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Reporting on the International Nosocomial Infection Control Consortium study results from 2015 to 2020, conducted in 630 intensive care units across 123 cities in 45 countries spanning Africa, Asia, Eastern Europe, Latin America, and the Middle East. Prospective intensive care unit patient data collected via International Nosocomial Infection Control Consortium Surveillance Online System. Centers for Disease Control and Prevention/National Health Care Safety Network definitions applied for device-associated health care–associated infections (DA-HAI). We gathered data from 204,770 patients, 1,480,620 patient days, 936,976 central line (CL)-days, 637,850 mechanical ventilators (MV)-days, and 1,005,589 urinary catheter (UC)-days. Our results showed 4,270 CL-associated bloodstream infections, 7,635 ventilator-associated pneumonia, and 3,005 UC-associated urinary tract infections. The combined rates of DA-HAIs were 7.28%, and 10.07 DA-HAIs per 1,000 patient days. CL-associated bloodstream infections occurred at 4.55 per 1,000 CL-days, ventilator-associated pneumonias at 11.96 per 1,000 MV-days, and UC-associated urinary tract infections at 2.91 per 1,000 UC days. In terms of resistance, Pseudomonas aeruginosa showed 50.73% resistance to imipenem, 44.99% to ceftazidime, 37.95% to ciprofloxacin, and 34.05% to amikacin. Meanwhile, Klebsiella spp had resistance rates of 48.29% to imipenem, 72.03% to ceftazidime, 61.78% to ciprofloxacin, and 40.32% to amikacin. Coagulase-negative Staphylococci and Staphylococcus aureus displayed oxacillin resistance in 81.33% and 53.83% of cases, respectively. The high rates of DA-HAI and bacterial resistance emphasize the ongoing need for continued efforts to control them. • The objective of this study is to identify rates of HAIs in limited resources countries. • Prospective cohort study over 6 years collected data 204,770 patients from 45 Countries. • The combined rates of HAIs were 7.28%, and 10.07 DA-HAIs per 1000 patient-days. • CLABSI rate 4.55/1,000 CL-days, VAP 1.96/1,000 MV-days, CAUTI 2.91/1,000 UC-days. • P aeruginosa showed 50.73% resistance to imipenem, and 44.99% to ceftazidime. [ABSTRACT FROM AUTHOR]

Central line (CL)-associated bloodstream infections (CLABSIs) occurring in the intensive care unit (ICU) are common and associated with a high burden. We implemented a multidimensional approach, incorporating an 11-element bundle, education, surveillance of CLABSI rates and clinical outcomes, monitoring compliance with bundle components, feedback of CLABSI rates and clinical outcomes, and performance feedback in 316 ICUs across 30 low- and middle-income countries. Our dependent variables were CLABSI per 1,000-CL-days and in-ICU all-cause mortality rates. These variables were measured at baseline and during the intervention, specifically during the second month, third month, 4 to 16 months, and 17 to 29 months. Comparisons were conducted using a two-sample t test. To explore the exposure-outcome relationship, we used a generalized linear mixed model with a Poisson distribution to model the number of CLABSIs. During 1,837,750 patient-days, 283,087 patients, used 1,218,882 CL-days. CLABSI per 1,000 CL-days rates decreased from 15.34 at the baseline period to 7.97 in the 2nd month (relative risk (RR) = 0.52; 95% confidence interval [CI] = 0.48-0.56; P <.001), 5.34 in the 3rd month (RR = 0.35; 95% CI = 0.32-0.38; P <.001), and 2.23 in the 17 to 29 months (RR = 0.15; 95% CI = 0.13-0.17; P <.001). In-ICU all-cause mortality rate decreased from 16.17% at baseline to 13.68% (RR = 0.84; P =.0013) at 17 to 29 months. The implemented approach was effective, and a similar intervention could be applied in other ICUs of low- and middle-income countries to reduce CLABSI and in-ICU all-cause mortality rates. • The objective of this study is to implement a strategy to reduce CLABSI rates. • An intervention was conducted in 316 ICUs in 30 countries. • During 1,837,750 patient-days, 283,087 patients, used 1,218,882 CL-days. • CLABSI per 1,000 CL-days rates decreased from 15.34 at baseline to 2.23 in the 17-29 months. • In-ICU all-cause mortality rate decreased from 16.17% at baseline to 13.68% at 17-29 months. [ABSTRACT FROM AUTHOR]

