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AbstractObjective:To identify urinary catheter (UC)–associated urinary tract infection (CAUTI) incidence and risk factors.Design:A prospective cohort study.Setting:The study was conducted across 623 ICUs of 224 hospitals in 114 cities in 37 African, Asian, Eastern European, Latin American, and Middle Eastern countries.Participants:The study included 169,036 patients, hospitalized for 1,166,593 patient days.Methods:Data collection took place from January 1, 2014, to February 12, 2022. We identified CAUTI rates per 1,000 UC days and UC device utilization (DU) ratios stratified by country, by ICU type, by facility ownership type, by World Bank country classification by income level, and by UC type. To estimate CAUTI risk factors, we analyzed 11 variables using multiple logistic regression.Results:Participant patients acquired 2,010 CAUTIs. The pooled CAUTI rate was 2.83 per 1,000 UC days. The highest CAUTI rate was associated with the use of suprapubic catheters (3.93 CAUTIs per 1,000 UC days); with patients hospitalized in Eastern Europe (14.03) and in Asia (6.28); with patients hospitalized in trauma (7.97), neurologic (6.28), and neurosurgical ICUs (4.95); with patients hospitalized in lower–middle-income countries (3.05); and with patients in public hospitals (5.89).The following variables were independently associated with CAUTI: Age (adjusted odds ratio [aOR], 1.01; P< .0001), female sex (aOR, 1.39; P< .0001), length of stay (LOS) before CAUTI-acquisition (aOR, 1.05; P< .0001), UC DU ratio (aOR, 1.09; P< .0001), public facilities (aOR, 2.24; P< .0001), and neurologic ICUs (aOR, 11.49; P< .0001).Conclusions:CAUTI rates are higher in patients with suprapubic catheters, in middle-income countries, in public hospitals, in trauma and neurologic ICUs, and in Eastern European and Asian facilities.Based on findings regarding risk factors for CAUTI, focus on reducing LOS and UC utilization is warranted, as well as implementing evidence-based CAUTI-prevention recommendations.

Boron nitride (BN) is an exceptional material, and among its polymorphs, two-dimensional (2D) hexagonal and three-dimensional (3D) cubic BN (h-BN and c-BN) phases are most common. The phase stability regimes of these BN phases are still under debate, and phase transformations of h-BN/c-BN remain a topic of interest. Here, we investigate the phase stability of 2D/3D h-BN/c-BN nanocomposites and show that the coexistence of two phases can lead to strong nonlinear optical properties and low thermal conductivity at room temperature. Furthermore, spark-plasma sintering of the nanocomposite shows complete phase transformation to 2D h-BN with improved crystalline quality, where 3D c-BN possibly governs the nucleation and growth kinetics. Our demonstration might be insightful in phase engineering of BN polymorph-based nanocomposites with desirable properties for optoelectronics and thermal energy management applications.

Limited information is available on outcomes of haploidentical stem cell transplantation (haploSCT) with posttransplant cyclophosphamide using myeloablative conditioning regimens in children and adolescents. We report the results of a single-institution retrospective study of myeloablative haploSCT in 36 children and adolescents (median age, 8 y; range, 9 mo to 22 y) with high-risk hematologic malignancies. Donor engraftment occurred in 31 of 33 evaluable patients (94%). Recovery of neutrophils and platelets occurred at a median of 15 and 20 days. Cumulative incidence of acute graft-versus-host-disease (GVHD) grades II to IV and grades III to IV at 100 days was 36±8.7% and 10±5.4% and of chronic GVHD at 1 year was 55±9.2%, with 31±8.6% moderate to severe. Nonrelapse mortality was 16±6.1% and 22±6.9% at 100 days and 1 year. The cumulative incidence of relapse at 4 years was 32±8.8%. With a median follow-up of 57 months (range, 8 to 89 mo), the overall survival and event-free survival at 4 years was 55.6±8.7% and 44.8±8.5%. Myeloablative conditioning T-replete haploSCT with posttransplant cyclophosphamide is a viable alternative to matched unrelated transplantation for children and adolescents with high-risk hematologic malignancies. The high rates of nonrelapse mortality and chronic GVHD is a concern and deserves careful consideration.

