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Using new and published photometric observations of (HR 6247), spanning 70 years, a period of 1.446 2700(5) days was determined. It was found that the epoch of primary minimum suggested by Shobbrook at HJD 244 9534.178 requires an adjustment to HJD 244 9534.177 00(9) to align all the available photometric data sets. Using the resulting combined data light curve, radial velocities derived from International Ultraviolet Explorer data and the modelling softwarephoebe, a new system solution for this binary was obtained. It appears that the secondary is close to, or just filling, its Roche lobe. [ABSTRACT FROM AUTHOR]

Background: Since 2007, New York State (NYS) hospitals have been required to report surgical site infections (SSIs) following colon procedures to the NYS Department of Health, using the National Healthcare Safety Network (NHSN). The purpose of this study was to identify risk factors for the development of SSIs in patients undergoing colon procedures., Methods: NYS has been conducting validation studies at hospitals to assess the accuracy of the surveillance data reported by the participating hospitals. A sample of patients undergoing colon procedures in NYS hospitals were included in hospital-acquired infection program validation studies in 2009 and 2010. Medical chart reviews and on-site visits were performed to verify patient information reported and to evaluate additional risk factors for SSI. Bivariable and multivariable logistic regressions were performed., Results: A total of 2,656 colon procedures were included in this analysis, including 698 SSI cases. Multivariable analysis indicated that SSI following colon procedure was associated with body mass index greater than 30 (odds ratio [OR], 1.48 [95% confidence interval (CI), 1.21-1.80]), male sex (OR, 1.34 [95% CI, 1.10-1.64]), American Society of Anesthesiologists physical classification score greater than 3 (OR, 1.33 [95% CI, 1.08-1.64]), procedure duration, transfusion (OR, 1.32 [95% CI, 1.05-1.66]), left-side colon surgical procedures, other gastroenterologic procedures, irrigation, hospital bed size greater than 500, and medical school affiliation., Conclusions: Male sex, obesity, transfusion, type of procedure, and prolonged duration were significant factors associated with overall infection risk after adjusting other factors. Additional factors not collected in the NHSN slightly improved prediction of SSIs.

Background: In 2007, New York State (NYS) hospitals began mandatory public reporting of central line-associated bloodstream infection (CLABSI) data associated with intensive care units (ICUs) into the National Healthcare Safety Network (NHSN). Facilities were required to use the NHSN device-associated CLABSI criteria to identify laboratory-confirmed bloodstream infections., Methods: Onsite audits were conducted in ICUs by NYS hospital-acquired infection program staff using a standardized database. Hospitals provided ICU patient medical records with a positive blood culture during a selected time frame., Results: Between 2007 and 2010, an average of 79% of all reporting hospitals were audited annually. Of the 5,697 patients audited, 3,104 (54%) had a central line in place, and 650 of the patients with a central line (21%) were identified as having a CLABSI by the hospital-acquired infection program reviewer. Between 2007 and 2010, the specificity increased from 90% to 99%, whereas the sensitivity remained stable at approximately 71%. As a result of the audit process, the NYS 2010 CLABSI rate increased by 5.6%., Conclusions: A standardized audit process has helped improve the accuracy of CLABSI reporting. Data validation provides consistent data for measuring the progress of infection prevention strategies and allows for relevant comparison of ICU data., (Published by Mosby, Inc.)

New York State Public Health Law §2819, requiring the mandatory public reporting of health care-associated infections, was enacted in July 2005. This article describes key provisions in the legislation, New York State health care-associated infection program development, the rationale for selection of the National Healthcare Safety Network for reporting, and lessons learned.

Objective: To determine whether the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN) laboratory-identified (LabID) event reporting module for Clostridium difficile infection (CDI) is an adequate proxy measure of clinical CDI for public reporting purposes by comparing the 2 surveillance methods., Design: Validation study., Setting: Thirty New York State acute care hospitals., Methods: Six months of data were collected by 30 facilities using a clinical infection surveillance definition while also submitting the NHSN LabID event for CDI. The data sets were matched and compared to determine whether the assigned clinical case status matched the LabID case status. A subset of mismatches was evaluated further, and reasons for the mismatches were quantified. Infection rates determined using the 2 definitions were compared., Results: A total of 3,301 CDI cases were reported. Analysis of the original data yielded a 67.3% (2,223/3,301) overall case status match. After review and validation, there was 81.3% (2,683/3,301) agreement. The most common reason for disagreement (54.9%) occurred because the symptom onset was less than 48 hours after admission but the positive specimen was collected on hospital day 4 or later. The NHSN LabID hospital onset rate was 29% higher than the corresponding clinical rate and was generally consistent across all hospitals., Conclusions: Use of the NHSN LabID event minimizes the burden of surveillance and standardizes the process. With a greater than 80% match between the NHSN LabID event data and the clinical infection surveillance data, the New York State Department of Health made the decision to use the NHSN LabID event CDI data for public reporting purposes.