Developing methods to record Alternating Hemiplegia of Childhood (AHC) spells is essential for clinical trials and patient care. Test the following hypotheses: 1) Video-library training improves participants' ability to correctly identify AHC spells. 2) A custom-designed event-calendar with weekly reviews results in consistent documentation of such events over time. 3) Use of an electronic diary (e-Diary) to register events is a useful tool. 1) A video-library of AHC type spells was developed along with specific training; the effect of the training was tested in 36 caregivers. 2) An event-calendar was similarly developed and provided to 5 caregivers with weekly videoconference meetings for 8 weeks. 3) An e-Diary was developed and offered to 33 patients; time of usage and caregivers' feedback (telephone interview) were analyzed. 1) Video-library training: Wilcoxon test showed improvement in caregiver identification of spells (p = 0.047), Cohen's Kappa demonstrated high degree of agreement between caregivers'-experts' classifications (>0.9). 2) Event-calendar: 96.42% of entries had complete information; this did not change during follow up (p = 0.804). 3) e-Diary: whereas 52% of respondents used the e-Diary when offered (duration: 10.5 ± 8.1 months), 96.3% indicated they would use it in future studies. Those who used it for 13 months, were very likely to use it during the rest of that year. Video-library training improved spell identification. Calendar with weekly reviews resulted in a sustained and consistent record keeping. Caregivers' e-Diary feedback was encouraging with long-term usage in many. These approaches could be helpful for AHC and, potentially, in similar disorders. [Display omitted] • To record Alternating Hemiplegia of Childhood related spells, we developed: • Video-library with caregiver training procedure that improved spell identification. • Event-Calendar that resulted in sustained and consistent record keeping. • e-Diary that half of the respondents used. • Such approaches could be helpful for AHC care and research and for similar disorders. [ABSTRACT FROM AUTHOR]

The sternal lift by Vacuum Bell (VB) is effective, as largely demonstrated by its intraoperative use during surgical procedure to elevate the sternum during the Nuss procedure routinely. Indeed, the thoracic remodelling during VB application is comparable to post-surgical scenario, and suitable to compare cardiovascular parameters of the two different thoracic configurations immediately. We would quantify and correlate preoperative parameters which determine the severity of the pectus excavatum (PE), and the cardiovascular effects at the baseline. Than we would assess the cardiovascular changes during VB positioning, mimicking the immediate, temporary effect of Pectus-correction. We included 26 consecutive patients (mean age is 13,3 +/- 2,2 years) symptomatic and non, with a previous clinical diagnosis of PE. CMR was performed before and during application of VB, using the same imaging protocol. In both conditions, we measured thoracic indexes, and cardiac function as well as flow through main vessels. Mean expiratory Haller Index (HI) was 5,4 (+/-1,4 SD; normal <3). During VB application, all patients showed improvement in the main morphologic parameters of the thorax (mean expiratory HI = 4,7 (+/-1,6 SD, delta -13%, P = 0,01). During VB application, a minimal but not significant increase of Right Ventricle End Diastolic Volume (RVEDVi) (delta +4,6%, P = 0,12), and Right Ventricle Ejection Fraction (RVEF) (delta +1,2%, P = 0,2) was observed. In adolescents affected by PE, cardiacMRI (CMR) demonstrates normal values of biventricular volume and systolic function. During VB application, beside significative improvements in chest wall anatomy, CMR shows a minimal positive variation in right ventricle volume and function. A minority of patients showed some degree of diastolic dysfunction at baseline, unchanged after VB application, with possible correlation between valve inflow and sternal impingement. [ABSTRACT FROM AUTHOR]

Detailed analysis of hematological manifestations (HM) in systemic lupus erythematosus (SLE) are limited and their clinical impact on disease remain obscure. Here, we aimed to decipher factors associated with different hematological abnormalities in SLE patients and to assess their impact on disease related outcomes. A dataset (GIPT) originating from SLE patients of six European tertiary centers was assessed. Six-monthly visits of each patient for at least 2 years were registered. The association between hematologic manifestations (HM; per ACR-1997criteria) and clinical/serologic variables, as well as the impact of HM on disease related outcomes (damage, infection and hemorrhage) were explored. Scores on the Systemic Lupus Erythematosus Disease Activity Index 2000(SLEDAI2K), the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI) and events for any infection and hemorrhage were recorded. Results were compared with a cross-sectional, well-characterized SLE dataset from Sweden. Descriptive statistics, the generalized estimating equations (GEE), general linear models (GLM), Cox regression models were applied. We monitored 1425 longitudinal visits in 286 SLE patients with HM (GIPT dataset: 88% female, 95% Caucasian, 68% dsDNA positive). Thrombocytopenia (regression coefficient [95% confidence interval] 1.86[1.1–3.13]) and neurologic involvement (ACR-8) (2.1[1.10–3.89]) were associated with lymphopenia (<1000/mm3); the latter was an independent predictor of organ damage accrual (1.68[1.2–2.62]). These associations were confirmed in an independent dataset of 1348 SLE patients (86% female, 93% Caucasian, 61% dsDNA positive) in Sweden.Severe lymphopenia (<500/mm3) and severe thrombocytopenia (<20 K/mm3) were associated with increased risk for infection (hazard ratio [95% confidence interval] 2.56[1.23–5.31]) and hemorrhage (4.38[2.10–11.1]), respectively, independent of the effect of other predictors. : Lymphopenia in SLE is independently associated with neurologic involvement and organ damage accrual, and thus, may be considered as a marker of severe/progressive disease. [ABSTRACT FROM AUTHOR]

