Calibrating Nonlinear Soil Material Properties for Seismic Analysis Using Soil Material Properties Intended for Linear Analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Spears, Robert Edward; Coleman, Justin Leigh

2015-08-01

Seismic analysis of nuclear structures is routinely performed using guidance provided in “Seismic Analysis of Safety-Related Nuclear Structures and Commentary (ASCE 4, 1998).” This document, which is currently under revision, provides detailed guidance on linear seismic soil-structure-interaction (SSI) analysis of nuclear structures. To accommodate the linear analysis, soil material properties are typically developed as shear modulus and damping ratio versus cyclic shear strain amplitude. A new Appendix in ASCE 4-2014 (draft) is being added to provide guidance for nonlinear time domain SSI analysis. To accommodate the nonlinear analysis, a more appropriate form of the soil material properties includes shear stressmore » and energy absorbed per cycle versus shear strain. Ideally, nonlinear soil model material properties would be established with soil testing appropriate for the nonlinear constitutive model being used. However, much of the soil testing done for SSI analysis is performed for use with linear analysis techniques. Consequently, a method is described in this paper that uses soil test data intended for linear analysis to develop nonlinear soil material properties. To produce nonlinear material properties that are equivalent to the linear material properties, the linear and nonlinear model hysteresis loops are considered. For equivalent material properties, the shear stress at peak shear strain and energy absorbed per cycle should match when comparing the linear and nonlinear model hysteresis loops. Consequently, nonlinear material properties are selected based on these criteria.« less

Seabed-Structure Interaction: Workshop Report and Recommendations for Future Research Held in Metairie, Louisiana on 5-6 November 1991.

DTIC Science & Technology

1992-02-01

14 Measurements of Sediment Properties and Data Analysis ............................................. 15 object...Object Sensing Methods (Detect/Classification) and (B) Sediment Properties Measurements and Data Analysis . Although important to the understanding of S...characterized by a variety of geological materials, seabed properties, and hydrodynamic processes, the problems of I modeling, analysis , and prediction of S-SI

Intrawound Vancomycin Decreases the Risk of Surgical Site Infection After Posterior Spine Surgery: A Multicenter Analysis.

PubMed

Devin, Clinton J; Chotai, Silky; McGirt, Matthew J; Vaccaro, Alexander R; Youssef, Jim A; Orndorff, Douglas G; Arnold, Paul M; Frempong-Boadu, Anthony K; Lieberman, Isador H; Branch, Charles; Hedayat, Hirad S; Liu, Ann; Wang, Jeffrey C; Isaacs, Robert E; Radcliff, Kris E; Patt, Joshua C; Archer, Kristin R

2018-01-01

Secondary analysis of data from a prospective multicenter observational study. The aim of this study was to evaluate the occurrence of surgical site infection (SSI) in patients with and without intrawound vancomycin application controlling for confounding factors associated with higher SSI after elective spine surgery. SSI is a morbid and expensive complication associated with spine surgery. The application of intrawound vancomycin is rapidly emerging as a solution to reduce SSI following spine surgery. The impact of intrawound vancomycin has not been systematically studied in a well-designed multicenter study. Patients undergoing elective spine surgery over a period of 4 years at seven spine surgery centers across the United States were included in the study. Patients were dichotomized on the basis of whether intrawound vancomycin was applied. Outcomes were occurrence of SSI within postoperative 30 days and SSI that required return to the operating room (OR). Multivariable random-effect log-binomial regression analyses were conducted to determine the relative risk of having an SSI and an SSI with return to OR. .: A total of 2056 patients were included in the analysis. Intrawound vancomycin was utilized in 47% (n = 966) of patients. The prevalence of SSI was higher in patients with no vancomycin use (5.1%) than those with use of intrawound vancomycin (2.2%). The risk of SSI was higher in patients in whom intrawound vancomycin was not used (relative risk (RR) -2.5, P < 0.001), increased number of levels exposed (RR -1.1, P = 0.01), and those admitted postoperatively to intensive care unit (ICU) (RR -2.1, P = 0.005). Patients in whom intrawound vancomycin was not used (RR -5.9, P < 0.001), increased number of levels were exposed (RR-1.1, P = 0.001), and postoperative ICU admission (RR -3.3, P < 0.001) were significant risk factors for SSI requiring a return to the OR. The intrawound application of vancomycin after posterior approach spine surgery was associated with a reduced risk of SSI and return to OR associated with SSI. 2.

Evaluation of New Cleanup Agents for Analysis of Pesticide Residues in Tea.

PubMed

Ueda, Yuko; Honda, Katsuhisa

2017-01-01

We evaluated the effectiveness of new cleanup agents (S-NH 2 and S-Si) compared with other previously reported cleanup agents (octadecylsilane, graphitized carbon, aminopropyl and silica gel) for removal of interfering substances such as catechin and caffeine prior to analysis of pesticide residues in tea. S-NH 2 and S-Si were highly efficient in removal of catechin and caffeine, respectively. Recoveries of 80 pesticides using S-NH 2 and S-Si were tested, and more than 70% of pesticides showed recovery greater than 70%. These results indicate that S-NH 2 and S-Si agents will be useful for analysis of pesticide residues in tea.

Turkish preservice science teachers' socioscientific issues-based teaching practices in middle school science classrooms

NASA Astrophysics Data System (ADS)

Genel, Abdulkadir; Sami Topçu, Mustafa

2016-01-01

Background: Despite a growing body of research and curriculum reforms including socioscientific issues (SSI) across the world, how preservice science teachers (PST) or in-service science teachers can teach SSI in science classrooms needs further inquiry. Purpose: The purpose of this study is to describe the abilities of PSTs to teach SSI in middle school science classrooms, and the research question that guided the present study is: How can we characterize Turkish PSTs' SSI-based teaching practices in middle school science classrooms (ages 11-14)? Sample: In order to address the research question of this study, we explored 10 Turkish PSTs' SSI-based teaching practices in middle school science classrooms. A purposeful sampling strategy was used, thus, PSTs were specifically chosen because they were ideal candidates to teach SSI and to integrate SSI into the science curricula since they were seniors in the science education program who had to take the field experience courses. Design and method: The participants' SSI teaching practices were characterized in light of qualitative research approach. SSI-based teaching practices were analyzed, and the transcripts of all videotape recordings were coded by two researchers. Results: The current data analysis describes Turkish PSTs' SSI-based teaching practices under five main categories: media, argumentation, SSI selection and presentation, risk analysis, and moral perspective. Most of PSTs did not use media resources in their lesson and none of them considered moral perspective in their teaching. While the risk analyses were very simple and superficial, the arguments developed in the classrooms generally remained at a simple level. PSTs did not think SSI as a central topic and discussed these issues in a very limited time and at the end of the class period. Conclusions: The findings of this study manifest the need of the reforms in science education programs. The present study provides evidence that moral, media, argumentation, risk analysis, and pedagogical aspects of SSI-based instruction should be incorporated into educational courses designed for the Turkish teacher education programs such as the science teaching methods course. When we find ways to improve PSTs or science teachers' SSI teaching practices in terms of these components, we can provide useful information for curriculum developers, policy-makers, and science educators in Turkey and other countries, that are facing similar problems. We believe that this study would initiate more investigative and exploratory studies toward this goal.

Pinatubo Emulation in Multiple Models (POEMs): co-ordinated experiments in the ISA-MIP model intercomparison activity component of the SPARC Stratospheric Sulphur and it's Role in Climate initiative (SSiRC)

NASA Astrophysics Data System (ADS)

Lee, Lindsay; Mann, Graham; Carslaw, Ken; Toohey, Matthew; Aquila, Valentina

2016-04-01

The World Climate Research Program's SPARC initiative has a new international activity "Stratospheric Sulphur and its Role in Climate" (SSiRC) to better understand changes in stratospheric aerosol and precursor gaseous sulphur species. One component of SSiRC involves an intercomparison "ISA-MIP" of composition-climate models that simulate the stratospheric aerosol layer interactively. Within PoEMS each modelling group will run a "perturbed physics ensemble" (PPE) of interactive stratospheric aerosol (ISA) simulations of the Pinatubo eruption, varying several uncertain parameters associated with the eruption's SO2 emissions and model processes. A powerful new technique to quantify and attribute sources of uncertainty in complex global models is described by Lee et al. (2011, ACP). The analysis uses Gaussian emulation to derive a probability density function (pdf) of predicted quantities, essentially interpolating the PPE results in multi-dimensional parameter space. Once trained on the ensemble, a Monte Carlo simulation with the fast Gaussian emulator enabling a full variance-based sensitivity analysis. The approach has already been used effectively by Carslaw et al., (2013, Nature) to quantify the uncertainty in the cloud albedo effect forcing from a 3D global aerosol-microphysics model allowing to compare the sensitivy of different predicted quantities to uncertainties in natural and anthropogenic emissions types, and structural parameters in the models. Within ISA-MIP, each group will carry out a PPE of runs, with the subsequent analysis with the emulator assessing the uncertainty in the volcanic forcings predicted by each model. In this poster presentation we will give an outline of the "PoEMS" analysis, describing the uncertain parameters to be varied and the relevance to further understanding differences identified in previous international stratospheric aerosol assessments.

Time-domain representation of frequency-dependent foundation impedance functions

USGS Publications Warehouse

Safak, E.

2006-01-01

Foundation impedance functions provide a simple means to account for soil-structure interaction (SSI) when studying seismic response of structures. Impedance functions represent the dynamic stiffness of the soil media surrounding the foundation. The fact that impedance functions are frequency dependent makes it difficult to incorporate SSI in standard time-history analysis software. This paper introduces a simple method to convert frequency-dependent impedance functions into time-domain filters. The method is based on the least-squares approximation of impedance functions by ratios of two complex polynomials. Such ratios are equivalent, in the time-domain, to discrete-time recursive filters, which are simple finite-difference equations giving the relationship between foundation forces and displacements. These filters can easily be incorporated into standard time-history analysis programs. Three examples are presented to show the applications of the method.

Neuropsychiatric subsyndromes and brain metabolic network dysfunctions in early onset Alzheimer's disease.

PubMed

Ballarini, Tommaso; Iaccarino, Leonardo; Magnani, Giuseppe; Ayakta, Nagehan; Miller, Bruce L; Jagust, William J; Gorno-Tempini, Maria Luisa; Rabinovici, Gil D; Perani, Daniela

2016-12-01

Neuropsychiatric symptoms (NPSs) often occur in early-age-of-onset Alzheimer's disease (EOAD) and cluster into sub-syndromes (SSy). The aim of this study was to investigate the association between 18 F-FDG-PET regional and connectivity-based brain metabolic dysfunctions and neuropsychiatric SSy. NPSs were assessed in 27 EOAD using the Neuropsychiatric Inventory and further clustered into four SSy (apathetic, hyperactivity, affective, and psychotic SSy). Eighty-five percent of EOAD showed at least one NPS. Voxel-wise correlations between SSy scores and brain glucose metabolism (assessed with 18 F-FDG positron emission tomography) were studied. Interregional correlation analysis was used to explore metabolic connectivity in the salience (aSN) and default mode networks (DMN) in a larger sample of EOAD (N = 51) and Healthy Controls (N = 57). The apathetic, hyperactivity, and affective SSy were highly prevalent (>60%) as compared to the psychotic SSy (33%). The hyperactivity SSy scores were associated with increase of glucose metabolism in frontal and limbic structures, implicated in behavioral control. A comparable positive correlation with part of the same network was found for the affective SSy scores. On the other hand, the apathetic SSy scores were negatively correlated with metabolism in the bilateral orbitofrontal and dorsolateral frontal cortex known to be involved in motivation and decision-making processes. Consistent with these SSy regional correlations with brain metabolic dysfunction, the connectivity analysis showed increases in the aSN and decreases in the DMN. Behavioral abnormalities in EOAD are associated with specific dysfunctional changes in brain metabolic activity, in particular in the aSN that seems to play a crucial role in NPSs in EOAD. Hum Brain Mapp 37:4234-4247, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Neuropsychiatric Subsyndromes and Brain Metabolic Network Dysfunctions in Early Onset Alzheimer’s Disease

PubMed Central

Tommaso, Ballarini; Leonardo, Iaccarino; Giuseppe, Magnani; Nagehan, Ayakta; Bruce L, Miller; William J, Jagust; Luisa, Gorno-Tempini Maria; Gil D, Rabinovici; Daniela, Perani

2017-01-01

Neuropsychiatric symptoms (NPSs) often occur in early-age-of-onset Alzheimer’s disease (EOAD) and cluster into sub-syndromes (SSy). The aim of this study was to investigate the association between 18F-FDG-PET regional and connectivity-based brain metabolic dysfunctions and neuropsychiatric SSy. NPSs were assessed in 27 EOAD using the Neuropsychiatric Inventory and further clustered into four SSy (apathetic, hyperactivity, affective and psychotic SSy). 85% of EOAD showed at least one NPS. Voxel-wise correlations between SSy scores and brain glucose metabolism (assessed with 18F-FDG positron emission tomography) were studied. Interregional correlation analysis was used to explore metabolic connectivity in the salience (aSN) and default mode networks (DMN) in a larger sample of EOAD (N=51) and Healthy Controls (N=57). The apathetic, hyperactivity and affective SSy were highly prevalent (>60%) as compared to the psychotic SSy (33%). The hyperactivity SSy scores were associated with increase of glucose metabolism in frontal and limbic structures, implicated in behavioral control. A comparable positive correlation with part of the same network was found for the affective SSy scores. On the other hand, the apathetic SSy scores were negatively correlated with metabolism in the bilateral orbitofrontal and dorsolateral frontal cortex known to be involved in motivation and decision-making processes. Consistent with these SSy regional correlations with brain metabolic dysfunction, the connectivity analysis showed increases in the aSN and decreases in the DMN. Behavioral abnormalities in EOAD are associated with specific dysfunctional changes in brain metabolic activity, in particular in the aSN that seems to play a crucial role in NPSs in EOAD. PMID:27412866

Comparison of ocean surface solar irradiance in the GLA General Circulation Model and satellite-based calculations

NASA Technical Reports Server (NTRS)

Chertock, Beth; Sud, Y. C.

1993-01-01

A global, 7-year satellite-based record of ocean surface solar irradiance (SSI) is used to assess the realism of ocean SSI simulated by the nine-layer Goddard Laboratory for Atmospheres (GLA) General Circulation Model (GCM). January and July climatologies of net SSI produced by the model are compared with corresponding satellite climatologies for the world oceans between 54 deg N and 54 deg S. This comparison of climatologies indicates areas of strengths and weaknesses in the GCM treatment of cloud-radiation interactions, the major source of model uncertainty. Realism of ocean SSI is also important for applications such as incorporating the GLA GCM into a coupled ocean-atmosphere GCM. The results show that the GLA GCM simulates too much SSI in the extratropics and too little in the tropics, especially in the summer hemisphere. These discrepancies reach magnitudes of 60 W/sq m and more. The discrepancies are particularly large in the July case off the western coast of North America. Positive and negative discrepancies in SSI are shown to be consistent with discrepancies in planetary albedo.

Association Between Smoking Status, Preoperative Exhaled Carbon Monoxide Levels, and Postoperative Surgical Site Infection in Patients Undergoing Elective Surgery

PubMed Central

Martin, David P.; Thompson, Rodney; Schroeder, Darrell R.; Hanson, Andrew C.; Warner, David O.

