities., Conclusions: Psychiatric health care facilities are uniquely vulnerable to COVID-19 outbreaks because they are congregate units that promote therapeutic interactions in shared spaces. IPC interventions used in acute medical care settings can also work effectively in psychiatric health care, but often require modifications to ensure staff and patient safety., (Copyright © 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

We instituted Personal Protective Equipment (PPE) Monitors as part of our care of COVID-19 patients in high-risk zones. PPE Monitors aided health care personnel (HCP) in donning and doffing, which contributed to nearly zero transmission of COVID-19 to HCP, despite their care of over 1400 COVID-19 patients., (Copyright © 2021 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Drug-specific agents for the reversal of direct oral anticoagulants (DOACs) were recently approved. We hypothesized that the approval of these reversal agents would lead improved outcomes for trauma patients taking DOACs., Methods: A multicenter, prospective (2015-2018), observational study of all adult trauma patients taking DOACs who were admitted to one of fifteen participating trauma centers was performed. The primary outcome was mortality., Results: For 606 trauma patients on DOACs, those reversed were older (78 vs. 74, p = 0.007), more severely injured (ISS: 16 vs. 5, p < 0.0001), had more severe head injuries (Head AIS: 2.9 vs. 1.3, p < 0.0001), and higher mortality (11% vs. 3%, p = 0.001). Patients who received drug-specific agents (idarucizumab, andexanet alfa) had higher mortality (30% vs. 8%, p = 0.04) than those reversed with factor concentrates. However, the low usage of drug-specific reversal agents limits our ability to assess their efficacy and safety., Conclusions: DOAC reversal was not independently associated with mortality. At present, the overall usage of drug-specific reversal agents is too sparing to meaningfully assess outcomes in trauma., Competing Interests: Declaration of competing interest There are no conflicts of interest to report., (Copyright © 2020. Published by Elsevier Inc.)

Health care facility-onset Clostridium difficile infections (HO-CDI) are an important national problem, causing increased morbidity and mortality. HO-CDI is an important metric for the Center for Medicare and Medicaid Service's (CMS) performance measures. Hospitals that fall into the worst-performing quartile in preventing hospital-acquired infections, including HO-CDI, may lose millions of dollars in reimbursement. Under pressure to reduce CDI and without a clear optimal method for C. difficile detection, health care facilities are questioning how best to use highly sensitive nucleic acid amplification tests (NAATs) to aid in the diagnosis of CDI. Our institution has used a two-step glutamate dehydrogenase (GDH)/toxin immunochromatographic assay/NAAT algorithm since 2009. In 2016, our institution set an organizational goal to reduce our CDI rates by 10% by July 2017. We achieved a statistically significant reduction of 42.7% in our HO-CDI rate by forming a multidisciplinary group to implement and monitor eight key categories of infection prevention interventions over a period of 13 months. Notably, we achieved this reduction without modifying our laboratory algorithm. Significant reductions in CDI rates can be achieved without altering sensitive laboratory testing methods., (Copyright © 2018 American Society for Microbiology.)

Objective: Targeted surveillance has focused on device-associated infections and surgical site infections (SSIs) and is often limited to healthcare-associated infections (HAIs) in high-risk areas. Longitudinal trends in all HAIs, including other types of HAIs, and HAIs outside of intensive care units (ICUs) remain unclear. We examined the incidences of all HAIs using comprehensive hospital-wide surveillance over a 12-year period (2001-2012)., Methods: This retrospective observational study was conducted at the University of North Carolina (UNC) Hospitals, a tertiary care academic facility. All HAIs, including 5 major infections with 14 specific infection sites as defined using CDC criteria, were ascertained through comprehensive hospital-wide surveillance. Generalized linear models were used to examine the incidence rate difference by infection type over time., Results: A total of 16,579 HAIs included 6,397 cases in ICUs and 10,182 cases outside ICUs. The incidence of overall HAIs decreased significantly hospital-wide (-3.4 infections per 1,000 patient days), in ICUs (-8.4 infections per 1,000 patient days), and in non-ICU settings (-1.9 infections per 1,000 patient days). The incidences of bloodstream infection, urinary tract infection, and pneumonia in hospital-wide settings decreased significantly, but the incidences of SSI and lower respiratory tract infection remained unchanged. The incidence of Clostridium difficile infection (CDI) increased remarkably. The outcomes were estimated to include 700 overall HAIs prevented, 40 lives saved, and cost savings in excess of $10 million., Conclusions: We demonstrated success in reducing overall HAIs over a 12-year period. Our data underscore the necessity for surveillance and infection prevention interventions outside of the ICUs, for non-device-associated HAIs, and for CDI.