Background To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach (IMA) on ventilator-associated pneumonia (VAP) rates in 11 hospitals within 5 cities of Argentina from January 2014-April 2017. Methods A multicenter, prospective, before–after surveillance study was conducted through the use of International Nosocomial Infection Control Consortium Surveillance Online System. During baseline, we performed outcome surveillance of VAP applying the definitions of the Centers for Disease Control andPrevention's National Healthcare Safety Network. During intervention, we implemented the IMA, which included a bundle of infection prevention practice interventions, education, outcome surveillance, process surveillance, feedback on VAP rates and consequences, and performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention. Results We recorded 3,940 patients admitted to 14 intensive care units. At baseline, there were 19.9 VAPs per 1,000 mechanical ventilator (MV)-days—with 2,920 MV-days and 58 VAPs, which was reduced during intervention to 9.4 VAPs per 1,000 MV-days—with 9,261 MV-days and 103 VAPs. This accounted for a 52% rate reduction (incidence density rate, 0.48; 95% confidence interval, 0.3-0.7; P .001). Conclusions Implementing the IMA was associated with significant reductions in VAP rates in intensive care units within Argentina. [ABSTRACT FROM AUTHOR]

Porous scaffolds based on alginate-polymethacrylate hybrid hydrogels intended for bone and cartilage regeneration were prepared through controlled calcium ions diffusion from an agar mould. The double interconnected network of such materials combines into a single porous structure maintained by both noncovalent crosslinks (calcium ions for alginate) and covalent crosslinks (polymethacrylate crosslinked by the addition of mixtures of mono and bifunctional monomers). The alginate component ensures the appropriate micro-environment to mimic the extra-cellular matrix, whereas the polymethacrylate improves the mechanical performances of the hybrid hydrogels, helping to overcome the mechanical limitations of the alginate component. Morphological characterization and porosity analysis of the hybrid scaffolds were assessed by scanning electron microscopy and micro-computed tomography. Relative concentration and distribution of calcium ions were evaluated by atomic absorption and dispersive X-ray analysis, respectively. Uniaxial compressive mechanical tests were conducted to evaluate the compressive elastic modulus of the hybrid hydrogels that was correlated with their swelling ratio and crosslinking degree. As was envisaged a much higher modulus (about seven times) was obtained for the hybrid Alg/HE hydrogel than with alginate alone. [ABSTRACT FROM AUTHOR]

Mutations in the ATP1A3 gene, which encodes the alpha 3 -subunit of sodium-potassium ATPase, are related to a spectrum of neurological diseases including Rapid onset Dystonia-Parkinsonism (RDP), Alternating Hemiplegia of Childhood (AHC) and Cerebellar ataxia, Areflexia, Pes cavus, Optic atrophy and Sensorineural hearing loss (CAPOS) syndrome. Moreover, an increasing number of patients with intermediate and non classical phenotypes have been reported. Herein we describe 7 patients with 6 different de novo ATP1A3 mutations, and we focus on paroxysmal and chronic movement disorders with the help of video documentation. Our cases confirm that ATP1A3 -related neurological disorders make up a phenotypic continuum rather than overlapping syndromes, in which early onset dystonia, ataxia and paroxysmal episodes with triggering or worsening factors are key diagnostic clues. Moreover, our experience suggests that ATP1A3 gene analysis should be extended both to children with channelopathy-like spells and to patients with early onset, fever-related encephalopathy. [ABSTRACT FROM AUTHOR]

Bioglass 45S5 has been successfully implemented in clinical applications, because of its capability of developing a strong bond with the bone tissue. However, its low mechanical strength does not allow applying it in places that support load. In addition to the high reactivity, an important requirement for its application is that the material must have a high porosity with pore sizes greater than 100 microns, one of the key features tissue engineering materials. In a previous work, glass compositions derived from Bioglass 45S5 were designed by means of natural minerals such as feldspar and quartz. Besides, leucite was developed as a reinforcing phase after thermal treatment, getting good bioactivity results. The objective of this study is to evaluate the possibility of producing porous scaffolds from such glasses. The foam replication technique is used to manufacture the scaffolds. Thermal evolutions of glasses are studied, so as to choose the best heat treatment schedule for the production of porous scaffolds. Textural characteristics are evaluated. [ABSTRACT FROM AUTHOR]