2017-01-01

Importance Cigarette smoking is a risk factor for many perioperative complications, including surgical site infection (SSI). The duration of abstinence from smoking required to reduce this risk is unknown. Objectives To evaluate if abstinence from smoking on the day of surgery is associated with a decreased frequency of SSI in patients who smoke cigarettes and to confirm that smoking is significantly independently associated with SSI when adjustment is made for potentially relevant covariates, such as body mass index. Design, Setting, and Participants In this observational, nested, matched case-control study, 2 analyses were performed at an academic referral center in the upper Midwest. Cases included all patients undergoing elective surgical procedures at Mayo Clinic, Rochester, Minnesota, between January 1, 2009, and July 31, 2014 (inclusive) who subsequently developed an SSI. Controls for both analyses were matched on age, sex, and type of surgery. Exposures Smoking status and preoperative exhaled carbon monoxide level, assessed by nurses in the preoperative holding area. Patients were classified as smoking on the day of surgery if they self-reported smoking or if their preoperative exhaled carbon monoxide level was 10 ppm or higher. Main Outcomes and Measures Surgical site infection after a surgical procedure at Mayo Clinic, Rochester, as identified by routine clinical surveillance using National Healthcare Safety Network criteria. Results Of the 6919 patients in the first analysis, 3282 (47%) were men and 3637 (53%) were women; median age (interquartile range) for control and SSI cases was 60 (48-70). Of the 392 patients in the second analysis, 182 (46%) were men and 210 (54%) were women; median age (interquartile range) for controls was 53 (45-49) and for SSI cases was 51 (45-60). During the study period, approximately 2% of surgical patients developed SSI annually. Available for the first analysis (evaluating the influence of current smoking status) were 2452 SSI cases matched to 4467 controls. The odds ratio for smoking and SSI was 1.51 (95% CI, 1.20-1.90; P < .001), which remained statistically significant after adjusting for covariates. In the second analysis (evaluating the influence of smoking on the day of surgery), there were 137 SSI cases matched to 255 controls. The odds ratio for smoking on the day of surgery and SSI was 1.96 (95% CI, 1.23-3.13; P < .001), which remained statistically significant after adjusting for covariates. Preoperative exhaled carbon monoxide level was not associated with the frequency of SSI, suggesting that the association between smoking on the day of surgery and SSI was not related to preoperative exhaled carbon monoxide levels. Conclusions and Relevance Current smoking is associated with the development of SSI, and smoking on the day of surgery is independently associated with the development of SSI. These data cannot distinguish whether abstinence per se reduces risk or whether it is associated with other factors that may be causative. PMID:28199450

SPARC's Stratospheric Sulfur and its Role in Climate Activity (SSiRC)

NASA Technical Reports Server (NTRS)

Thomason, Larry

2015-01-01

The stratospheric aerosol layer is a key component in the climate system. It affects the radiative balance of the atmosphere directly through interactions with solar and terrestrial radiation, and indirectly through its effect on stratospheric ozone. Because the stratospheric aerosol layer is prescribed in many climate models and Chemistry-Climate Models (CCMs), model simulations of future atmospheric conditions and climate generally do not account for the interaction between the aerosol-sulfur cycle and changes in the climate system. The present understanding of how the stratospheric aerosol layer may be affected by future climate change and how the stratospheric aerosol layer may drive climate change is, therefore, very limited. The purposes of SSiRC (Stratospheric Sulfur and its Role in Climate) include: (i) providing a coordinating structure for the various individual activities already underway in different research centers; (ii) encouraging and supporting new instrumentation and measurements of sulfur containing compounds, such as COS, DMS, and non-volcanic SO2 in the UT/LS globally; and (iii) initiating new model/data inter-comparisons. SSiRC is developing collaborations with a number of other SPARC activities including CCMI and ACAM. This presentation will highlight the scientific goals of this project and on-going activities and propose potential interactions between SSiRC and ACAM.

Surgical Site Infections Following Pediatric Ambulatory Surgery: An Epidemiologic Analysis.

PubMed

Rinke, Michael L; Jan, Dominique; Nassim, Janelle; Choi, Jaeun; Choi, Steven J

2016-08-01

OBJECTIVE To identify surgical site infection (SSI) rates following pediatric ambulatory surgery, SSI outcomes and risk factors, and sensitivity and specificity of SSI administrative billing codes. DESIGN Retrospective chart review of pediatric ambulatory surgeries with International Classification of Disease, Ninth Revision (ICD-9) codes for SSI, and a systematic random sampling of 5% of surgeries without SSI ICD-9 codes, all adjudicated for SSI on the basis of an ambulatory-adapted National Healthcare Safety Network definition. SETTING Urban pediatric tertiary care center April 1, 2009-March 31, 2014. METHODS SSI rates and sensitivity and specificity of ICD-9 codes were estimated using sampling design, and risk factors were analyzed in case-rest of cohort, and case-control, designs. RESULTS In 15,448 pediatric ambulatory surgeries, 34 patients had ICD-9 codes for SSI and 25 met the adapted National Healthcare Safety Network criteria. One additional SSI was identified with systematic random sampling. The SSI rate following pediatric ambulatory surgery was 2.9 per 1,000 surgeries (95% CI, 1.2-6.9). Otolaryngology surgeries demonstrated significantly lower SSI rates compared with endocrine (P=.001), integumentary (P=.001), male genital (P<.0001), and respiratory (P=.01) surgeries. Almost half of patients with an SSI were admitted, 88% received antibiotics, and 15% returned to the operating room. No risk factors were associated with SSI. The sensitivity of ICD-9 codes for SSI following ambulatory surgery was 55.31% (95% CI, 12.69%-91.33%) and specificity was 99.94% (99.89%-99.97%). CONCLUSIONS SSI following pediatric ambulatory surgery occurs at an appreciable rate and conveys morbidity on children. Infect Control Hosp Epidemiol 2016;37:931-938.

Impact of a surgical site infection reduction strategy after colorectal resection.

PubMed

Connolly, T M; Foppa, C; Kazi, E; Denoya, P I; Bergamaschi, R

2016-09-01

This study was performed to determine the impact of a surgical site infection (SSI) reduction strategy on SSI rates following colorectal resection. American College of Surgeons National Surgical Quality Improvement Program (NSQIP) data from 2006-14 were utilized and supplemented by institutional review board-approved chart review. The primary end-point was superficial and deep incisional SSI. The inclusion criterion was colorectal resection. The SSI reduction strategy consisted of preoperative (blood glucose, bowel preparation, shower, hair removal), intra-operative (prophylactic antibiotics, antimicrobial incisional drape, wound protector, wound closure technique) and postoperative (wound dressing technique) components. The SSI reduction strategy was prospectively implemented and compared with historical controls (pre-SSI strategy arm). Statistical analysis included Pearson's chi-square test, and Student's t-test performed with spss software. Of 1018 patients, 379 were in the pre-SSI strategy arm, 311 in the SSI strategy arm and 328 were included to test durability. The study arms were comparable for all measured parameters. Preoperative wound class, operation time, resection type and stoma creation did not differ significantly. The SSI strategy arm demonstrated a significant decrease in overall SSI rates (32.19% vs 18.97%) and superficial SSI rates (23.48% vs 8.04%). Deep SSI and organ space rates did not differ. A review of patients testing durability demonstrated continued improvement in overall SSI rates (8.23%). The implementation of an SSI reduction strategy resulted in a 41% decrease in SSI rates following colorectal resection over its initial 3 years, and its durability as demonstrated by continuing improvement was seen over an additional 2 years. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

Predicting surgical site infection after spine surgery: a validated model using a prospective surgical registry.

PubMed

Lee, Michael J; Cizik, Amy M; Hamilton, Deven; Chapman, Jens R

2014-09-01

The impact of surgical site infection (SSI) is substantial. Although previous study has determined relative risk and odds ratio (OR) values to quantify risk factors, these values may be difficult to translate to the patient during counseling of surgical options. Ideally, a model that predicts absolute risk of SSI, rather than relative risk or OR values, would greatly enhance the discussion of safety of spine surgery. To date, there is no risk stratification model that specifically predicts the risk of medical complication. The purpose of this study was to create and validate a predictive model for the risk of SSI after spine surgery. This study performs a multivariate analysis of SSI after spine surgery using a large prospective surgical registry. Using the results of this analysis, this study will then create and validate a predictive model for SSI after spine surgery. The patient sample is from a high-quality surgical registry from our two institutions with prospectively collected, detailed demographic, comorbidity, and complication data. An SSI that required return to the operating room for surgical debridement. Using a prospectively collected surgical registry of more than 1,532 patients with extensive demographic, comorbidity, surgical, and complication details recorded for 2 years after the surgery, we identified several risk factors for SSI after multivariate analysis. Using the beta coefficients from those regression analyses, we created a model to predict the occurrence of SSI after spine surgery. We split our data into two subsets for internal and cross-validation of our model. We created a predictive model based on our beta coefficients from our multivariate analysis. The final predictive model for SSI had a receiver-operator curve characteristic of 0.72, considered to be a fair measure. The final model has been uploaded for use on SpineSage.com. We present a validated model for predicting SSI after spine surgery. The value in this model is that it gives the user an absolute percent likelihood of SSI after spine surgery based on the patient's comorbidity profile and invasiveness of surgery. Patients are far more likely to understand an absolute percentage, rather than relative risk and confidence interval values. A model such as this is of paramount importance in counseling patients and enhancing the safety of spine surgery. In addition, a tool such as this can be of great use particularly as health care trends toward pay for performance, quality metrics (such as SSI), and risk adjustment. To facilitate the use of this model, we have created a Web site (SpineSage.com) where users can enter patient data to determine likelihood for SSI. Copyright © 2014 Elsevier Inc. All rights reserved.

Pollen–pistil interactions and self-incompatibility in the Asteraceae: new insights from studies of Senecio squalidus (Oxford ragwort)

PubMed Central

Allen, Alexandra M.; Thorogood, Christopher J.; Hegarty, Matthew J.; Lexer, Christian; Hiscock, Simon J.

2011-01-01

Background Pollen–pistil interactions are an essential prelude to fertilization in angiosperms and determine compatibility/incompatibility. Pollen–pistil interactions have been studied at a molecular and cellular level in relatively few families. Self-incompatibility (SI) is the best understood pollen–pistil interaction at a molecular level where three different molecular mechanisms have been identified in just five families. Here we review studies of pollen–pistil interactions and SI in the Asteraceae, an important family that has been relatively understudied in these areas of reproductive biology. Scope We begin by describing the historical literature which first identified sporophytic SI (SSI) in species of Asteraceae, the SI system later identified and characterized at a molecular level in the Brassicaceae. Early structural and cytological studies in these two families suggested that pollen–pistil interactions and SSI were similar, if not the same. Recent cellular and molecular studies in Senecio squalidus (Oxford ragwort) have challenged this belief by revealing that despite sharing the same genetic system of SSI, the Brassicaceae and Asteraceae molecular mechanisms are different. Key cellular differences have also been highlighted in pollen–stigma interactions, which may arise as a consequence of the Asteraceae possessing a ‘semi-dry’ stigma, rather than the ‘dry’ stigma typical of the Brassicaceae. The review concludes with a summary of recent transcriptomic analyses aimed at identifying proteins regulating pollen–pistil interactions and SI in S. squalidus, and by implication the Asteraceae. The Senecio pistil transcriptome contains many novel pistil-specific genes, but also pistil-specific genes previously shown to play a role in pollen–pistil interactions in other species. Conclusions Studies in S. squalidus have shown that stigma structure and the molecular mechanism of SSI in the Asteraceae and Brassicaceae are different. The availability of a pool of pistil-specific genes for S. squalidus offers an opportunity to elucidate the molecular mechanisms of pollen–pistil interactions and SI in the Asteraceae. PMID:21752792

Sporophytic self-incompatibility in Senecio squalidus (Asteraceae): S allele dominance interactions and modifiers of cross-compatibility and selfing rates

PubMed Central

Brennan, A C; Tabah, D A; Harris, S A; Hiscock, S J

2011-01-01

Understanding genetic mechanisms of self-incompatibility (SI) and how they evolve is central to understanding the mating behaviour of most outbreeding angiosperms. Sporophytic SI (SSI) is controlled by a single multi-allelic locus, S, which is expressed in the diploid (sporophyte) plant to determine the SI phenotype of its haploid (gametophyte) pollen. This allows complex patterns of independent S allele dominance interactions in male (pollen) and female (pistil) reproductive tissues. Senecio squalidus is a useful model for studying the genetic regulation and evolution of SSI because of its population history as an alien invasive species in the UK. S. squalidus maintains a small number of S alleles (7–11) with a high frequency of dominance interactions. Some S. squalidus individuals also show partial selfing and/or greater levels of cross-compatibility than expected under SSI. We previously speculated that these might be adaptations to invasiveness. Here we describe a detailed characterization of the regulation of SSI in S. squalidus. Controlled crosses were used to determine the S allele dominance hierarchy of six S alleles and effects of modifiers on cross-compatibility and partial selfing. Complex dominance interactions among S alleles were found with at least three levels of dominance and tissue-specific codominance. Evidence for S gene modifiers that increase selfing and/or cross-compatibility was also found. These empirical findings are discussed in the context of theoretical predictions for maintenance of S allele dominance interactions, and the role of modifier loci in the evolution of SI. PMID:20372180

Sporophytic self-incompatibility in Senecio squalidus (Asteraceae): S allele dominance interactions and modifiers of cross-compatibility and selfing rates.

PubMed

Brennan, A C; Tabah, D A; Harris, S A; Hiscock, S J

2011-01-01

Understanding genetic mechanisms of self-incompatibility (SI) and how they evolve is central to understanding the mating behaviour of most outbreeding angiosperms. Sporophytic SI (SSI) is controlled by a single multi-allelic locus, S, which is expressed in the diploid (sporophyte) plant to determine the SI phenotype of its haploid (gametophyte) pollen. This allows complex patterns of independent S allele dominance interactions in male (pollen) and female (pistil) reproductive tissues. Senecio squalidus is a useful model for studying the genetic regulation and evolution of SSI because of its population history as an alien invasive species in the UK. S. squalidus maintains a small number of S alleles (7-11) with a high frequency of dominance interactions. Some S. squalidus individuals also show partial selfing and/or greater levels of cross-compatibility than expected under SSI. We previously speculated that these might be adaptations to invasiveness. Here we describe a detailed characterization of the regulation of SSI in S. squalidus. Controlled crosses were used to determine the S allele dominance hierarchy of six S alleles and effects of modifiers on cross-compatibility and partial selfing. Complex dominance interactions among S alleles were found with at least three levels of dominance and tissue-specific codominance. Evidence for S gene modifiers that increase selfing and/or cross-compatibility was also found. These empirical findings are discussed in the context of theoretical predictions for maintenance of S allele dominance interactions, and the role of modifier loci in the evolution of SI.

Risk factors for unavoidable removal of instrumentation after surgical site infection of spine surgery

PubMed Central

Tominaga, Hiroyuki; Setoguchi, Takao; Kawamura, Hideki; Kawamura, Ichiro; Nagano, Satoshi; Abematsu, Masahiko; Tanabe, Fumito; Ishidou, Yasuhiro; Yamamoto, Takuya; Komiya, Setsuro

2016-01-01

Abstract Surgical site infection (SSI) after spine instrumentation is difficult to treat, and often requires removal of instrumentation. The removal of instrumentation after spine surgery is a severe complication that can lead to the deterioration of activities of daily living and poor prognosis. Although there are many reports on SSI after spine surgery, few reports have investigated the risk factors for the removal of instrumentation after spine surgery SSI. This study aimed to identify the risk factors for unavoidable removal of instrumentation after SSI of spine surgery. We retrospectively reviewed 511 patients who underwent spine surgery with instrumentation at Kagoshima University Hospital from January 2006 to December 2014. Risk factors associated with SSI were analyzed via multiple logistic regression analysis. Parameters of the group that needed instrumentation removal were compared with the group that did not require instrumentation removal using the Mann–Whitney U and Fisher's exact tests. The posterior approach was used in most cases (453 of 511 cases, 88.6%). SSI occurred in 16 of 511 cases (3.14%) of spine surgery with instrumentation. Multivariate logistic regression analysis identified 2 significant risk factors for SSI: operation time, and American Society of Anesthesiologists physical status classification ≥ 3. Twelve of the 16 patients with SSI (75%) were able to keep the instrumentation after SSI. Pseudarthrosis occurred in 2 of 4 cases (50%) after instrumentation removal. Risk factors identified for instrumentation removal after spine SSI were a greater number of past surgeries, low preoperative hemoglobin, high preoperative creatinine, high postoperative infection treatment score for the spine, and the presence of methicillin-resistant Staphylococcus aureus. In these high risk cases, attempts should be made to decrease the risk factors preoperatively, and careful postoperative monitoring should be conducted. PMID:27787365

Risk factors for unavoidable removal of instrumentation after surgical site infection of spine surgery: A retrospective case-control study.

PubMed

Tominaga, Hiroyuki; Setoguchi, Takao; Kawamura, Hideki; Kawamura, Ichiro; Nagano, Satoshi; Abematsu, Masahiko; Tanabe, Fumito; Ishidou, Yasuhiro; Yamamoto, Takuya; Komiya, Setsuro

2016-10-01

Surgical site infection (SSI) after spine instrumentation is difficult to treat, and often requires removal of instrumentation. The removal of instrumentation after spine surgery is a severe complication that can lead to the deterioration of activities of daily living and poor prognosis. Although there are many reports on SSI after spine surgery, few reports have investigated the risk factors for the removal of instrumentation after spine surgery SSI. This study aimed to identify the risk factors for unavoidable removal of instrumentation after SSI of spine surgery. We retrospectively reviewed 511 patients who underwent spine surgery with instrumentation at Kagoshima University Hospital from January 2006 to December 2014. Risk factors associated with SSI were analyzed via multiple logistic regression analysis. Parameters of the group that needed instrumentation removal were compared with the group that did not require instrumentation removal using the Mann-Whitney U and Fisher's exact tests. The posterior approach was used in most cases (453 of 511 cases, 88.6%). SSI occurred in 16 of 511 cases (3.14%) of spine surgery with instrumentation. Multivariate logistic regression analysis identified 2 significant risk factors for SSI: operation time, and American Society of Anesthesiologists physical status classification ≥ 3. Twelve of the 16 patients with SSI (75%) were able to keep the instrumentation after SSI. Pseudarthrosis occurred in 2 of 4 cases (50%) after instrumentation removal. Risk factors identified for instrumentation removal after spine SSI were a greater number of past surgeries, low preoperative hemoglobin, high preoperative creatinine, high postoperative infection treatment score for the spine, and the presence of methicillin-resistant Staphylococcus aureus. In these high risk cases, attempts should be made to decrease the risk factors preoperatively, and careful postoperative monitoring should be conducted.