Objective: To efficiently validate the accuracy of surgical site infection (SSI) data reported to the National Healthcare Safety Network (NHSN) by New York State (NYS) hospitals., Design: Validation study., Setting: 176 NYS hospitals., Methods: NYS Department of Health staff validated the data reported to NHSN by review of a stratified sample of medical records from each hospital. The four strata were (1) SSIs reported to NHSN; (2) records with an indication of infection from diagnosis codes in administrative data but not reported to NHSN as SSIs; (3) records with discordant procedure codes in NHSN and state data sets; (4) records not in the other three strata., Results: A total of 7,059 surgical charts (6% of the procedures reported by hospitals) were reviewed. In stratum 1, 7% of reported SSIs did not meet the criteria for inclusion in NHSN and were subsequently removed. In stratum 2, 24% of records indicated missed SSIs not reported to NHSN, whereas in strata 3 and 4, only 1% of records indicated missed SSIs; these SSIs were subsequently added to NHSN. Also, in stratum 3, 75% of records were not coded for the correct NHSN procedure. Errors were highest for colon data; the NYS colon SSI rate increased by 7.5% as a result of hospital audits., Conclusions: Audits are vital for ensuring the accuracy of hospital-acquired infection (HAI) data so that hospital HAI rates can be fairly compared. Use of administrative data increased the efficiency of identifying problems in hospitals' SSI surveillance that caused SSIs to be unreported and caused errors in denominator data.

Background: All hospitals in New York State (NYS) are required to report surgical site infections (SSIs) occurring after coronary artery bypass graft surgery. This report describes the risk adjustment method used by NYS for reporting hospital SSI rates, and additional methods used to explore remaining differences in infection rates., Methods: All patients undergoing coronary artery bypass graft surgery in NYS in 2008 were monitored for chest SSI following the National Healthcare Safety Network protocol. The NYS Cardiac Surgery Reporting System and a survey of hospital infection prevention practices provided additional risk information. Models were developed to standardize hospital-specific infection rates and to assess additional risk factors and practices., Results: The National Healthcare Safety Network risk score based on duration of surgery, American Society of Anesthesiologists score, and wound class were not highly predictive of chest SSIs. The addition of diabetes, obesity, end-stage renal disease, sex, chronic obstructive pulmonary disease, and Medicaid payer to the model improved the discrimination between procedures that resulted in SSI and those that did not by 25%. Hospital-reported infection prevention practices were not significantly related to SSI rates., Conclusions: Additional risk factors collected using a secondary database improved the prediction of SSIs, however, there remained unexplained variation in rates between hospitals., (Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.)

Meaningful comparison of patient outcomes requires an assessment of the severity of illness for the patients being compared. The more severe the underlying illness, the worse the expected outcome. We studied several severity of illness indicators derived from different methodologies in a medical intensive care unit. We compared the Acute Physiologic and Chronic Health Evaluation II, the accepted benchmark indicator for intensive care units, with one complex indicator, Computerized Severity Score, and three simpler indicators, Comorbidity, McCabe-Jackson, and American Society of Anesthesiologists. We found that all correlated well with a comorbidity index. We conclude that the Acute Physiologic and Chronic Health Evaluation II, the Computerized Severity Score, and the McCabe-Jackson scoring systems appear to be comparable predictors of comorbidity in a medical intensive care unit. Selection of a severity indicator will depend on the resources available and the intended uses.

A 12-year-old girl developed a reversible myeloradiculopathy 1 week after a wasp sting. Delayed neurologic hypersensitivity reactions to Hymenopteran stings occur primarily in adults. Reactions involving both the peripheral and central nervous systems are extremely rare and have never been reported in a child. The mechanisms underlying this uncommon reaction may be related to age-dependent differences in immunologic responses.

In a routine donor center, a program of hollow-fiber filtration can be instituted. With the Organon Teknika PLASMAPUR system the collection of 600 ml plasma was completed within 50 min in 76% of the procedures. Changing the tubing set took 12-15 min. From the plasma a frozen cryoprecipitate is made with a recovery of 59%. After pooling, lyophilization and heat treatment, the recovery is 42%.

Infection control programs are primarily oriented toward chronicling the incidence of nosocomial infections (NI). Intervention programs oriented toward preventing infection would be facilitated by identifying patients at greatest risk of NI acquisition. We studied the number of comorbidities as a risk predictor for NIs in patients admitted to the medical intensive care unit (ICU) for three or more days. In 148 patients, we found by regression analysis that the number of comorbidities varied directly with the development of nosocomial infections, as well as with the appearance of new complications and length of ICU stay. Diagnosis-related groups did not adequately account for the variance in comorbidities observed.