El adenomioma constituye una patología benigna, poco frecuente a nivel del cérvix. Se define como una forma localizada de adenomiosis que se encuentra rodeada de una proliferación muscular benigna conformando una tumoración similar al leiomioma. De las tres variantes histológicas que se describen en el cérvix, la que se observa con mayor frecuencia es la de tipo endocervical. Presentamos el caso de una mujer de 34años con una tumoración en segmento uterino inferior que creció durante la gestación reemplazando todo el cérvix hasta ocluir el canal endocervical. La ecografía y la tomografía mostraron un tumor mixto que lateralizaba el útero y la vejiga. En la especuloscopia se observó que la tumoración protruía hacia el canal vaginal. La evaluación histopatológica permitió establecer el diagnóstico de un adenomioma de tipo endometrioide localizado en el cérvix.

COCKTAIL NOIRFrom Gangsters and Gin Joints to Gumshoes and GimletsBy Scott M. Deitche256 pp. Reservoir Square, paper, $24. You can take the writer out of the barroom, but you can't [...]

Ventilator associated pneumonia (VAP) occurring in the intensive care unit (ICU) are common, costly, and potentially lethal.

We evaluated the outcome of 71 children with de novo acute myeloid leukemia enrolled in 2 consecutive protocols in the main pediatric hospital in Uruguay. In the LAM97 protocol (n=34), patients received, as consolidation, autologous or allogeneic hematopoietic stem cell transplantation (HSCT), depending on the availability or not of a matched sibling donor. In the LAM08 protocol (n=37), patients were stratified into risk groups, autologous HSCT was abandoned, and allogeneic HSCT was limited to intermediate-risk patients with matched sibling donor and to all patients who fulfilled the high-risk criteria. Complete remission was achieved in 91% and 92% of patients in LAM97 and LAM08, respectively. Deaths in complete remission were 9.6% and 17.6%, respectively. The incidence of relapse was significantly higher in LAM97, 35.4%, versus 12.5% in LAM08. The 5-year event-free survival and overall survival were 50.0% and 55.9% in LAM97 and 59.9% and 64.8% in LAM08. The 5-year overall survival rates in each of the risk groups were 85.7% and 100% for low risk, 50.0% and 61.2% for intermediate risk, and 42.9% and 50.0% for high risk in LAM97 and LAM08 protocols, respectively. Survival has improved over the last 2 decades, and results are comparable to those published in Europe and North America.

High-temperature polymers are attractive for applications in extreme temperatures, where they maintain their mechanical flexibility and electrical insulating properties. However, their heat dissipation capability is limited due to their intrinsically low thermal conductivities. Hexagonal boron nitride (hBN) is a chemically inert, thermally stable, and electrically insulative compound with a high thermal conductivity, making it an ideal candidate as a filler within a high-temperature polymer matrix to increase the thermal conductivity. This study evaluates the effect of filler size and dispersion on thermal conductivity by producing homogeneous composite samples using a combination of solvent mixing and resonant acoustic mixing (RAM). We carefully characterized our samples, including the spread of the size distribution, and observed that the smaller sized hBN centered around 5 μm was able to integrate more seamlessly into the polytetrafluoroethylene (PTFE) matrix with particle size in the 15 μm range and hence outperformed 30 μm, in contrast to the conventional wisdom, which asserts that larger fillers universally perform better than smaller ones. Our thermal conductivity of hBN/PTFE composites at 30 wt % is 2× higher than the literature values. Notably, we reached the record-high value of 3.5 W/m K at 40 wt % with an onset of percolation at 20 wt %, attributed to optimized hBN dispersion that facilitates the formation of thermal percolation. Our findings provide general guidelines to enhance the thermal conductivity of polymer composites for thermal management, ranging from power transmission to microelectronics cooling.