Sternal wound infection after cardiac surgery: incidence and risk factors according to clinical presentation.

PubMed

Lemaignen, A; Birgand, G; Ghodhbane, W; Alkhoder, S; Lolom, I; Belorgey, S; Lescure, F-X; Armand-Lefevre, L; Raffoul, R; Dilly, M-P; Nataf, P; Lucet, J C

2015-07-01

The incidence of surgical site infection (SSI) after cardiac surgery depends on the definition used. A distinction is generally made between mediastinitis, as defined by the US Centers for Disease Control and Prevention (CDC), and superficial SSI. Our objective was to decipher these entities in terms of presentation and risk factors. We performed a 7-year single centre analysis of prospective surveillance of patients with cardiac surgery via median sternotomy. SSI was defined as the need for reoperation due to infection. Among 7170 patients, 292 (4.1%) developed SSI, including 145 CDC-defined mediastinitis (CDC-positive SSI, 2.0%) and 147 superficial SSI without associated bloodstream infection (CDC-negative SSI, 2.1%). Median time to reoperation for CDC-negative SSI was 18 days (interquartile range, 14-26) and 16 (interquartile range, 11-24) for CDC-positive SSI (p 0.02). Microorganisms associated with CDC-negative SSI were mainly skin commensals (62/147, 41%) or originated in the digestive tract (62/147, 42%); only six were due to Staphylococcus aureus (4%), while CDC-positive SSI were mostly due to S. aureus (52/145, 36%) and germs from the digestive tract (52/145, 36%). Risk factors for SSI were older age, obesity, chronic obstructive bronchopneumonia, diabetes mellitus, critical preoperative state, postoperative vasopressive support, transfusion or prolonged ventilation and coronary artery bypass grafting, especially if using both internal thoracic arteries in female patients. The number of internal thoracic arteries used and factors affecting wound healing were primarily associated with CDC-negative SSI, whereas comorbidities and perioperative complications were mainly associated with CDC-positive SSI. These 2 entities differed in time to revision surgery, bacteriology and risk factors, suggesting a differing pathophysiology. Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Improving Public Reporting and Data Validation for Complex Surgical Site Infections After Coronary Artery Bypass Graft Surgery and Hip Arthroplasty

PubMed Central

Calderwood, Michael S.; Kleinman, Ken; Murphy, Michael V.; Platt, Richard; Huang, Susan S.

2014-01-01

Background  Deep and organ/space surgical site infections (D/OS SSI) cause significant morbidity, mortality, and costs. Rates are publicly reported and increasingly used as quality metrics affecting hospital payment. Lack of standardized surveillance methods threaten the accuracy of reported data and decrease confidence in comparisons based upon these data. Methods  We analyzed data from national validation studies that used Medicare claims to trigger chart review for SSI confirmation after coronary artery bypass graft surgery (CABG) and hip arthroplasty. We evaluated code performance (sensitivity and positive predictive value) to select diagnosis codes that best identified D/OS SSI. Codes were analyzed individually and in combination. Results  Analysis included 143 patients with D/OS SSI after CABG and 175 patients with D/OS SSI after hip arthroplasty. For CABG, 9 International Classification of Diseases, 9th Revision (ICD-9) diagnosis codes identified 92% of D/OS SSI, with 1 D/OS SSI identified for every 4 cases with a diagnosis code. For hip arthroplasty, 6 ICD-9 diagnosis codes identified 99% of D/OS SSI, with 1 D/OS SSI identified for every 2 cases with a diagnosis code. Conclusions  This standardized and efficient approach for identifying D/OS SSI can be used by hospitals to improve case detection and public reporting. This method can also be used to identify potential D/OS SSI cases for review during hospital audits for data validation. PMID:25734174

Risk factors for superficial surgical site infection after elective rectal cancer resection: a multivariate analysis of 8880 patients from the American College of Surgeons National Surgical Quality Improvement Program database.

PubMed

Sutton, Elie; Miyagaki, Hiromichi; Bellini, Geoffrey; Shantha Kumara, H M C; Yan, Xiaohong; Howe, Brett; Feigel, Amanda; Whelan, Richard L

2017-01-01

Superficial surgical site infection (sSSI) is one of the most common complications after colorectal resection. The goal of this study was to determine the comorbidities and operative characteristics that place patients at risk for sSSI in patients who underwent rectal cancer resection. The American College of Surgeons National Surgical Quality Improvement Program database was queried (via diagnosis and Current Procedural Terminology codes) for patients with rectal cancer who underwent elective resection between 2005 and 2012. Patients for whom data concerning 27 demographic factors, comorbidities, and operative characteristics were available were eligible. A univariate and multivariate analysis was performed to identify possible risk factors for sSSI. A total of 8880 patients met the entry criteria and were included. sSSIs were diagnosed in 861 (9.7%) patients. Univariate analysis found 14 patients statistically significant risk factors for sSSI. Multivariate analysis revealed the following risk factors: male gender, body mass index (BMI) >30, current smoking, history of chronic obstructive pulmonary disease (COPD), American Society of Anesthesiologists III/IV, abdominoperineal resection (APR), stoma formation, open surgery (versus laparoscopic), and operative time >217 min. The greatest difference in sSSI rates was noted in patients with COPD (18.9 versus 9.5%). Of note, 54.2% of sSSIs was noted after hospital discharge. With regard to the timing of presentation, univariate analysis revealed a statistically significant delay in sSSI presentation in patients with the following factors and/or characteristics: BMI <30, previous radiation therapy (RT), APR, minimally invasive surgery, and stoma formation. Multivariate analysis suggested that only laparoscopic surgery (versus open) and preoperative RT were risk factors for delay. Rectal cancer resections are associated with a high incidence of sSSIs, over half of which are noted after discharge. Nine patient and operative characteristics, including smoking, BMI, COPD, APR, and open surgery were found to be significant risk factors for SSI on multivariate analysis. Furthermore, sSSI presentation in patients who had laparoscopic surgery and those who had preoperative RT is significantly delayed for unclear reasons. Copyright © 2016 Elsevier Inc. All rights reserved.

Percent body fat and prediction of surgical site infection.

PubMed

Waisbren, Emily; Rosen, Heather; Bader, Angela M; Lipsitz, Stuart R; Rogers, Selwyn O; Eriksson, Elof

2010-04-01

Obesity is a risk factor for surgical site infection (SSI) after elective surgery. Body mass index (BMI) is commonly used to define obesity (BMI >or=30 kg/m(2)), but percent body fat (%BF) (obesity is >25%BF [men]; >31%BF [women]) might better predict SSI risk because BMI might not reflect body composition. This prospective study included 591 elective surgical patients 18 to 64 years of age from September 2008 through February 2009. Height and weight were measured for BMI. %BF was calculated by bioelectrical impedance analysis. Preoperative, operative, and 30-day postoperative data were captured through interviews and chart review. Our primary, predetermined outcomes measurement was SSI as defined by the Center for Disease Control and Prevention. Mean %BF and BMI were 34+/-10 and 29+/-8, respectively. Four-hundred and nine (69%) patients were obese by %BF; 225 (38%) were obese by BMI. SSI developed in 71 (12%) patients. With BMI defining obesity, SSI incidence was 12.3% in nonobese and 11.6% in obese patients (p = 0.8); Using %BF, SSI occurred in 5.0% of nonobese and 15.2% of obese patients (p < 0.001). In univariate analyses, significant predictors of SSI were %BF (p = 0.005), obesity by %BF (p < 0.001), smoking (p = 0.002), National Nosocomial Infections Surveillance score (p < 0.001), postoperative hyperglycemia (p = 0.03), and anemia (p = 0.02). In multivariable analysis, obese patients by %BF had a 5-fold higher risk for SSI than nonobese patients (odds ratio = 5.3; 95% CI, 1.2-23.1; p = 0.03). Linear regression was used to show that there is a positive, nonlinear relationship between %BF and BMI. Obesity, defined by %BF, is associated with a 5-fold increased SSI risk. This risk increases as %BF increases. %BF is a more sensitive and precise measurement of SSI risk than BMI. Additional studies are required to better understand this relationship. Copyright (c) 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

How do we understand the disagreement in the frequency of surgical site infection between the CDC and Clavien-Dindo classifications?

PubMed

Yamamoto, Takanobu; Takahashi, Satoshi; Ichihara, Koji; Hiyama, Yoshiki; Uehara, Teruhisa; Hashimoto, Jiro; Hirobe, Megumi; Masumori, Naoya

2015-02-01

To clarify the discrepancy in the incidence and severity of surgical site infections (SSI) for radical cystectomy between reports based on the CDC guideline and those using the Clavien-Dindo classification we evaluated 449 consecutive patients who underwent radical cystectomy for bladder cancer between 1990 and 2012. Of the 115 (25.6%) patients with SSI defined by the CDC guideline, 89 could be analyzed. We compared the SSI rates and severity defined by the CDC guideline and Clavien-Dindo classifications. There were 58 patients with superficial SSI, 16 with deep SSI, and 15 with organ/space SSI according to the CDC guideline. All patients with organ/space SSI were judged as "not having SSI" by the Clavien-Dindo classification. They were classified as having "intestinal prolapse", "intestinal fistula", "abdominal abscess" and "pelvic abscess." There was a significant association between the treatment duration and depth of SSI based on the CDC guideline by Spearman's rank-correlation coefficient (p < 0.001, r = 0.614) and with the grade of complications (p < 0.001, r = 0.632) in the Clavien-Dindo classification. Multivariate analysis showed that patients with grade III SSI in the Clavien-Dindo classification needed a significantly longer treatment duration. It is necessary to be aware that a discrepancy can occur automatically due to the different natures of the definitions. Using the CDC guideline, we can effectively estimate the future treatment period when SSI occurs. With the Clavien-Dindo classification, grade III SSI requires a longer treatment duration. Copyright © 2014 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

A single-center retrospective review of postoperative infectious complications in the surgical management of mandibular fractures: Postoperative antibiotics add no benefit.

PubMed

Domingo, Fernando; Dale, Elizabeth; Gao, Cuilan; Groves, Cynthia; Stanley, Daniel; Maxwell, Robert A; Waldrop, Jimmy L

2016-12-01

Mandibular fractures are common facial injuries and treatment may be complicated by post-operative infection. Risk of infection from contamination with oral flora is well established but no consensus exists regarding antibiotic prophylaxis. The purpose of this study is to assess risk factors and perioperative antibiotics on surgical site infection (SSI) rates following mandibular fracture surgery. Retrospective medical record review was completed for trauma patients of any age surgically treated for mandibular fractures at a Level I Trauma Center from September 2006 to June 2012. Outcomes analysis was performed to determine SSI rates related to perioperative antibiotic use and other risk factors that may contribute to SSI. 359 patients met inclusion criteria for analysis. 76% were male. Mean age was 30.5 years. Thirty-eight patients developed SSI (10.6%). SSI rate was lower in closed versus open surgery (3.2% vs. 16.3%, p=0.0001), and in closed versus open fractures (1% vs. 14%, p=0.0005). SSI rate increased in patients with tobacco, alcohol, and drug use (14.6%, 13.2%, 53.6%, p<0.0001), traumatic dental injuries (19.6%, p=0.0110), and patients in motor vehicle crashes (12.2%, p=0.0062). SSI rates stratified by Injury Severity Score (ISS) less than or equal to 16 (23/255 [9%]) versus ISS greater than 16 (15/104 [14%]) trended toward more severely injured patients developing SSI, p=0.1347. SSI rate was similar in patients who did and did not receive post-operative antibiotics (14.7% vs. 9.6%, p=0.2556). Type of antibiotic, duration of post-operative antibiotic administration, and duration between injury and surgery did not effect SSI rate. Findings suggest that following surgical treatment of mandible fractures, open surgery, open fractures, and risk factors including substance abuse, traumatic dental injury, and mechanism of injury significantly increase SSI rates, while post-operative antibiotics do not appear to provide additional benefit compared to pre-operative antibiotics alone. Therapeutic study, level IV.

Evaluation Intravenous Drip Cephazolin Prophylaxis of Breast Cancer Surgery Site Infection.

PubMed

Yang, Sufang; Liu, Guohua; Tang, Danling; Cai, De

2017-09-01

The efficacy of antibiotic prophylaxis for the prevention of surgical site infection (SSI) after breast cancer surgery remains uncertain. The authors of a recent Cochrane meta-analysis based on 15 randomized trials were unable to draw a definitive conclusion. The purpose of this study was to determine the effectiveness of prophylactic antibiotics for the prevention of SSI after breast cancer surgery and the risk factors for SSI. Breast cancer patients who underwent mastectomy at the authors' institution were enrolled in this study. All the patients give cephazolin by intravenous drip within 1 hour before surgery. Surgical site infection was defined using Centers for Disease Control criteria. Risk factors were abstracted from the electronic medical record. Pearson χ test, Student t test, and multivariable logistic regression were used for the analysis. Four hundred fifty-eight patients undergoing mastectomy were enrolled in this study, including 293 with intravenous drip cephazolin and 165 without. Among them, an overall SSI rate of 6.1% was observed; 4.2% of patients without prophylactic antibiotics developed SSI compared with 7.2% with antibiotics (P = 0.210). Factors associated with SSI were hypertension, diabetes, length of stay (d), age, and length of stay. Weight, duration of surgery, No. of drains, surgical procedure, and type of breast disease were not associated with increased SSI rates. Surgical site infection rates among patients who did and did not receive cephazolin after mastectomy had no significantly different. What is more, the authors should focus on advanced age, hypertension, diabetes, length of stay, and length of stay to decrease development of postoperative SSI rates.

Measurements of the Solar Spectral Irradiance Variability over Solar Cycles 21 to 24

NASA Astrophysics Data System (ADS)

Woods, T. N.

2017-12-01

The solar irradiance is the primary natural energy input into Earth's atmosphere and climate system. Understanding the long-term variations of the solar spectral irradiance (SSI) over time scales of the 11-year solar activity cycle and longer is critical for most Sun-climate research topics. There are satellite measurements of the SSI since the 1970s that contribute to understanding the solar cycle variability over Solar Cycles 21 to 24. A limiting factor for the accuracy of these results is the uncertainties for the instrument degradation corrections, for which there are fairly large corrections relative to the amount of solar cycle variability at some wavelengths. A summary of these satellite SSI measurements, which are primarily in the ultraviolet and only recently in the visible and near infrared, will be presented. Examining SSI trends using a new analysis technique is helping to identify some uncorrected instrumental trends, which once applied to the SSI trends has the potential to provide more accurate solar cycle variability results. This new technique examines the SSI trends at different levels of solar activity to provide long-term trends in a SSI record, and one of the most common components of these derived long-term trends is a downward trend that we attribute to being most likely from uncorrected instrument degradation. Examples of this analysis will be presented for some of the satellite SSI measurements to demonstrate this new technique and how it has potential to improve the understanding of solar cycle variability and to clarify the uncertainties of the trends.

Psychometric properties and clinical utility of the Scale for Suicidal Ideation (SSI) in adolescents

PubMed Central

Holi, Matti M; Pelkonen, Mirjami; Karlsson, Linnea; Kiviruusu, Olli; Ruuttu, Titta; Heilä, Hannele; Tuisku, Virpi; Marttunen, Mauri

2005-01-01

Background Accurate assessment of suicidality is of major importance in both clinical and research settings. The Scale for Suicidal Ideation (SSI) is a well-established clinician-rating scale but its suitability to adolescents has not been studied. The aim of this study was to evaluate the reliability and validity, and to test an appropriate cutoff threshold for the SSI in a depressed adolescent outpatient population and controls. Methods 218 adolescent psychiatric outpatient clinic patients suffering from depressive disorders and 200 age- and sex-matched school-attending controls were evaluated by the SSI for presence and severity of suicidal ideation. Internal consistency, discriminative-, concurrent-, and construct validity as well as the screening properties of the SSI were evaluated. Results Cronbach's α for the whole SSI was 0.95. The SSI total score differentiated patients and controls, and increased statistically significantly in classes with increasing severity of suicidality derived from the suicidality items of the K-SADS-PL diagnostic interview. Varimax-rotated principal component analysis of the SSI items yielded three theoretically coherent factors suggesting construct validity. Area under the receiver operating characteristic (ROC) curve was 0.84 for the whole sample and 0.80 for the patient sample. The optimal cutoff threshold for the SSI total score was 3/4 yielding sensitivity of 75% and specificity of 88.9% in this population. Conclusions SSI appears to be a reliable and a valid measure of suicidal ideation for depressed adolescents. PMID:15691388

Psychometric properties and clinical utility of the Scale for Suicidal Ideation (SSI) in adolescents.