With the goal of achieving economy in infection control surveillance we tested the relative efficiency of the various surveillance sources for detecting nosocomial infections (NIs). We reviewed the initial and final surveillance sources of 415 NIs at Hackensack Hospital during an 11-month period; cultures were taken on most of the patients with NIs. Positive microbiology cultures were the initial sources in 64.8% of NIs and secondary sources in 23.6%. Chart review of patients with positive cultures added another 2.9%. Therefore, 91.3% of NIs could have been detected by positive culture reports. The remainder were discoverable by notification from nurses, or by studying admission cards or temperature rounds. Although the NIs missed by lack of a positive culture report often were significant infections, these alternate methods of surveillance did not help to detect any clusters of infections that could be traced to a particular source among the staff or the environment.

To assess the importance of nosocomial infections as a contributory cause of death in patients who die in the hospital, we studied the hospital course of 100 consecutive patients who died at Columbia-Presbyterian Medical Center and 100 consecutive patients who died at Hackensack Hospital. The epidemiologic patterns of infection were similar although the institutions provide care for different types of patients. There were 88 nosocomial infections in 63 patients. When the nosocomial infection was causally related or contributed to death, infection of the lower respiratory tract was predominant in 31 of 52 (60 per cent) instances. When the nosocomial infection was unrelated to death, urinary tract infection was predominant in 13 of 36 (36 per cent) infections. Among those who died with nosocomial infection, 42 of 63 (67 per cent) patients were terminal on admission and were typically in their 60's with metastatic carcinoma. The 21 patients who were not terminal on admission were typically in their late 70's and had complications of arteriosclerotic cardiovascular disease. Pneumonia was the most frequent nosocomial infection related to death. There is need to devise a pneumonia prevention program that identifies those at high risk and reduces the chance of aspiration of pharyngeal secretions and spread of virulent bacteria from person to person.

Many health care providers order an unnecessary number of blood cultures. We studied the ordering habits in our medical intensive care unit and recommended a protocol for appropriate ordering. Implementation of the protocol resulted in a significant reduction in the number of episodes of suspected sepsis, from 39% of patient discharges during the baseline period to 16% during the study period (p = 0.008). The mean number of blood cultures decreased significantly from 1.2 per patient discharge to 0.3 (p = 0.003). The number of episodes when more than four blood cultures were ordered decreased from 7 to 0, resulting in an annual cost savings estimated at $8025. The net benefit was reversed, however, when the protocol ceased to be actively implemented. We concluded that the appropriate ordering of blood cultures can be effected by establishing a protocol that is actively and continuously implemented.

Nemaline myopathy is not usually considered to involve cardiac muscle and rarely is associated with nocturnal hypoventilation. We report a boy, 5 1/2 years of age, with nemaline myopathy who presented with respiratory failure. Echocardiography demonstrated the septum to left ventricular posterior wall ratio to be increased which is consistent with a hypertrophic cardiomyopathy. Because of nocturnal hypoventilation, tracheostomy was placed for ventilatory assistance. A process involving both muscle and nervous tissue may underlie this congenital myopathy; routine cardiac and pulmonary function evaluations may be indicated in these patients.

In an earlier study, nosocomial infections were reported to occur in one third of patients who died in the hospital. Lower respiratory tract infections appeared to be causally related to death, whereas urinary tract infections were not. A case-control study was therefore conducted to begin to explore epidemiologically these causal suppositions. By definition, all 100 patients in the case group died in the hospital and all 100 patients in the control group survived hospitalization. A patient in the control group was matched to a patient in the case group for age, sex, service, primary discharge diagnosis, and severity of primary diagnosis. Secondary discharge diagnoses were comparable in both groups. Nosocomial infections were present in 33 percent of patients in the case group and 13 percent of patients in the control group (p less than 0.001). Lower respiratory tract nosocomial infections occurred in 18 percent of patients in the case group and 4 percent of patients in the control group (p less than 0.005). Urinary tract nosocomial infections occurred in 6 percent of patients in the case group and 8 percent of patients in the control group (p = NS). Presence of a terminal prognosis on admission was found more often in case group patients than in control group patients (76 percent versus 11 percent, p less than 0.001). Nosocomial infections appeared to favor a fatal outcome only in those whose condition was not terminal on admission (p less than 0.05). In those whose condition was terminal on admission, the incidence of infection was equal in those who survived and in those who died. In conclusion, in these two groups well matched by many criteria, differences in prognosis on admission probably accounted for the major differences in survival. Nosocomial infections may affect outcome in those whose condition is not terminal on admission.