OBJECTIVETo analyze the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and the INICC Surveillance Online System (ISOS) on central line-associated bloodstream infection (CLABSI) rates in 14 intensive care units (ICUs) in Argentina from January 2014 to April 2017.DESIGNThis prospective, pre–post surveillance study of 3,940 ICU patients was conducted in 11 hospitals in 5 cities in Argentina. During our baseline evaluation, we performed outcome and process surveillance of CLABSI applying Centers for Disease Control and Prevention/National Health Safety Network (CDC/NHSN) definitions. During the intervention, we implemented the IMA through ISOS: (1) a bundle of infection prevention practice interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback on CLABSI rates and consequences, and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention on the CLABSI rate.RESULTSDuring the baseline period, 5,118 CL days and 49 CLABSIs were recorded, for a rate of 9.6 CLABSIs per 1,000 central-line (CL) days. During the intervention, 15,659 CL days and 68 CLABSIs were recorded, for a rate of 4.1 CLABSIs per 1,000 CL days. The CLABSI rate was reduced by 57% (incidence density rate: 0.43; 95% confidence interval, 0.34–0.6; P<.001).CONCLUSIONSImplementing IMA through ISOS was associated with a significant reduction in the CLABSI rate in ICUs in Argentina.Infect Control Hosp Epidemiol2018;39:445–451

There is considerable controversy surrounding whether or not children with Immune Thrombocytopenic Purpura (ITP) should be treated if they present without bleeding. One of the potential benefits of treatment would be to improve the child's health-related quality of life (HRQoL).Variables including age, sex, type of ITP(acute versus chronic), treatment (observation, IVIG, Anti-D, and prednisone), platelet count and country of origin were analysed by multiple regression to determine their relationship to HRQoL as measured by the Kid's ITP Tools (KIT) child self-report version.77 children from Uruguay (n=15), France (n=25), Germany (n=13) and the UK (n=24) self-completed the KIT. Mean platelet counts were: 6 for acute ITP patients (mean age 8.6 yrs) and 30 for chronic patients (mean age of 10.8 years). KIT scores by type of ITP and country are shown in the Figure. Multiple regression found that only the type of ITP (p=0.04) and the country of origin (p=0.029) were significantly associated with the KIT scores. Age, sex, platelet count and treatment were not correlated with KIT scores (p>0.16).The method of treatment did not have a significant impact on child-reported HRQoL. However, differences in HRQoL scores were found between acute and chronic groups and by country of origin.Klaassen: Cangene : Research Funding. Blanchette:Cangene: Research Funding. Young:Cangene: Research Funding.

Here, we report for the first time results on well-characterized c-axis quasi-homoepitaxial multilayers made of NdBa2Cu3O7-?(NBCO) and PrBa2Cu3O7-?(PBCO) films with very smooth surface morphology and high crystallinity, that were grown on SrTiO3substrates by pulsed laser deposition (PLD). The X-ray diffraction, transmission electron microscopy (TEM) and Rutherford backscattering spectrometry (RBS) analysis provide evidence of long-range crystalline perfection, and a well equilibrated and relaxed crystal. Our results show the importance of using barrier layer materials of PBCO sandwiched between NBCO electrodes for the fabrication of electronic devices.

The article focuses on a study of LAMA2-related dystrophies (LAMA2-RDs) in children aged 5 years and younger. Topics include the classification of LAMA2-RD into complete or partial deficiency of laminin-211, the early natural history and phenotypic classification of affected patients, and common clinical issues such as respiratory insufficiency and feeding difficulties.

2021 JAN 16 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Investigators publish new report on Periodontal Diseases and Conditions - Periodontitis. According [...]

Exigent circumstances can extinguish or suspend a wide range of legal obligations. They may empower governments to seize property or quarantine individuals. They may excuse the nonperformance of private or [...]

D. Dispute Subject Matter As to the subject matter of disputes, investment treaty arbitration has historically been used primarily in cases involving the extractive industries. These types of projects are [...]