PubMed

Holi, Matti M; Pelkonen, Mirjami; Karlsson, Linnea; Kiviruusu, Olli; Ruuttu, Titta; Heilä, Hannele; Tuisku, Virpi; Marttunen, Mauri

2005-02-03

Accurate assessment of suicidality is of major importance in both clinical and research settings. The Scale for Suicidal Ideation (SSI) is a well-established clinician-rating scale but its suitability to adolescents has not been studied. The aim of this study was to evaluate the reliability and validity, and to test an appropriate cutoff threshold for the SSI in a depressed adolescent outpatient population and controls. 218 adolescent psychiatric outpatient clinic patients suffering from depressive disorders and 200 age- and sex-matched school-attending controls were evaluated by the SSI for presence and severity of suicidal ideation. Internal consistency, discriminative-, concurrent-, and construct validity as well as the screening properties of the SSI were evaluated. Cronbach's alpha for the whole SSI was 0.95. The SSI total score differentiated patients and controls, and increased statistically significantly in classes with increasing severity of suicidality derived from the suicidality items of the K-SADS-PL diagnostic interview. Varimax-rotated principal component analysis of the SSI items yielded three theoretically coherent factors suggesting construct validity. Area under the receiver operating characteristic (ROC) curve was 0.84 for the whole sample and 0.80 for the patient sample. The optimal cutoff threshold for the SSI total score was 3/4 yielding sensitivity of 75% and specificity of 88.9% in this population. SSI appears to be a reliable and a valid measure of suicidal ideation for depressed adolescents.

Multi-equilibrium property of metabolic networks: SSI module.

PubMed

Lei, Hong-Bo; Zhang, Ji-Feng; Chen, Luonan

2011-06-20

Revealing the multi-equilibrium property of a metabolic network is a fundamental and important topic in systems biology. Due to the complexity of the metabolic network, it is generally a difficult task to study the problem as a whole from both analytical and numerical viewpoint. On the other hand, the structure-oriented modularization idea is a good choice to overcome such a difficulty, i.e. decomposing the network into several basic building blocks and then studying the whole network through investigating the dynamical characteristics of the basic building blocks and their interactions. Single substrate and single product with inhibition (SSI) metabolic module is one type of the basic building blocks of metabolic networks, and its multi-equilibrium property has important influence on that of the whole metabolic networks. In this paper, we describe what the SSI metabolic module is, characterize the rates of the metabolic reactions by Hill kinetics and give a unified model for SSI modules by using a set of nonlinear ordinary differential equations with multi-variables. Specifically, a sufficient and necessary condition is first given to describe the injectivity of a class of nonlinear systems, and then, the sufficient condition is used to study the multi-equilibrium property of SSI modules. As a main theoretical result, for the SSI modules in which each reaction has no more than one inhibitor, a sufficient condition is derived to rule out multiple equilibria, i.e. the Jacobian matrix of its rate function is nonsingular everywhere. In summary, we describe SSI modules and give a general modeling framework based on Hill kinetics, and provide a sufficient condition for ruling out multiple equilibria of a key type of SSI module.

Multi-equilibrium property of metabolic networks: SSI module

PubMed Central

2011-01-01

Background Revealing the multi-equilibrium property of a metabolic network is a fundamental and important topic in systems biology. Due to the complexity of the metabolic network, it is generally a difficult task to study the problem as a whole from both analytical and numerical viewpoint. On the other hand, the structure-oriented modularization idea is a good choice to overcome such a difficulty, i.e. decomposing the network into several basic building blocks and then studying the whole network through investigating the dynamical characteristics of the basic building blocks and their interactions. Single substrate and single product with inhibition (SSI) metabolic module is one type of the basic building blocks of metabolic networks, and its multi-equilibrium property has important influence on that of the whole metabolic networks. Results In this paper, we describe what the SSI metabolic module is, characterize the rates of the metabolic reactions by Hill kinetics and give a unified model for SSI modules by using a set of nonlinear ordinary differential equations with multi-variables. Specifically, a sufficient and necessary condition is first given to describe the injectivity of a class of nonlinear systems, and then, the sufficient condition is used to study the multi-equilibrium property of SSI modules. As a main theoretical result, for the SSI modules in which each reaction has no more than one inhibitor, a sufficient condition is derived to rule out multiple equilibria, i.e. the Jacobian matrix of its rate function is nonsingular everywhere. Conclusions In summary, we describe SSI modules and give a general modeling framework based on Hill kinetics, and provide a sufficient condition for ruling out multiple equilibria of a key type of SSI module. PMID:21689474

Failure of Colorectal Surgical Site Infection Predictive Models Applied to an Independent Dataset: Do They Add Value or Just Confusion?

PubMed

Bergquist, John R; Thiels, Cornelius A; Etzioni, David A; Habermann, Elizabeth B; Cima, Robert R

2016-04-01

Colorectal surgical site infections (C-SSIs) are a major source of postoperative morbidity. Institutional C-SSI rates are modeled and scrutinized, and there is increasing movement in the direction of public reporting. External validation of C-SSI risk prediction models is lacking. Factors governing C-SSI occurrence are complicated and multifactorial. We hypothesized that existing C-SSI prediction models have limited ability to accurately predict C-SSI in independent data. Colorectal resections identified from our institutional ACS-NSQIP dataset (2006 to 2014) were reviewed. The primary outcome was any C-SSI according to the ACS-NSQIP definition. Emergency cases were excluded. Published C-SSI risk scores: the National Nosocomial Infection Surveillance (NNIS), Contamination, Obesity, Laparotomy, and American Society of Anesthesiologists (ASA) class (COLA), Preventie Ziekenhuisinfecties door Surveillance (PREZIES), and NSQIP-based models were compared with receiver operating characteristic (ROC) analysis to evaluate discriminatory quality. There were 2,376 cases included, with an overall C-SSI rate of 9% (213 cases). None of the models produced reliable and high quality C-SSI predictions. For any C-SSI, the NNIS c-index was 0.57 vs 0.61 for COLA, 0.58 for PREZIES, and 0.62 for NSQIP: all well below the minimum "reasonably" predictive c-index of 0.7. Predictions for superficial, deep, and organ space SSI were similarly poor. Published C-SSI risk prediction models do not accurately predict C-SSI in our independent institutional dataset. Application of externally developed prediction models to any individual practice must be validated or modified to account for institution and case-mix specific factors. This questions the validity of using externally or nationally developed models for "expected" outcomes and interhospital comparisons. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Solar Array and Auroral Charging Studies of DMSP Spacecraft

NASA Technical Reports Server (NTRS)

Matias, Kelwin

2013-01-01

The SSJ electrostatic analyzers and the SSIES plasma instruments on the DMSP spacecraft in low Earth polar orbit can be used to conduct case studies of auroral and solar array charging. We will use a program written in the Interactive Data Language (IDL) to evaluate questionable charging events in the SSJ records by comparing charging signatures in SSJ and SSIES data. In addition, we will assemble a number of case studies of solar array charging showing the signatures from the SSJ data and compare to the SSIES charging signatures. In addition we will use Satellite Tool Kit (STK) to propagate orbits, obtain solar intensity, and use to verify onset of charging with sunrise.

Surgical site infections: reanalysis of risk factors.

PubMed

Malone, Debra L; Genuit, Thomas; Tracy, J Kathleen; Gannon, Christopher; Napolitano, Lena M

2002-03-01

Surgical site infections (SSI) are the most common nosocomial infection in surgical patients, accounting for 38% of all such infections, and are a significant source of postoperative morbidity resulting in increased hospital length of stay and increased cost. During 1986-1996 the Center for Disease Control and Prevention's National Nosocomial Infections Surveillance system reported 15,523 SSI following 593,344 operations (2.6%). Previous studies have documented patient characteristics associated with an increased risk of SSI, including diabetes, tobacco or steroid use, obesity, malnutrition, and perioperative blood transfusion. In this study we sought to reevaluate risk factors for SSI in a large cohort of noncardiac surgical patients. Prospective data (NSQIP) were collected on 5031 noncardiac surgical patients at the Veteran's Administration Maryland Healthcare System from 1995 to 2000. All preoperative risk factors were evaluated as independent predictors of surgical site infection. The mean age of the study cohort was 61 plus minus 13. SSI occurred in 162 patients, comprising 3.2% of the study cohort. Gram-positive organisms were the most common bacterial etiology. Multiple logistic regression analysis documented that diabetes (insulin- and non-insulin-dependent), low postoperative hematocrit, weight loss (within 6 months), and ascites were significantly associated with increased SSI. Tobacco use, steroid use, and chronic obstructive pulmonary disease (COPD) were not predictors for SSI. This study confirms that diabetes and malnutrition (defined as significant weight loss 6 months prior to surgery) are significant preoperative risk factors for SSI. Postoperative anemia is a significant risk factor for SSI. In contrast to prior analyses, this study has documented that tobacco use, steroid use, and COPD are not independent predictors of SSI. Future SSI studies should target early preoperative intervention and optimization of patients with diabetes and malnutrition.

Secondary School Students' Understanding of Science and Their Socioscientific Reasoning

NASA Astrophysics Data System (ADS)

Karahan, Engin; Roehrig, Gillian

2017-08-01

Research in socioscientific issue (SSI)-based interventions is relatively new (Sadler in Journal of Research in Science Teaching 41:513-536, 2004; Zeidler et al. in Journal of Research in Science Teaching 46:74-101, 2009), and there is a need for understanding more about the effects of SSI-based learning environments (Sadler in Journal of Research in Science Teaching 41:513-536, 2004). Lee and Witz (International Journal of Science Education 31:931-960, 2009) highlighted the need for detailed case studies that would focus on how students respond to teachers' practices of teaching SSI. This study presents case studies that investigated the development of secondary school students' science understanding and their socioscientific reasoning within SSI-based learning environments. A multiple case study with embedded units of analysis was implemented for this research because of the contextual differences for each case. The findings of the study revealed that students' understanding of science, including scientific method, social and cultural influences on science, and scientific bias, was strongly influenced by their experiences in SSI-based learning environments. Furthermore, multidimensional SSI-based science classes resulted in students having multiple reasoning modes, such as ethical and economic reasoning, compared to data-driven SSI-based science classes. In addition to portraying how participants presented complexity, perspectives, inquiry, and skepticism as aspects of socioscientific reasoning (Sadler et al. in Research in Science Education 37:371-391, 2007), this study proposes the inclusion of three additional aspects for the socioscientific reasoning theoretical construct: (1) identification of social domains affecting the SSI, (2) using cost and benefit analysis for evaluation of claims, and (3) understanding that SSIs and scientific studies around them are context-bound.

Impact of a surgical site infection (SSI) surveillance program in orthopedics and traumatology.

PubMed

Mabit, C; Marcheix, P S; Mounier, M; Dijoux, P; Pestourie, N; Bonnevialle, P; Bonnomet, F

2012-10-01

Surveillance of surgical site infections (SSI) is a priority. One of the fundamental principles for the surveillance of SSI is based on receiving effective field feedback (retro-information). The aim of this study was to report the results of a program of SSI surveillance and validate the hypothesis that there is a correlation between creating a SSI surveillance program and a reduction in SSI. The protocol was based on the weekly collection of surveillance data obtained directly from the different information systems in different departments. A delay of 3 months was established before extraction and analysis of data and information from the surgical teams. The NNIS index (National Nosocomial Infections Surveillance System) developed by the American surveillance system and the reduction of length of hospital stay index Journées d'hospitalisation évitées (JHE). Since the end of 2009, 7156 surgical procedures were evaluated (rate of inclusion 97.3%), and 84 SSI were registered with a significant decrease over time from 1.86% to 0.66%. A total of 418 days of hospitalization have been saved since the beginning of the surveillance system. Our surveillance system has three strong points: follow-up is continuous, specifically adapted to orthopedic traumatology and nearly exhaustive. The extraction of data directly from hospital information systems effectively improves the collection of data on surgical procedures. The implementation of a SSI surveillance protocol reduces SSI. Level III. Prospective study. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Refinements to SSiB with an Emphasis on Snow-Physics: Evaluation and Validation Using GSWP and Valdai Data

NASA Technical Reports Server (NTRS)

Mocko, David M.; Sud, Y. C.

2000-01-01

Refinements to the snow-physics scheme of SSiB (Simplified Simple Biosphere Model) are described and evaluated. The upgrades include a partial redesign of the conceptual architecture to better simulate the diurnal temperature of the snow surface. For a deep snowpack, there are two separate prognostic temperature snow layers - the top layer responds to diurnal fluctuations in the surface forcing, while the deep layer exhibits a slowly varying response. In addition, the use of a very deep soil temperature and a treatment of snow aging with its influence on snow density is parameterized and evaluated. The upgraded snow scheme produces better timing of snow melt in GSWP-style simulations using ISLSCP Initiative I data for 1987-1988 in the Russian Wheat Belt region. To simulate more realistic runoff in regions with high orographic variability, additional improvements are made to SSiB's soil hydrology. These improvements include an orography-based surface runoff scheme as well as interaction with a water table below SSiB's three soil layers. The addition of these parameterizations further help to simulate more realistic runoff and accompanying prognostic soil moisture fields in the GSWP-style simulations. In intercomparisons of the performance of the new snow-physics SSiB with its earlier versions using an 18-year single-site dataset from Valdai Russia, the version of SSiB described in this paper again produces the earliest onset of snow melt. Soil moisture and deep soil temperatures also compare favorably with observations.

Oleic acid levels regulated by glycerolipid metabolism modulate defense gene expression in Arabidopsis

PubMed Central

Kachroo, Aardra; Venugopal, Srivathsa C.; Lapchyk, Ludmila; Falcone, Deane; Hildebrand, David; Kachroo, Pradeep

2004-01-01

Stearoyl-acyl-carrier-protein-desaturase-mediated conversion of stearic acid (18:0) to oleic acid (18:1) is a key step, which regulates levels of unsaturated fatty acids in cells. We previously showed that stearoyl-acyl-carrier-protein-desaturase mutants ssi2/fab2 carrying a loss-of-function mutation in the plastidial glycerol-3-phosphate (G3P) acyltransferase (act1) have elevated 18:1 levels and are restored in their altered defense signaling. Because G3P is required for the acylation of 18:1 by G3P acyltransferase, it was predicted that reduction of G3P levels should increase 18:1 levels and thereby revert ssi2-triggered phenotypes. Here we show that a mutation in G3P dehydrogenase restores both salicylic acid- and jasmonic acid-mediated phenotypes of ssi2 plants. The G3P dehydrogenase gene was identified by map-based cloning of the ssi2 suppressor mutant rdc8 (gly1-3) and confirmed by epistatic analysis of ssi2 with gly1-1. Restoration of ssi2-triggered phenotypes by the gly1-3 mutation was age-dependent and correlated with the levels of 18:1. Regeneration of G3P pools by glycerol application in ssi2 and ssi2 gly1-3 plants caused a marked reduction in the 18:1 levels, which rendered these plants hypersensitive to glycerol. This hypersensitivity in ssi2 was rescued by the act1 mutation. Furthermore, overexpression of the ACT1 gene resulted in enhanced sensitivity to glycerol. Glycerol application also lowered the 18:1 content in SSI2 plants and converted these into ssi2-mimics. Our results show that 18:1 levels in plastids are regulated by means of acylation with G3P, and a balance between G3P and 18:1 is critical for the regulation of salicylic acid- and jasmonic acid-mediated signaling pathways. PMID:15044700

Risk Assessment of Abdominal Wall Thickness Measured on Pre-Operative Computerized Tomography for Incisional Surgical Site Infection after Abdominal Surgery.