The dyes commonly used in the textile industry have structural resonant valence distribution, within a complex molecule, which determines the color of the dyes. The coloring is produced by chromospheres holding radiation in UV-visible range. Besides coloring, these compounds can be found in waste water and cause serious problems in living organisms, because their biodegradation products may be a source of toxic substances such as amines, which are generated from the characteristic azo chromospheres groups in most of the dyes. Current treatments for color removal from hazardous waste from these materials are complex and costly, for this reason some industries do not treat the wastes generated during the staining step. The aim of this study is to evaluate the use of nanoclay as adsorbents for dye used in the textile industry. The dyes used in this work are commercially known as: Orange GR, Black GN an African Brown. Nanoclay was obtained by bentonite treated with organic cation. The retention of the dye was evaluated by measurements in the UV-visible spectrum by using a HP-8354 equipment. [ABSTRACT FROM AUTHOR]

Abstract: The clay minerals, lamellar solids of aluminum silicate hydrate of layer structure, present physical and chemical properties that are attractive for applications in different industries. These materials represent a promising option to achieve retention of certain contaminants present in the aqueous solution, due to their natural ability for adsorption. Heavy metals such as lead, cadmium, mercury, cooper and zinc, etc., contained in effluents produced by various anthropogenic activities constitute an important phase of pollution. Adverse effects on the health of the population because of the deteriorating quality of watercourses require reversing the current situation. This study evaluates the adsorption of lead and cadmium in aqueous solution by a bentonite, a rock composed majorly by clay minerals of the smectite group. The adsorption capacity was analyzed in the natural condition of the bentonite and after thermal treatment up to 750¼C. [Copyright &y& Elsevier]

Teamwork is one of the most important trend in modern medicine. Airway team were created in many places to respond in a multidisciplinary and coordinated way to challenging clinical problems which were beyond the possibility of an individual management. In this chapter, we illustrate the historical steps leading to the development of an airway team in a pediatric referral hospital, describe the present teamwork activity defining the key points for the creation of a team and discussing different organization models; finally we delineate possible future directions for the airway teams in the globalized world. [ABSTRACT FROM AUTHOR]

Thyroid disease can significantly impact the pregnant woman and her child. Human and animal studies have firmly linked overt hypothyroidism and overt hyperthyroidism to miscarriage, preterm delivery and other adverse pregnancy outcomes. Overt hypothyroidism and overt hyperthyroidism affect 1% of all pregnancies. Treatment is widely available, and if detected early, results in decreased rates of adverse outcomes. Universal screening for thyroid disease in pregnancy can identify patients with thyroid disease requiring treatment, and ultimately decrease rates of complications. Universal screening is cost-effective compared to the currently accepted practice of targeted screening and may even be cost-saving in some healthcare systems. Targeted screening, which is recommended by most professional associations, fails to detect a large proportion of pregnant women with thyroid disease. In fact, an increasing number of providers are performing universal screening for thyroid disease in pregnancy, contrary to society guidelines. Limited evidence concerning the impact of untreated and treated subclinical disease and thyroid autoimmunity has distracted from the core rationale for universal screening – the beneficial impact of detecting and treating overt thyroid disease. Evidence supporting universal screening for overt disease stands independently from that of subclinical and autoimmune disease. The time to initiate universal screening is now. [ABSTRACT FROM AUTHOR]

Abstract: The γ-ray-induced grafting of polybutadiene oligomers onto precipitated silica was investigated in the dose range up to 200kGy by THA, FTIR, CP/MAS NMR, TEM microscopy, inverse gas chromatography (IGC), with determination of the grafting yields and the characterization of the modified silica with respect to surface energy, SiO2–oligomer interaction and morphology. The matrix EPR spectroscopy was employed for investigating the nature of the intermediate radicals in the grafting mechanism. [Copyright &y& Elsevier]

Nowadays, the investigation of smart methods promoting PVDF β phase has become an important research topic in many energy related fields. In this work, compression moulding was proposed as an effective, simple and easy-scalable technique to tune PVDF polymorphism and obtain the desired crystalline form, exploiting a procedure in two steps. After a preliminary principal component analysis of the infrared spectra, the different moulding conditions tested were correlated with the electroactive phase amount, obtaining a non-monotonous trend. Finally, dielectric and dynamic-mechanical measurements were carried out on selected samples. Experimental evidence indicates that the double-step moulding induces the β phase formation due to the orienting effect generated by the shear stresses in the not completely molten polymer. Moreover, this method determines an increase in permittivity, a reduction of the dielectric losses and a change of PVDF molecular relaxations with respect to the reference film moulded through a simple single-step moulding. Image 1 • A double-step (DS) moulding is proposed to promote β phase formation in PVDF. • PCA validates the quantitative evaluation of β phase achieved by ATR-FTIR. • The obtained β phase amount is correlated with moulding conditions through MLR. • The DS moulding allows to tune the PVDF polymorphism. • The DS moulding affects also molecular relaxations and enhances dielectric response. [ABSTRACT FROM AUTHOR]