PubMed

Tongyoo, Assanee; Chatthamrak, Putipan; Sriussadaporn, Ekkapak; Limpavitayaporn, Palin; Mingmalairak, Chatchai

2015-07-01

The surgical site infection (SSI) is a common complication of abdominal operation. It relates to increased hospital stay, increased healthcare cost, and decreased patient's quality of life. Obesity, usually defined by BMI, is known as one of the risks of SSI. However, the thickness of subcutaneous layers of abdominal wall might be an important local factor affecting the rate of SSI after the abdominal operations. The objective of this study is to assess the importance of the abdominal wall thickness on incisional SSI rate. The subjects of the present study were patients who had undergone major abdominal operations at Thammasat University Hospital between June 2013 and May 2014, and had been investigated with CT scans before their operations. The demographic data and clinical information of these patients were recorded. The thickness ofsubcutaneous fatty tissue from skin down to the most superficial layer of abdominal wall muscle at the surgical site was measured on CT images. The wound infectious complication was reviewed and categorized as superficial and deep incisional SSIfollowing the definition from Centersfor Disease Control and Prevention (CDC) guidelines. The significance ofeach potentialfactors on SSI rates was determined separately with student t-test for quantitative data and χ2-test for categorical data. Then all factors, which had p < 0.10, were included into the multivariate logistic regression analysis and were analyzed with significance at p < 0.05. One hundred and thirty-nine patients were included in this study. They all underwent major abdominal surgery and had had pre-operative CTscans. Post-operative SSI was 25.2% (35/139), superficial and deep types in 27 and 8 patients, respectively. The comparison of abdominal wall thickness between patients with and without infection was significantly different (20.0 ± 8.4 mm and 16.0 ± 7.2 mm, respectively). When the thickness at 20 mm was used as the cut-off value, 43 of 139 patients had abdominal wall thickness ≥ 20 mm. The incidence of SSI of the thickness ±20 mm group was 37.2% (16/43) and of the less thickness group was 19.8% (19/96), with p < 0.05. The univariate analysis revealed that abdominal wall thickness ≥ 20 mm, body weight ≥ 60 kg, and wound classification were the important factors related to SSI after the abdominal operation. However, only abdominal wall thickness and wound classification were still significant by multivariate analysis. The findings of this study confirmed the significance of the subcutaneous thickness of abdominal wall at the surgical site on the incidence of incisional SSI. The thickness ≥ 20 mm had an effect on increasing post operative SSI rate especially in contaminated operations. These findings could be helpful in making healthcare providers fully aware and thus exercise special attention in wound care or even develop new modalities to prevent SSI in patients with the aforementioned risks.

Suture, synthetic, or biologic in contaminated ventral hernia repair.

PubMed

Bondre, Ioana L; Holihan, Julie L; Askenasy, Erik P; Greenberg, Jacob A; Keith, Jerrod N; Martindale, Robert G; Roth, J Scott; Liang, Mike K

2016-02-01

Data are lacking to support the choice between suture, synthetic mesh, or biologic matrix in contaminated ventral hernia repair (VHR). We hypothesize that in contaminated VHR, suture repair is associated with the lowest rate of surgical site infection (SSI). A multicenter database of all open VHR performed at from 2010-2011 was reviewed. All patients with follow-up of 1 mo and longer were included. The primary outcome was SSI as defined by the Centers for Disease Control and Prevention. The secondary outcome was hernia recurrence (assessed clinically or radiographically). Multivariate analysis (stepwise regression for SSI and Cox proportional hazard model for recurrence) was performed. A total of 761 VHR were reviewed for a median (range) follow-up of 15 (1-50) mo: there were 291(38%) suture, 303 (40%) low-density and/or mid-density synthetic mesh, and 167(22%) biologic matrix repair. On univariate analysis, there were differences in the three groups including ethnicity, ASA, body mass index, institution, diabetes, primary versus incisional hernia, wound class, hernia size, prior VHR, fascial release, skin flaps, and acute repair. The unadjusted outcomes for SSI (15.1%; 17.8%; 21.0%; P = 0.280) and recurrence (17.8%; 13.5%; 21.5%; P = 0.074) were not statistically different between groups. On multivariate analysis, biologic matrix was associated with a nonsignificant reduction in both SSI and recurrences, whereas synthetic mesh associated with fewer recurrences compared to suture (hazard ratio = 0.60; P = 0.015) and nonsignificant increase in SSI. Interval estimates favored biologic matrix repair in contaminated VHR; however, these results were not statistically significant. In the absence of higher level evidence, surgeons should carefully balance risk, cost, and benefits in managing contaminated ventral hernia repair. Copyright © 2016 Elsevier Inc. All rights reserved.

Intensive postoperative glucose control reduces the surgical site infection rates in gynecologic oncology patients.

PubMed

Al-Niaimi, Ahmed N; Ahmed, Mostafa; Burish, Nikki; Chackmakchy, Saygin A; Seo, Songwon; Rose, Stephen; Hartenbach, Ellen; Kushner, David M; Safdar, Nasia; Rice, Laurel; Connor, Joseph

2015-01-01

SSI rates after gynecologic oncology surgery vary from 5% to 35%, but are up to 45% in patients with diabetes mellitus (DM). Strict postoperative glucose control by insulin infusion has been shown to lower morbidity, but not specifically SSI rates. Our project studied continuous postoperative insulin infusion for 24h for gynecologic oncology patients with DM and hyperglycemia with a target blood glucose of <139 mL/dL and a primary outcome of the protocol's impact on SSI rates. We compared SSI rates retrospectively among three groups. Group 1 was composed of patients with DM whose blood glucose was controlled with intermittent subcutaneous insulin injections. Group 2 was composed of patients with DM and postoperative hyperglycemia whose blood glucose was controlled by insulin infusion. Group 3 was composed of patients with neither DM nor hyperglycemia. We controlled for all relevant factors associated with SSI. We studied a total of 372 patients. Patients in Group 2 had an SSI rate of 26/135 (19%), similar to patients in Group 3 whose rate was 19/89 (21%). Both were significantly lower than the SSI rate (43/148, 29%) of patients in Group 1. This reduction of 35% is significant (p = 0.02). Multivariate analysis showed an odd ratio = 0.5 (0.28-0.91) in reducing SSI rates after instituting this protocol. Initiating intensive glycemic control for 24h after gynecologic oncology surgery in patients with DM and postoperative hyperglycemia lowers the SSI rate by 35% (OR = 0.5) compared to patients receiving intermittent sliding scale insulin and to a rate equivalent to non-diabetics. Copyright © 2014. Published by Elsevier Inc.

Combination of Oral Antibiotics and Mechanical Bowel Preparation Reduces Surgical Site Infection in Colorectal Surgery.

PubMed

Ohman, Kerri A; Wan, Leping; Guthrie, Tracey; Johnston, Bonnie; Leinicke, Jennifer A; Glasgow, Sean C; Hunt, Steven R; Mutch, Matthew G; Wise, Paul E; Silviera, Matthew L

2017-10-01

Surgical site infections (SSI) are a common complication after colorectal surgery. An infection prevention bundle (IPB) was implemented to improve outcomes. A standardized IPB that included the administration of oral antibiotics with a mechanical bowel preparation, preoperative shower with chlorhexidine, hair removal and skin preparation in holding, antibiotic wound irrigation, and a "clean-closure" protocol was implemented in January 2013. Data from the American College of Surgeons NSQIP were analyzed at a single academic institution to compare pre-IPB and post-IPB SSI rates. In January 2014, a prospective database was implemented to determine compliance with individual IPB elements and their effect on outcomes. For the 24 months pre-IPB, the overall SSI rate was 19.7%. During the 30 months after IPB implementation, the SSI rate decreased to 8.2% (p < 0.0001). A subset of 307 patients was identified in both NSQIP and our prospective compliance databases. Elements of IPB associated with decreased SSI rates included preoperative shower with chlorhexidine (4.6% vs 16.2%; p = 0.005), oral antibiotics (3.4% vs 15.4%; p < 0.001), and mechanical bowel preparation (4.4% vs 14.3%; p = 0.008). Patients who received a full bowel preparation of both oral antibiotics and a mechanical bowel preparation had a 2.7% SSI rate compared with 15.8% for all others (p < 0.001). On multivariate analysis, full bowel preparation was independently associated with significantly fewer SSI (adjusted odds ratio 0.2; 95% CI 0.1 to 0.9; p = 0.006). Implementation of an IPB was successful in decreasing SSI rates in colorectal surgery patients. The combination of oral antibiotics with a mechanical bowel preparation was the strongest predictor of decreased SSI. Copyright © 2017 American College of Surgeons. All rights reserved.

Surgical site infection after central venous catheter-related infection in cardiac surgery. Analysis of a cohort of 7557 patients.

PubMed

Le Guillou, V; Tavolacci, M-P; Baste, J-M; Hubscher, C; Bedoit, E; Bessou, J-P; Litzler, P-Y

2011-11-01

The aim of this study was to establish the relationship between the occurrence of a surgical site infection (SSI) and the presence of a central venous catheter-related infection (CVCRI). The Department of Thoracic and Cardiovascular Surgery, University Hospital, Rouen, has carried out a prospective epidemiological survey of all nosocomial infections (pneumonia, SSI and CVCRI) since 1997. The study group included all consecutive patients who underwent cardiac surgery over a 10-year period from 1997 to 2007. A nested case-control study was conducted to identify the risk factors for SSI after CVCRI. Cases were patients with SSI after CVCRI and controls were randomized from patients who presented with CVCRI not followed by SSI. In total, 7557 patients were included and 133 SSIs (1.7%) were identified. The rate of superficial SSI was 0.7% [95% confidence interval (CI): 0.5-0.9] and of mediastinitis was 1.0% (95% CI: 0.8-1.2). Among the 133 cases of SSI, 12 (9.0%; 95% CI: 5.0-14.8) occurred after a CVCRI with identical micro-organisms. CVCRI [adjusted odds ratio (aOR): 5.2; 95% CI: 3.2-8.5], coronary artery bypass grafting (aOR: 2.9; 95% CI: 1.6-5.2), and obesity (aOR: 11.4; 95% CI: 1.0-130.1) were independent factors associated with SSI. The new finding of this study is that patients with CVCRI were 5.2 times more likely to develop SSI compared to patients without CVCRI. Copyright © 2011 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Short Operative Duration and Surgical Site Infection Risk in Hip and Knee Arthroplasty Procedures

PubMed Central

Dicks, Kristen V.; Baker, Arthur W.; Durkin, Michael J.; Anderson, Deverick J.; Moehring, Rebekah W.; Chen, Luke F.; Sexton, Daniel J.; Weber, David J.; Lewis, Sarah S.

2016-01-01

OBJECTIVE To determine the association (1) between shorter operative duration and surgical site infection (SSI) and (2) between surgeon median operative duration and SSI risk among first-time hip and knee arthroplasties. DESIGN Retrospective cohort study SETTING A total of 43 community hospitals located in the southeastern United States. PATIENTS Adults who developed SSIs according to National Healthcare Safety Network criteria within 365 days of first-time knee or hip arthroplasties performed between January 1, 2008 and December 31, 2012. METHODS Log-binomial regression models estimated the association (1) between operative duration and SSI outcome and (2) between surgeon median operative duration and SSI outcome. Hip and knee arthroplasties were evaluated in separate models. Each model was adjusted for American Society of Anesthesiology score and patient age. RESULTS A total of 25,531 hip arthroplasties and 42,187 knee arthroplasties were included in the study. The risk of SSI in knee arthroplasties with an operative duration shorter than the 25th percentile was 0.40 times the risk of SSI in knee arthroplasties with an operative duration between the 25th and 75th percentile (risk ratio [RR], 0.40; 95% confidence interval [CI], 0.38–0.56; P <.01). Short operative duration did not demonstrate significant association with SSI for hip arthroplasties (RR, 1.04; 95% CI, 0.79–1.37; P =.36). Knee arthroplasty surgeons with shorter median operative durations had a lower risk of SSI than surgeons with typical median operative durations (RR, 0.52; 95% CI, 0.43–0.64; P <.01). CONCLUSIONS Short operative durations were not associated with a higher SSI risk for knee or hip arthroplasty procedures in our analysis. PMID:26391277

Predictive factors for surgical site infection in general surgery.

PubMed

Haridas, Manjunath; Malangoni, Mark A

2008-10-01

Global parameters, such as wound class, the American Society of Anesthesiologists' physical classification score, and prolonged operative time, have been associated with the risk of surgical site infection (SSI). We hypothesized that additional risk factors for SSI would be identified by controlling for these parameters and that deep and organ/space SSI may have different risk factors for occurrence. A retrospective review was performed on general and vascular surgical patients who underwent an operation between June 2000 and June 2006 at a single institution. Patients with SSI were matched with a case-control cohort of patients without infection (no SSI) according to age, sex, ASA score, wound class, and type of operative procedure. Data were analyzed using bivariate and regression analyses. Overall, 10,253 general surgical procedures were performed during the 6-year period; 316 patients (3.1%) developed SSI. In all, 300 patients with 251 superficial (83.6%), 22 deep (7.3%), and 27 organ/space (9%) SSIs were matched for comparison. Multivariate logistic regression analysis identified previous operation (odds ratio [OR], 2.4; 95% confidence interval [CI] = 1.6-3.7), duration of operation >or=75th percentile (OR, 1.8; 95% CI = 1.2-2.8), hypoalbuminemia (OR, 1.8; 95% CI = 1.1-2.8), and a history of chronic obstructive pulmonary disease (OR, 1.7; 95% CI = 1.0-2.8) as independent risk factors for SSI. Only hypoalbuminemia (OR, 2.9; 95% CI = 1.4-6.3) and a previous operation (OR, 2.0; 95% CI = 1.0-4.4) were significantly associated with deep or organ/space infections. These results demonstrate additional factors that increase the risk of developing SSI. Deep and organ/space infections have a different risk profile. This information should guide clinicians in their assessment of SSI risk and should identify targets for intervention to decrease the incidence of SSI.

Contextualizing Nature of Science Instruction in Socioscientific Issues

NASA Astrophysics Data System (ADS)

Eastwood, Jennifer Lynne; Sadler, Troy D.; Zeidler, Dana L.; Lewis, Anna; Amiri, Leila; Applebaum, Scott

2012-10-01

The purpose of this study was to investigate the effects of two learning contexts for explicit-reflective nature of science (NOS) instruction, socioscientific issues (SSI) driven and content driven, on student NOS conceptions. Four classes of 11th and 12th grade anatomy and physiology students participated. Two classes experienced a curricular sequence organized around SSI (the SSI group), and two classes experienced a content-based sequence (the Content group). An open-ended NOS questionnaire was administered to both groups at the beginning and end of the school year and analyzed to generate student profiles. Quantitative analyses were performed to compare pre-instruction NOS conceptions between groups as well as pre to post changes within groups and between groups. Both SSI and Content groups showed significant gains in most NOS themes, but between-group gains were not significantly different. Qualitative analysis of post-instruction responses, however, revealed that students in the SSI group tended to use examples to describe their views of the social/cultural NOS. The findings support SSI contexts as effective for promoting gains in students' NOS understanding and suggest that these contexts facilitate nuanced conceptions that should be further explored.

Predictors of surgical site infection in laparoscopic and open ventral incisional herniorrhaphy.

PubMed

Kaafarani, Haytham M A; Kaufman, Derrick; Reda, Domenic; Itani, Kamal M F

2010-10-01

Surgical site infection (SSI) after ventral incisional hernia repair (VIH) can result in serious consequences. We sought to identify patient, procedure, and/or hernia characteristics that are associated with SSI in VIH. Between 2004 and 2006, patients were randomized in four Veteran Affairs (VA) hospitals to undergo laparoscopic or open VIH. Patients who developed SSI within eight weeks postoperatively were compared to those who did not. A bivariate analysis for each factor and a multiple logistic regression analysis were performed to determine factors associated with SSI. The variables studied included patient characteristics and co-morbidities (e.g., age, gender, race, ethnicity, body mass index, ASA classification, diabetes, steroid use), hernia characteristics (e.g., size, duration, number of previous incisions), procedure characteristics (e.g., open versus laparoscopic, blood loss, use of postoperative drains, operating room temperature) and surgeons' experience (resident training level, number of open VIH previously performed by the attending surgeon). Antibiotic prophylaxis, anticoagulation protocols, preparation of the skin, draping of the wound, body temperature control, and closure of the surgical site were all standardized and monitored throughout the study period. Out of 145 patients who underwent VIH, 21 developed a SSI (14.5%). Patients who underwent open VIH had significantly more SSIs than those who underwent laparoscopic VIH (22.1% versus 3.4%; P = 0.002). Among patients who underwent open VIH, those who developed SSI had a recorded intraoperative blood loss greater than 25 mL (68.4% versus 40.3%; P = 0.030), were more likely to have a drain placed (79.0% versus 49.3%; P = 0.021) and were more likey to be operated on by surgeons with less than 75 open VIH case experience (52.6% versus 28.4%; P = 0.048). Patient and hernia characteristics were similar between the two groups. In a multiple logistic regression analysis, the open surgical technique was associated with SSI (OR 8.03, 95% CI 2.03, 31.72; P = 0.003) while controlling for the VA medical center where the procedure was performed (P = 0.041). Open surgical technique and the medical center rather than patient co-morbidities or hernia characteristics are associated with the formation of postoperative SSI in VIH. Published by Elsevier Inc.

Reliability and validity of the student stress inventory-stress manifestations questionnaire and its association with personal and academic factors in university students.

PubMed

Simonelli-Muñoz, Agustín J; Balanza, Serafín; Rivera-Caravaca, José Miguel; Vera-Catalán, Tomás; Lorente, Ana María; Gallego-Gómez, Juana I

2018-05-01

Stress affects us in every environment and it is also present in the educational sphere. Previous studies have reported a high prevalence of stress in university students. The Student Stress Inventory-Stress Manifestations (SSI-SM), identify stressors and evaluate stress manifestations in adolescents but its validity in university students remains uncertain. We aimed to determine the internal consistency and validity of an adapted version of the Student Stress Inventory-Stress Manifestations (SSI-SM) for university students and to investigate if high stress levels are associated with personal and academic factors. In this quantitative, descriptive, cross-sectional study, we included 115 university students of the Nursing Degree during the second semester of the 2014/2015 academic year. Information about personal issues, lifestyle and academic performance was recorded and the stress was evaluated with the SSI-SM questionnaire. The internal consistency and homogeneity of the SSI-SM questionnaire was tested and a factorial analysis was performed. After the homogeneity analysis, the final version of the SSI-SM questionnaire included 19 items, with a Cronbach's alpha of 0.924. In the factorial analysis, 4 factors were found ('Self-concept', 'Sociability', 'Uncertainty' and 'Somatization'; all Cronbach's alpha >0.700). Students with higher values on the SSI-SM were, in overall, women (41.0 ± 12.7 vs. 33.2 ± 9.5; p = 0.001) and had significantly more family conflicts (47.6 ± 13.8 vs. 35.2 ± 9.6; p < 0.001), consumed less alcohol (R = -0.184, p = 0.048), slept less hours (R = -0.193, p = 0.038) and had worse academic performance in Clinical Nursing (36.3 ± 10.4 vs. 41.2 ± 13.3, p = 0.039). After exclude three items of the original SSI-SM, higher scores in the SSI-SM are correlated with stress level in a cohort of university students of the Nursing Degree. Family conflicts, female gender, absence of alcohol consumption, few sleep hours and poor academic performance are associated with higher stress levels. Copyright © 2018 Elsevier Ltd. All rights reserved.

Science teachers teaching socioscientific issues (SSI): Four case studies

NASA Astrophysics Data System (ADS)

Lee, Hyunju

Socioscientific issues (SSI) are a class of issues that represent the social, ethical, and moral aspects of science in society. The need for the inclusion of SSI into science curricula has been generally accepted, but relatively few science teachers have incorporated SSI into their courses. Most science teachers feel that their most important task by far is to teach the principles of science, and any substantive pedagogical changes represent a burden. However, there are some teachers who address SSI out of personal initiatives. This dissertation study investigates four high school science teachers who address SSI out of their own initiative and explores their deeper inspirations, values, philosophies, and personal ideals that lead them to teach SSI. The overall approach is based on essentialist methodology (Witz, Goodwin, Hart, & Thomas, 2001; Witz, 2006a) with its focus on "the participant as ally" and "essentialist portraiture." The primary data source is four to six in-depth interviews with individual teachers (about 40-90 minutes for each interview). The interviews are complemented by extensive classroom observations of individual teachers' teaching SSI and by document analysis (including teaching materials, rubrics, student group projects and journals, etc.). There are two major findings. First, the teachers' deeper values and ideals are a source of larger inspiration that plays a significant role in changing their teaching practice. This inspiration may involve higher aspects (e.g., deep concern for students' development, unselfishness, caring, etc.) and commitment. Their teaching represents an integration of their personal experiences, values, concerns, and worldviews, which forms a larger inspiration for teaching. Teaching SSI is a part of this larger process. Second, the current curriculum reforms (STS, SSI, and NOS) only suggest theoretical ideals and do not effectively touch teachers' deeper values and ideals. Basically, the teachers are doing what they think is important for students and are developing their own approaches without any contact with the reform efforts. This brings some consequences in their teaching of SSI. Overall, this study suggests that real changes in science education can be achieved only if they are synchronized with individual teachers' deeper motivations.

Comparative analysis of different weight matrices in subspace system identification for structural health monitoring

NASA Astrophysics Data System (ADS)

Shokravi, H.; Bakhary, NH

2017-11-01

Subspace System Identification (SSI) is considered as one of the most reliable tools for identification of system parameters. Performance of a SSI scheme is considerably affected by the structure of the associated identification algorithm. Weight matrix is a variable in SSI that is used to reduce the dimensionality of the state-space equation. Generally one of the weight matrices of Principle Component (PC), Unweighted Principle Component (UPC) and Canonical Variate Analysis (CVA) are used in the structure of a SSI algorithm. An increasing number of studies in the field of structural health monitoring are using SSI for damage identification. However, studies that evaluate the performance of the weight matrices particularly in association with accuracy, noise resistance, and time complexity properties are very limited. In this study, the accuracy, noise-robustness, and time-efficiency of the weight matrices are compared using different qualitative and quantitative metrics. Three evaluation metrics of pole analysis, fit values and elapsed time are used in the assessment process. A numerical model of a mass-spring-dashpot and operational data is used in this research paper. It is observed that the principal components obtained using PC algorithms are more robust against noise uncertainty and give more stable results for the pole distribution. Furthermore, higher estimation accuracy is achieved using UPC algorithm. CVA had the worst performance for pole analysis and time efficiency analysis. The superior performance of the UPC algorithm in the elapsed time is attributed to using unit weight matrices. The obtained results demonstrated that the process of reducing dimensionality in CVA and PC has not enhanced the time efficiency but yield an improved modal identification in PC.

Use of prophylactic postoperative antibiotics during surgical drain presence following mastectomy.

PubMed

Edwards, Brandy L; Stukenborg, George J; Brenin, David R; Schroen, Anneke T

2014-10-01

National guidelines recommend one dose of perioperative antibiotics for breast surgery and discourage postoperative continuation. However, reported skin and soft tissue infection (SSI) rates after mastectomy range from 1-26 %, higher than expected for clean cases. Utility of routine or selective postoperative antibiotic use for duration of drain presence following mastectomy remains uncertain. This study included all female patients who underwent mastectomy without reconstruction at our institution between 2005 and 2012. SSI was defined using CDC criteria or clinical diagnosis of cellulitis. Information on risk factors for infection (age, body mass index [BMI], smoking status, diabetes, steroid use), prior breast cancer treatment, drain duration, and antibiotic use was abstracted from medical records. Multivariable logistic regression was used to assess the association between postoperative antibiotic use and the occurrence of SSI, adjusting for concurrent risk factors. Among 480 patients undergoing mastectomy without reconstruction, 425 had sufficient documentation for analysis. Of these, 268 were prescribed antibiotics (63 %) at hospital discharge. An overall SSI rate of 7.3 % was observed, with 14 % of patients without postoperative antibiotics developing SSI compared with 3.4 % with antibiotics (p < 0.0001). Factors independently associated with SSI were smoking and advancing age. Diabetes, steroid use, BMI, prior breast surgery, neoadjuvant chemotherapy, prior radiation, concomitant axillary surgery, and drain duration were not associated with increased SSI rates. SSI rates among patients who did and did not receive postoperative antibiotics after mastectomy were significantly different, particularly among smokers and women of advanced age. These patient subgroups may warrant special consideration for postoperative antibiotics.

Use of Prophylactic Postoperative Antibiotics During Surgical Drain Presence Following Mastectomy

PubMed Central

Edwards, Brandy L.; Stukenborg, George J.; Brenin, David R.; Schroen, Anneke T.

2015-01-01

Background National guidelines recommend one dose of perioperative antibiotics for breast surgery and discourage postoperative continuation. However, reported skin and soft tissue infection (SSI) rates after mastectomy range from 1–26 %, higher than expected for clean cases. Utility of routine or selective postoperative antibiotic use for duration of drain presence following mastectomy remains uncertain. Methods This study included all female patients who underwent mastectomy without reconstruction at our institution between 2005 and 2012. SSI was defined using CDC criteria or clinical diagnosis of cellulitis. Information on risk factors for infection (age, body mass index [BMI], smoking status, diabetes, steroid use), prior breast cancer treatment, drain duration, and antibiotic use was abstracted from medical records. Multivariable logistic regression was used to assess the association between postoperative antibiotic use and the occurrence of SSI, adjusting for concurrent risk factors. Results Among 480 patients undergoing mastectomy without reconstruction, 425 had sufficient documentation for analysis. Of these, 268 were prescribed antibiotics (63 %) at hospital discharge. An overall SSI rate of 7.3 % was observed, with 14 % of patients without postoperative antibiotics developing SSI compared with 3.4 % with antibiotics (p < 0.0001). Factors independently associated with SSI were smoking and advancing age. Diabetes, steroid use, BMI, prior breast surgery, neoadjuvant chemotherapy, prior radiation, concomitant axillary surgery, and drain duration were not associated with increased SSI rates. Conclusions SSI rates among patients who did and did not receive postoperative antibiotics after mastectomy were significantly different, particularly among smokers and women of advanced age. These patient subgroups may warrant special consideration for postoperative antibiotics. PMID:25138078

Risk factors for surgical site infection following nonshunt pediatric neurosurgery: a review of 9296 procedures from a national database and comparison with a single-center experience

PubMed Central

Sherrod, Brandon A.; Arynchyna, Anastasia A.; Johnston, James M.; Rozzelle, Curtis J.; Blount, Jeffrey P.; Oakes, W. Jerry; Rocque, Brandon G.

2017-01-01

Objective Surgical site infection (SSI) following CSF shunt operations has been well studied, yet risk factors for nonshunt pediatric neurosurgery are less well understood. The purpose of this study was to determine SSI rates and risk factors following nonshunt pediatric neurosurgery using a nationwide patient cohort and an institutional dataset specifically for better understanding SSI. Methods The authors reviewed the American College of Surgeons National Surgical Quality Improvement Program Pediatric (ACS NSQIP-P) database for the years 2012–2014, including all neurosurgical procedures performed on pediatric patients except CSF shunts and hematoma evacuations. SSI included deep (intracranial abscesses, meningitis, osteomyelitis, and ventriculitis) and superficial wound infections. The authors performed univariate analyses of SSI association with procedure, demographic, comorbidity, operative, and hospital variables, with subsequent multivariate logistic regression analysis to determine independent risk factors for SSI within 30 days of the index procedure. A similar analysis was performed using a detailed institutional infection database from Children’s Hospital of Alabama (COA). Results A total of 9296 nonshunt procedures were identified in NSQIP-P with an overall 30-day SSI rate of 2.7%. The 30-day SSI rate in the COA institutional database was similar (3.3% of 1103 procedures, p = 0.325). Postoperative time to SSI in NSQIP-P and COA was 14.6 ± 6.8 days and 14.8 ± 7.3 days, respectively (mean ± SD). Myelomeningocele (4.3% in NSQIP-P, 6.3% in COA), spine (3.5%, 4.9%), and epilepsy (3.4%, 3.1%) procedure categoriess had the highest SSI rates by procedure category in both NSQIP-P and COA. Independent SSI risk factors in NSQIP-P included postoperative pneumonia (OR 4.761, 95% CI 1.269–17.857, p = 0.021), immune disease/immunosuppressant use (OR 3.671, 95% CI 1.371–9.827, p = 0.010), cerebral palsy (OR 2.835, 95% CI 1.463–5.494, p = 0.002), emergency operation (OR 1.843, 95% CI 1.011–3.360, p = 0.046), spine procedures (OR 1.673, 95% CI 1.036–2.702, p = 0.035), acquired CNS abnormality (OR 1.620, 95% CI 1.085–2.420, p = 0.018), and female sex (OR 1.475, 95% CI 1.062–2.049, p = 0.021). The only COA factor independently associated with SSI in the COA database included clean-contaminated wound classification (OR 3.887, 95% CI 1.354–11.153, p = 0.012), with public insurance (OR 1.966, 95% CI 0.957–4.041, p = 0.066) and spine procedures (OR 1.982, 95% CI 0.955–4.114, p = 0.066) approaching significance. Both NSQIP-P and COA multivariate model C-statistics were > 0.7. Conclusions NSQIP-P SSI rates, but not risk factors, were similar to data from a single center. PMID:28186476

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wight, L.; Zaslawsky, M.

Two approaches for calculating soil structure interaction (SSI) are compared: finite element and lumped mass. Results indicate that the calculations with the lumped mass method are generally conservative compared to those obtained by the finite element method. They also suggest that a closer agreement between the two sets of calculations is possible, depending on the use of frequency-dependent soil springs and dashpots in the lumped mass calculations. There is a total lack of suitable guidelines for implementing the lumped mass method of calculating SSI, which leads to the conclusion that the finite element method is generally superior for calculative purposes.

Contributions of human activities to suspended-sediment yield during storm events from a steep, small, tropical watershed, American Samoa

NASA Astrophysics Data System (ADS)

Messina, A. T.; Biggs, T. W.

2014-12-01

Anthropogenic watershed disturbance by agriculture, deforestation, roads, and urbanization can alter the timing, composition, and mass of sediment loads to adjacent coral reefs, causing enhanced sediment stress on corals near the outlets of impacted watersheds like Faga'alu, American Samoa. To quantify the increase in sediment loading to the adjacent priority coral reef experiencing sedimentation stress, suspended-sediment yield (SSY) from undisturbed and human-disturbed portions of a small, steep, tropical watershed was measured during baseflow and storm events of varying magnitude. Data on precipitation, discharge, turbidity, and suspended-sediment concentration (SSC) were collected over three field campaigns and continuous monitoring from January 2012 to March 2014, which included 88 storm events. A combination of paired- and nested-watershed study designs using sediment budget, disturbance ratio, and sediment rating curve methodologies was used to quantify the contribution of human-disturbed areas to total SSY. SSC during base- and stormflows was significantly higher downstream of an open-pit aggregate quarry, indicating the quarry is a key sediment source requiring sediment discharge mitigation. Comparison of event-wise SSY from the upper, undisturbed watershed, and the lower, human-disturbed watershed showed the Lower watershed accounted for more than 80% of total SSY on average, and human activities have increased total sediment loading to the coast by approximately 200%. Four storm characteristics were tested as predictors of event SSY using Pearson's and Spearman's correlation coefficients. Similar to mountainous watersheds in semi-arid and temperate watersheds, SSY from both the undisturbed and disturbed watersheds had the highest correlation with event maximum discharge, Qmax (Pearson's R=0.88 and 0.86 respectively), and were best fit by a power law relationship. The resulting model of event-SSY from Faga'alu is being incorporated as part of a larger project investigating relationships and interactions between terrigenous sediment, water circulation over the reef, and the spatial distribution of sediment accumulation under various conditions in a linked watershed and fringing-reef embayment.

Postoperative infection in spine surgery: does the month matter?

PubMed

Durkin, Michael J; Dicks, Kristen V; Baker, Arthur W; Moehring, Rebekah W; Chen, Luke F; Sexton, Daniel J; Lewis, Sarah S; Anderson, Deverick J

2015-07-01

The relationship between time of year and surgical site infection (SSI) following neurosurgical procedures is poorly understood. Authors of previous reports have demonstrated that rates of SSI following neurosurgical procedures performed during the summer months were higher compared with rates during other seasons. It is unclear, however, if this difference was related to climatological changes or inexperienced medical trainees (the July effect). The aim of this study was to evaluate for seasonal variation of SSI following spine surgery in a network of nonteaching community hospitals. The authors analyzed 6 years of prospectively collected surveillance data (January 1, 2007, to December 31, 2012) from all laminectomies and spinal fusions from 20 hospitals in the Duke Infection Control Outreach Network of community hospitals. Surgical site infections were defined using National Healthcare Safety Network criteria and identified using standardized methods across study hospitals. Regression models were then constructed using Poisson distribution to evaluate for seasonal trends by month. Each analysis was first performed for all SSIs and then for SSIs caused by specific organisms or classes of organisms. Categorical analysis was performed using two separate definitions of summer: June through September (definition 1), and July through September (definition 2). The prevalence rate of SSIs during the summer was compared with the prevalence rate during the remainder of the year by calculating prevalence rate ratios and 95% confidence intervals. The authors identified 642 SSIs following 57,559 neurosurgical procedures (overall prevalence rate = 1.11/100 procedures); 215 occurred following 24,466 laminectomies (prevalence rate = 0.88/100 procedures), and 427 following 33,093 spinal fusions (prevalence rate = 1.29/100 procedures). Common causes of SSI were Staphylococcus aureus (n = 380; 59%), coagulase-negative staphylococci (n = 90; 14%), and Escherichia coli (n = 41; 6.4%). Poisson regression models demonstrated increases in the rates of SSI during each of the summer months for all SSIs and SSIs due to gram-positive cocci, S. aureus, and methicillin-sensitive S. aureus. Categorical analysis confirmed that the rate of SSI during the 4-month summer period was higher than the rate during the remainder of the year, regardless of which definition for summer was used (definition 1, p = 0.008; definition 2, p = 0.003). Similarly, the rates of SSI due to grampositive cocci and S. aureus were higher during the summer months than the remainder of the year regardless of which definition of summer was used. However, the rate of SSI due to gram-negative bacilli was not. The rate of SSI following fusion or spinal laminectomy/laminoplasty was higher during the summer in this network of community hospitals. The increase appears to be related to increases in SSIs caused by gram-positive cocci and, more specifically, S. aureus. Given the nonteaching nature of these hospitals, the findings demonstrate that increases in the rate of SSI during the summer are more likely related to ecological and/or environmental factors than the July effect.

Analysis of a Floodplain I-Wall Embedded in Horizontally Stratified Soil Layers During Flood Events Using Corps I-Wall Software Version 1.0

DTIC Science & Technology

2016-07-01

and gap propagation engineering methodology implemented within the software (CI-Wall) makes use of a hydraulic fracturing criterion, as discussed in...moist unit weight). Soil unit weights: Because of the presence of the upper moist (i.e, non - saturated) region R01 clay layer that is immediately...from two series of complete soil-structure interaction (SSI) non - linear finite element studies for I-Walls at New Orleans and other locations

Decoupling Solar Variability and Instrument Trends Using the Multiple Same-Irradiance-Level (MuSIL) Analysis Technique

NASA Astrophysics Data System (ADS)

Woods, Thomas N.; Eparvier, Francis G.; Harder, Jerald; Snow, Martin

2018-05-01

The solar spectral irradiance (SSI) dataset is a key record for studying and understanding the energetics and radiation balance in Earth's environment. Understanding the long-term variations of the SSI over timescales of the 11-year solar activity cycle and longer is critical for many Sun-Earth research topics. Satellite measurements of the SSI have been made since the 1970s, most of them in the ultraviolet, but recently also in the visible and near-infrared. A limiting factor for the accuracy of previous solar variability results is the uncertainties for the instrument degradation corrections, which need fairly large corrections relative to the amount of solar cycle variability at some wavelengths. The primary objective of this investigation has been to separate out solar cycle variability and any residual uncorrected instrumental trends in the SSI measurements from the Solar Radiation and Climate Experiment (SORCE) mission and the Thermosphere, Mesosphere, Ionosphere, Energetic, and Dynamics (TIMED) mission. A new technique called the Multiple Same-Irradiance-Level (MuSIL) analysis has been developed, which examines an SSI time series at different levels of solar activity to provide long-term trends in an SSI record, and the most common result is a downward trend that most likely stems from uncorrected instrument degradation. This technique has been applied to each wavelength in the SSI records from SORCE (2003 - present) and TIMED (2002 - present) to provide new solar cycle variability results between 27 nm and 1600 nm with a resolution of about 1 nm at most wavelengths. This technique, which was validated with the highly accurate total solar irradiance (TSI) record, has an estimated relative uncertainty of about 5% of the measured solar cycle variability. The MuSIL results are further validated with the comparison of the new solar cycle variability results from different solar cycles.

Mono- and polynuclear Co(II) silanethiolates with aliphatic diamines

NASA Astrophysics Data System (ADS)

Pladzyk, Agnieszka; Baranowska, Katarzyna

2014-01-01

Four Co(II) complexes, [Co{SSi(OtBu)3}2(dmpda)] 1, [Co{SSi(OtBu)3}2(bda)2]n2 [Co{SSi(OtBu)3}2(pda)2]n3 and [Co{SSi(OtBu)3}2(hda)2]n4 [dmpda = 3-(dimethylamino)-1-propylamine; bda = 1.4-butanediamine; pda = 1.5-pentanediamine; had = 1.6-hexanediamine] have been synthesized and characterized using X-ray diffraction. Complex 1 is mononuclear and contains Co(II) coordinated by dmpda molecule in chelating mode, whereas compounds 3 and 4 are one-dimensional polymers with pda and hda diamines as bridges between the metallic centers respectively. In all complexes tri-tert-butoxysilanethiolate residue acts as terminal S-donor ligand. Full characterization of obtained compounds 1-4 was additionally carried out with the use of IR and UV-vis spectroscopy, elemental and thermal analysis.

Surgical site infections following craniotomy focusing on possible post-operative acquisition of infection: prospective cohort study.

PubMed

Sneh-Arbib, O; Shiferstein, A; Dagan, N; Fein, S; Telem, L; Muchtar, E; Eliakim-Raz, N; Rubinovitch, B; Rubin, G; Rappaport, Z H; Paul, M

2013-12-01

Neurosurgery is characterized by a prolonged risk period for surgical site infection (SSI), mainly related to the presence of cerebrospinal fluid (CSF) drains. We aimed to examine factors associated with post-neurosurgical SSIs, focusing on post-operative factors. A prospective cohort study was conducted in a single center over a period of 18 months in Israel. Included were adult patients undergoing clean or clean-contaminated craniotomy, including craniotomies with external CSF drainage or shunts. SSIs were defined by the Centers for Disease Control and Prevention (CDC) criteria for healthcare-associated infections. All patients were followed up for 90 days and those with foreign body insertion for 1 year. We compared patients with and without SSI. A multivariable regression analysis for SSI was conducted including uncorrelated variables significantly associated with SSI. A total of 502 patients were included, with 138 (27.5%) undergoing emergent or urgent craniotomy. The overall SSI rate was 5.6% (28 patients), of which 3.2% (16 patients) were intracerebral. Non-elective surgery, external CSF drainage/monitoring devices, re-operation, and post-operative respiratory failure were independently associated with subsequent SSI. External CSF devices was the only significant risk factor for intracerebral SSIs (p < 0.001). Internal shunts or other foreign body insertions were not associated with SSIs. A phenotypically identical isolate to that causing the SSI was isolated from respiratory secretions prior to the SSI in 4/9 patients with microbiologically documented intracerebral SSIs. Patients with SSIs had longer hospital stay, poorer functional capacity on discharge, and higher 90-day mortality. We raise the possibility of post-operative infection acquisition through external CSF devices. Standard operating procedures for their maintenance are necessary.

Independent risk factors for surgical site infection after cesarean delivery in a rural tertiary care medical center.

PubMed

Vallejo, Manuel C; Attaallah, Ahmed F; Shapiro, Robert E; Elzamzamy, Osama M; Mueller, Michael G; Eller, Warren S

2017-02-01

We aimed to determine the incidence of surgical site infection (SSI) after cesarean delivery (CD) and identify the risk factors in a rural population. We identified 218 SSI patients by International Classification of Disease codes and matched them with 3131 parturients (control) from the electronic record database in a time-matched retrospective quality assurance analysis. The incidence of SSI after CD was 7.0 %. Risk factors included higher body mass index (BMI) [40.30 ± 10.60 kg/m 2 SSI (95 % CI 38.73-41.87) vs 34.05 ± 8.24 kg/m 2 control (95 % CI 33.75-34.35, P < 0.001)], years of education [13.28 ± 2.44 years SSI (95 % CI 12.9-13.66) vs 14.07 ± 2.81 years control (95 % CI 13.96-14.18, P < 0.001)], number of prior births [2 (1-9) SSI vs 1 (1-11) control (P < 0.001)], tobacco use (OR 1.49; 95 % CI 1.06-2.09, P = 0.03), prior diagnosis of hypertension (OR 1.80; 95 % CI 1.34-2.42, P < 0.001), gestational diabetes (OR 1.59; 95 % CI 1.18-2.13, P = 0.003), and an emergency/STAT CD (OR 1.6; 95 % CI 1.1-2.3, P = 0.01). Risk factors for SSI after CD included higher BMI, less years of education, higher prior births, tobacco use, prior diagnosis of hypertension, gestational diabetes, and emergency/STAT CD. The presence of ruptured membranes was protective against SSI.

Middle Atmosphere Response to Different Descriptions of the 11-Year Solar Cycle in Spectral Irradiance in a Chemistry-Climate Model

NASA Technical Reports Server (NTRS)

Swartz, W. H.; Stolarski, R. S.; Oman, L. D.; Fleming, E. L.; Jackman, C. H.

2012-01-01

The 11-year solar cycle in solar spectral irradiance (SSI) inferred from measurements by the SOlar Radiation & Climate Experiment (SORCE) suggests a much larger variation in the ultraviolet than previously accepted. We present middle atmosphere ozone and temperature responses to the solar cycles in SORCE SSI and the ubiquitous Naval Research Laboratory (NRL) SSI reconstruction using the Goddard Earth Observing System chemistry-climate model (GEOS CCM). The results are largely consistent with other recent modeling studies. The modeled ozone response is positive throughout the stratosphere and lower mesosphere using the NRL SSI, while the SORCE SSI produces a response that is larger in the lower stratosphere but out of phase with respect to total solar irradiance above 45 km. The modeled responses in total ozone are similar to those derived from satellite and ground-based measurements, 3-6 Dobson Units per 100 units of 10.7-cm radio flux (F10.7) in the tropics. The peak zonal mean tropical temperature response 50 using the SORCE SSI is nearly 2 K per 100 units 3 times larger than the simulation using the NRL SSI. The GEOS CCM and the Goddard Space Flight Center (GSFC) 2-D coupled model are used to examine how the SSI solar cycle affects the atmosphere through direct solar heating and photolysis processes individually. Middle atmosphere ozone is affected almost entirely through photolysis, whereas the solar cycle in temperature is caused both through direct heating and photolysis feedbacks, processes that are mostly linearly separable. Further, the net ozone response results from the balance of ozone production at wavelengths less than 242 nm and destruction at longer wavelengths, coincidentally corresponding to the wavelength regimes of the SOLar STellar Irradiance Comparison Experiment (SOLSTICE) and Spectral Irradiance Monitor (SIM) on SORCE, respectively. A higher wavelength-resolution analysis of the spectral response could allow for a better prediction of the atmospheric response to arbitrary SSI variations.

Surgical site infection after surgery to repair femoral neck fracture: a French multicenter retrospective study.

PubMed

Merrer, Jacques; Girou, Emmanuelle; Lortat-Jacob, Alain; Montravers, Philippe; Lucet, Jean-Christophe

2007-10-01

Femoral neck fracture is the most frequent orthopedic emergency among elderly persons. Despite a high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) carriage in this population, no multicenter study of antibiotic prophylaxis practices and the rate and microbiological characteristics of surgical site infection (SSI) has been performed in France. Retrospective, multicenter cohort study. Twenty-two university and community hospitals in France. Each center provided data on 25 consecutive patients who underwent surgery for femoral neck fracture during the first quarter of 2005. Demographic, clinical, and follow-up characteristics were recorded, and most patients had a follow-up office visit or were involved in a telephone survey 1 year after surgery. These 22 centers provided data on 541 patients, 396 (73%) of whom were followed up 1 year after surgery. Of 504 (93%) patients for whom antibiotic prophylaxis was recorded, 433 (86%) received a cephalosporin. Twenty-two patients had an SSI, for a rate of 5.6% (95% confidence interval, 3.7-8.0). SSI was reported for 15 (6.9%) of patients who had a prosthesis placed and for 7 (3.9%) who underwent osteosynthesis (P=.27). SSI was diagnosed a median of 30 days after surgery (interquartile range, 21-41 days); 7 (32%) of these SSIs were superficial infections, and 15 (68%) were deep or organ-space infections. MRSA caused 7 SSIs (32%), Pseudomonas aeruginosa caused 5 (23%), other staphylococci caused 4 (18%), and other bacteria caused 2 (9%); the etiologic pathogen was unknown in 4 cases (18%). Reoperation was performed for 14 patients with deep or organ-space SSI, including 6 of 7 patients with MRSA SSI. The mortality rate 1 year after surgery was 20% overall but 50% among patients with SSI. In univariate analysis, only the National Nosocomial Infections Surveillance System risk index score was significantly associated with SSI (P=.006). SSI after surgery for femoral neck fracture is severe, and MRSA is the most frequently encountered etiologic pathogen. A large, multicenter prospective trial is necessary to determine whether the use of antibiotic prophylaxis effective against MRSA would decrease the SSI rate in this population.

Antimicrobial prophylaxis to prevent surgical site infection in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion: 2 doses versus antibiotics till drain removal.

PubMed

Kamath, Vijay H D; Cheung, Jason Pui Yin; Mak, Kin Cheung; Wong, Yat Wa; Cheung, Wai Yuen; Luk, Keith Dip Kei; Cheung, Kenneth Man Chee

2016-10-01

There is much variation in the choice, timing and duration of antimicrobial prophylaxis for preventing surgical site infections (SSI) but no guideline exists for scoliosis surgery. The aim of study was to compare the efficacy of two antimicrobial prophylaxis (AMP) protocols with cephazolin in preventing SSI in adolescent idiopathic scoliosis (AIS). A retrospective comparative analysis of two post-operative AMP protocols (two postoperative doses versus continued antibiotics till drain removal) was performed. Patient characteristics, pre-operative, intra- and post-operative risk factors for infection, drain use, generic drug name and number of doses administered were recorded from 226 patients with AIS who had undergone posterior spinal fusion. Details of superficial or deep SSI and wound healing aberrations, and serious adverse events were recorded. Analysis was performed to evaluate differences in the pre-, intra- and post-operative variables between the two groups. 155 patients received 2 postoperative doses of AMP and 71 patients had antibiotics till drain removal. The average follow-up was 43 months. The overall rate of SSI was 1.7 % for the spine wound and 1.3 % for the iliac crest wound. 1.9 % of patients with 2 doses of AMP and 1.4 % of patients with antibiotics till drain removal had SSI. No adverse reactions attributable to cephazolin were observed. This is the first study on the AMP protocol in scoliosis surgery for SSI prevention. Results suggest that two doses of AMP are as effective as continued antimicrobial use until drain removal. Cephazolin appears to be effective and safe for prophylaxis.

Efficacy of prophylactic antibiotic administration for breast cancer surgery in overweight or obese patients: a randomized controlled trial.

PubMed

Gulluoglu, Bahadir M; Guler, Sertac Ata; Ugurlu, M Umit; Culha, Gulcan

2013-01-01

To assess the impact of prophylactic antibiotics on the prevention of surgical site infection (SSI) and the cost-effectiveness of this prophylaxis for breast cancer surgery in overweight or obese women. SSI is higher than expected after breast surgery. Obesity was found to be one of the risk factors. The trial was designed as a phase IV randomized, controlled, parallel-group efficacy trial. It was conducted at a tertiary university hospital. Overweight or obese women with clinically early-stage breast cancer who had been assigned to undergo surgery were eligible. Patients were randomly allocated to either a prophylaxis or a control group by using a computer-generated list. The prophylaxis group received 1 g ampicillin-sulbactam intravenously at anesthesia. The control group received no intervention. Patients and observers were blinded to the assignments. The primary outcome was the comparison of SSI incidences of the 2 groups. Patients were monitored for 30 days. A total of 369 patients were included in final analysis, out of which 187 were allocated for prophylaxis and 182 were randomly assigned to the control group. Analysis was done according to the intention-to-treat principle. Prophylaxis significantly reduced the SSI rate (4.8%) in the prophylaxis group when compared with that in the control group [13.7%; relative risk (RR) 0.35; 95% CI: 0.17-0.73]. No adverse reaction was observed. The mean SSI-related cost (20.26 USD) was found to be significantly higher in the control group when compared with that (8.48 USD) in the prophylaxis group. Antibiotic prophylaxis significantly decreased SSI incidence after elective surgery and was shown to be cost-effective in obese breast cancer patients. ClinicalTrials.gov Identifier: NCT00356148.

Zn(II) and Cd(II) coordination polymers with tri-tert-butoxysilanethiol and bipyridines. Synthesis, crystal structure and spectroscopy

NASA Astrophysics Data System (ADS)

Pladzyk, Agnieszka; Ponikiewski, Łukasz; Stanulewicz, Natalia; Hnatejko, Zbigniew

2013-12-01

Three new zinc(II) and cadmium(II) silanethiolate complexes [Zn{SSi(OtBu)3}2(μ-bpea)ṡCH3CN]n1, [Cd{SSi(OtBu)3}2(μ-bpea)ṡ2CHCl3]n2 and [Cd{SSi(OtBu)3}2(μ-bpey)ṡC7H8]n3 with two bypiridine derivatives, [bpea = 1,2-bis(4-pyridyl)ethane and bpey = 1,2-bis(4-pyridyl)ethylene] have been synthesized and structurally characterized by X-ray crystallography. Their structures and properties have also been established with elemental analysis, IR, TGA and photoluminescent studies. Complexes 1-3 exhibit one-dimensional (1D) chain structures in which [M{SSi(OtBu)3}2] (M = Zn, Cd) units are held together by bpea or bpey bridges, respectively. Complexes are stable up to 300 °C and display blue emissions.

Secondary signal imaging (SSI) electron tomography (SSI-ET): A new three-dimensional metrology for mesoscale specimens in transmission electron microscope.

PubMed

Han, Chang Wan; Ortalan, Volkan

2015-09-01

We have demonstrated a new electron tomography technique utilizing the secondary signals (secondary electrons and backscattered electrons) for ultra thick (a few μm) specimens. The Monte Carlo electron scattering simulations reveal that the amount of backscattered electrons generated by 200 and 300keV incident electrons is a monotonic function of the sample thickness and this causes the thickness contrast satisfying the projection requirement for the tomographic reconstruction. Additional contribution of the secondary electrons emitted from the edges of the specimens enhances the visibility of the surface features. The acquired SSI tilt series of the specimen having mesoscopic dimensions are successfully reconstructed verifying that this new technique, so called the secondary signal imaging electron tomography (SSI-ET), can directly be utilized for 3D structural analysis of mesoscale structures. Published by Elsevier Ltd.

Antibiotic prophylaxis and incisional surgical site infection following colorectal cancer surgery: an analysis of 330 cases.

PubMed

Lohsiriwat, Varut; Lohsiriwat, Darin

2009-01-01

To evaluate the rate of incisional surgical site infection (SSI) following colorectal cancer surgery in a university hospital and to determine whether duration of prophylactic antibiotic administration can affect the development of this complication. The medical records of 330 patients with colorectal cancer undergoing elective oncological resection between 2003 and 2006 at Siriraj Hospital were reviewed. Patients were divided into two groups according to the duration of antibiotic administration; group A: prophylactic antibiotics were discontinued within 24 hours after surgery and group B: antibiotics administration was extended beyond 24 hours after surgery. Data including rate of incisional SSI were analyzed. There were 180 males and 150 females, with a mean age of 63 years. There were 126 patients (38%) in group A and 204 patients (62%) in group B. There was no statistical difference in patient characteristics and tumor-related variables between the two groups, except tumor location. Overall rate of incisional SSI was 14.5%. The rate of incisional SSI was not statistically different between the two groups (group A 11.1% vs. group B 16.7%, p = 0.22). Patients with incisional SSI had a significantly longer hospital stay than patients without incisional SSI (15.9 vs. 8.3 days, p < 0.001). This present study found the overall rate of incisional SSI following colorectal surgery to be 14.5%. There was no significant difference in the rate of this complication between the two groups. Thus, surgeons should be encouraged to use a shorter duration of antibiotics to prevent the emergence of antibiotic-resistant bacterial infection and reduce hospital expenditure.

The diagnostic performance of shear wave elastography for malignant cervical lymph nodes: A systematic review and meta-analysis.

PubMed

Suh, Chong Hyun; Choi, Young Jun; Baek, Jung Hwan; Lee, Jeong Hyun

2017-01-01

To evaluate the diagnostic performance of shear wave elastography for malignant cervical lymph nodes. We searched the Ovid-MEDLINE and EMBASE databases for published studies regarding the use of shear wave elastography for diagnosing malignant cervical lymph nodes. The diagnostic performance of shear wave elastography was assessed using bivariate modelling and hierarchical summary receiver operating characteristic modelling. Meta-regression analysis and subgroup analysis according to acoustic radiation force impulse imaging (ARFI) and Supersonic shear imaging (SSI) were also performed. Eight eligible studies which included a total sample size of 481 patients with 647 cervical lymph nodes, were included. Shear wave elastography showed a summary sensitivity of 81 % (95 % CI: 72-88 %) and specificity of 85 % (95 % CI: 70-93 %). The results of meta-regression analysis revealed that the prevalence of malignant lymph nodes was a significant factor affecting study heterogeneity (p < .01). According to the subgroup analysis, the summary estimates of the sensitivity and specificity did not differ between ARFI and SSI (p = .93). Shear wave elastography is an acceptable imaging modality for diagnosing malignant cervical lymph nodes. We believe that both ARFI and SSI may have a complementary role for diagnosing malignant cervical lymph nodes. • Shear wave elastography is acceptable modality for diagnosing malignant cervical lymph nodes. • Shear wave elastography demonstrated summary sensitivity of 81 % and specificity of 85 %. • ARFI and SSI have complementary roles for diagnosing malignant cervical lymph nodes.

Traveling Exhibitions: translating current science into effective science exhibitions

NASA Astrophysics Data System (ADS)

Dusenbery, P.; Morrow, C.; Harold, J.

The Space Science Institute (SSI) of Boulder, Colorado has recently developed two museum exhibits called the Space Weather Center and MarsQuest. It is currently planning to develop two other exhibitions called Cosmic Origins and InterActive Earth. Museum exhibitions provide research scientists the opportunity to engage in a number of activities that are vital to the success of earth and space outreach programs. The Space Weather Center was developed in partnership with various research missions at NASA's Goddard Space Flight Center. The focus of the presentation will be on the Institute's MarsQuest exhibition. This project is a 5000 square-foot, 2.5M, traveling exhibition that is now touring the country. The exhibit's 3-year tour is enabling millions of Americans to share in the excitement of the scientific exploration of Mars and learn more about their own planet in the process. The associated planetarium show and education program will also be described, with particular emphasis on workshops to orient host museum staff (e.g. museum educators and docents). The workshops make innovative connections between the exhibitions interactive experiences and lesson plans aligned with the National Science Education Standards. SSI is also developing an interactive web site called MarsQuest On-line. The linkage between the web site, education program and exhibit will be discussed. MarsQuest and SSI's other exhibitions are good models for actively involving scientists and their discoveries to help improve informal science education in the museum community and for forging a stronger connection between formal and informal education.

Costs Associated With Surgical Site Infections in Veterans Affairs Hospitals.

PubMed

Schweizer, Marin L; Cullen, Joseph J; Perencevich, Eli N; Vaughan Sarrazin, Mary S

2014-06-01

Surgical site infections (SSIs) are potentially preventable complications that are associated with excess morbidity and mortality. To determine the excess costs associated with total, deep, and superficial SSIs among all operations and for high-volume surgical specialties. Surgical patients from 129 Veterans Affairs (VA) hospitals were included. The Veterans Health Administration Decision Support System and VA Surgical Quality Improvement Program databases were used to assess costs associated with SSIs among VA patients who underwent surgery in fiscal year 2010. Linear mixed-effects models were used to evaluate incremental costs associated with SSIs, controlling for patient risk factors, surgical risk factors, and hospital-level variation in costs. Costs of the index hospitalization and subsequent 30-day readmissions were included. Additional analysis determined potential cost savings of quality improvement programs to reduce SSI rates at hospitals with the highest risk-adjusted SSI rates. Among 54,233 VA patients who underwent surgery, 1756 (3.2%) experienced an SSI. Overall, 0.8% of the cohort had a deep SSI, and 2.4% had a superficial SSI. The mean unadjusted costs were $31,580 and $52,620 for patients without and with an SSI, respectively. In the risk-adjusted analyses, the relative costs were 1.43 times greater for patients with an SSI than for patients without an SSI (95% CI, 1.34-1.52; difference, $11,876). Deep SSIs were associated with 1.93 times greater costs (95% CI, 1.71-2.18; difference, $25,721), and superficial SSIs were associated with 1.25 times greater costs (95% CI, 1.17-1.35; difference, $7003). Among the highest-volume specialties, the greatest mean cost attributable to SSIs was $23,755 among patients undergoing neurosurgery, followed by patients undergoing orthopedic surgery, general surgery, peripheral vascular surgery, and urologic surgery. If hospitals in the highest 10th percentile (ie, the worst hospitals) reduced their SSI rates to the rates of the hospitals in the 50th percentile, the Veterans Health Administration would save approximately $6.7 million per year. Surgical site infections are associated with significant excess costs. Among analyzed surgery types, deep SSIs and SSIs among neurosurgery patients are associated with the highest risk-adjusted costs. Large potential savings per year may be achieved by decreasing SSI rates.

Solar Spectral Irradiance Variability of Some Chromospheric Emission Lines Through the Solar Activity Cycles 21-23

NASA Astrophysics Data System (ADS)

Göker, Ü. D.; Gigolashvili, M. Sh.; Kapanadze, N.

2017-06-01

A study of variations of solar spectral irradiance (SSI) in the wavelength ranges 121.5 nm-300.5 nm for the period 1981-2009 is presented. We used various data for ultraviolet (UV) spectral lines and international sunspot number (ISSN) from interactive data centers such as SME (NSSDC), UARS (GDAAC), SORCE (LISIRD) and SIDC, respectively. We reduced these data by using the MATLAB software package. In this respect, we revealed negative correlations of intensities of UV (289.5 nm-300.5 nm) spectral lines originating in the solar chromosphere with the ISSN index during the unusually prolonged minimum between the solar activity cycles (SACs) 23 and 24. We also compared our results with the variations of solar activity indices obtained by the ground-based telescopes. Therefore, we found that plage regions decrease while facular areas are increasing in SAC 23. However, the decrease in plage regions is seen in small sunspot groups (SGs), contrary to this, these regions in large SGs are comparable to previous SACs or even larger as is also seen in facular areas. Nevertheless, negative correlations between ISSN and SSI data indicate that these variations are in close connection with the classes of sunspots/SGs, faculae and plage regions. Finally, we applied the time series analysis of spectral lines corresponding to the wavelengths 121.5 nm-300.5 nm and made comparisons with the ISSN data. We found an unexpected increase in the 298.5 nm line for the Fe II ion. The variability of Fe II ion 298.5 nm line is in close connection with the facular areas and plage regions, and the sizes of these solar surface indices play an important role for the SSI variability, as well. So, we compared the connection between the sizes of faculae and plage regions, sunspots/SGs, chemical elements and SSI variability. Our future work will be the theoretical study of this connection and developing of a corresponding model.

Seasonal Variations in the Risk of Reoperation for Surgical Site Infection Following Elective Spinal Fusion Surgery: A Retrospective Study Using the Japanese Diagnosis Procedure Combination Database.

PubMed

Ohya, Junichi; Chikuda, Hirotaka; Oichi, Takeshi; Kato, So; Matsui, Hiroki; Horiguchi, Hiromasa; Tanaka, Sakae; Yasunaga, Hideo

2017-07-15

A retrospective study of data abstracted from the Diagnosis Procedure Combination (DPC) database, a national representative database in Japan. The aim of this study was to examine seasonal variations in the risk of reoperation for surgical site infection (SSI) following spinal fusion surgery. Although higher rates of infection in the summer than in other seasons were thought to be caused by increasing inexperience of new staff, high temperature, and high humidity, no studies have examined seasonal variations in the risk of SSI following spinal fusion surgery in the country where medical staff rotation timing is not in summer season. In Japan, medical staff rotation starts in April. We retrospectively extracted the data of patients who were admitted between July 2010 and March 2013 from the DPC database. Patients were included if they were aged 20 years or older and underwent elective spinal fusion surgery. The primary outcome was reoperation for SSI during hospitalization. We performed multivariate analysis to clarify the risk factors of primary outcome with adjustment for patient background characteristics. We identified 47,252 eligible patients (23,659 male, 23,593 female). The mean age of the patients was 65.4 years (range, 20-101 yrs). Overall, reoperation for SSI occurred in 0.93% of the patients during hospitalization. The risk of reoperation for SSI was significantly higher in April (vs. February; odds ratio, 1.93; 95% confidence interval, 1.09-3.43, P = 0.03) as well as other known risk factors. In subgroup analysis with stratification for type of hospital, month of surgery was identified as an independent risk factor of reoperation for SSI among cases in an academic hospital, although there was no seasonal variation among those in a nonacademic hospital. This study showed that month of surgery is a risk factor of reoperation for SSI following elective spinal fusion surgery, nevertheless, in the country where medical staff rotation timing is not in summer season. 3.

Performance of statistical process control methods for regional surgical site infection surveillance: a 10-year multicentre pilot study.

PubMed

Baker, Arthur W; Haridy, Salah; Salem, Joseph; Ilieş, Iulian; Ergai, Awatef O; Samareh, Aven; Andrianas, Nicholas; Benneyan, James C; Sexton, Daniel J; Anderson, Deverick J

2017-11-24

Traditional strategies for surveillance of surgical site infections (SSI) have multiple limitations, including delayed and incomplete outbreak detection. Statistical process control (SPC) methods address these deficiencies by combining longitudinal analysis with graphical presentation of data. We performed a pilot study within a large network of community hospitals to evaluate performance of SPC methods for detecting SSI outbreaks. We applied conventional Shewhart and exponentially weighted moving average (EWMA) SPC charts to 10 previously investigated SSI outbreaks that occurred from 2003 to 2013. We compared the results of SPC surveillance to the results of traditional SSI surveillance methods. Then, we analysed the performance of modified SPC charts constructed with different outbreak detection rules, EWMA smoothing factors and baseline SSI rate calculations. Conventional Shewhart and EWMA SPC charts both detected 8 of the 10 SSI outbreaks analysed, in each case prior to the date of traditional detection. Among detected outbreaks, conventional Shewhart chart detection occurred a median of 12 months prior to outbreak onset and 22 months prior to traditional detection. Conventional EWMA chart detection occurred a median of 7 months prior to outbreak onset and 14 months prior to traditional detection. Modified Shewhart and EWMA charts additionally detected several outbreaks earlier than conventional SPC charts. Shewhart and SPC charts had low false-positive rates when used to analyse separate control hospital SSI data. Our findings illustrate the potential usefulness and feasibility of real-time SPC surveillance of SSI to rapidly identify outbreaks and improve patient safety. Further study is needed to optimise SPC chart selection and calculation, statistical outbreak detection rules and the process for reacting to signals of potential outbreaks. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Student Identity Considerations and Implications Associated with Socioscientific Issues Instruction

NASA Astrophysics Data System (ADS)

Ruzek, Mitchel James

The purpose of this investigation was to explore how aspects of identity, perceived levels of controversy, and the strength of a student's attachment to their controversial identity relate to conceptual understanding and knowledge acquisition during socioscientific issues (SSI) based instruction in a biology classroom. The knowledge gained from this study will have the capacity to enhance our understanding of the role that attachment to identity plays during SSI negotiation. Additionally, insight was gained into the role played by aspects of identity in conceptual understanding of scientifically controversial topics during SSI based instruction. This study contributed to the existing knowledge base in science education by illuminating processes involved in socioscientific issue navigation among students of differing perceptions of controversy as well as students who held aspects of controversial identity that may or may not interact with the specific issues chosen. Students demonstrated evidence of variations of reasoning, justification, perception of controversy, and aspects of knowledge gain as they negotiated the issues of marijuana safety and fast food legality. Additionally, evidence was provided that showed general knowledge gain throughout the group during socioscientific issues instruction. It has been said that one of the appeals of the SSI instructional model is that is serves not only as a context for the delivery of content, but acts as a catalyst for various forms of epistemological beliefs and research into the development of conceptual and psychological knowledge structures (Zeidler, 2013). This investigation supports the deeper understanding of the contribution of controversy perception to epistemology as well as conceptual and psychological knowledge structures during SSI navigation.

Postoperative urinary tract infection and surgical site infection in instrumented spinal surgery: is there a link?

PubMed

Núñez-Pereira, S; Rodríguez-Pardo, D; Pellisé, F; Pigrau, C; Bagó, J; Villanueva, C; Cáceres, E

2014-08-01

A potential relationship between postoperative urinary tract infection (UTI) and surgical site infection (SSI) following posterior spinal fusion and instrumentation (PSFI) was investigated. A retrospective review was performed of prospectively collected demographic, clinical and microbiological data of 466 consecutive patients (median age, 53.7 years (interquartile range (IQR) 33.8-65.6); 58.6% women) undergoing PSFI to identify those with UTI in the first 4 weeks and SSI in the first 12 weeks after PSFI. Overall, 40.8% had an American Society of Anesthesiologists score of >2, and 49.8% had undergone fusion of more than three segments. Eighty-nine patients had UTI, 54 had SSI, and 22 had both conditions. In nine of the 22 (38%) cases, the two infections were caused by the same microorganism. The urinary tract was the probable source of SSI by Gram-negative bacteria in 38% (8/21) of cases. On multivariate analysis, UTI (OR 3.1, 95% CI 1.6-6.1; P 0.001) and instrumentation of more than three segments (OR 2.7, 95% CI 1.1-6.3; P 0.024) were statistically associated with SSI. Patients receiving ciprofloxacin for UTI had higher microbial resistance rates to fluoroquinolones at SSIs (46.13%) than those without ciprofloxacin (21.9%), although the difference did not reach statistical significance (p 0.1). In our series, UTI was significantly associated with SSI after PSFI. On the basis of our results, we conclude that further efforts to reduce the incidence of postoperative UTI and provide adequate empirical antibiotic therapy that avoids quinolones whenever possible may help to reduce SSI rates and potential microbial resistance. © 2014 The Authors Clinical Microbiology and Infection © 2014 European Society of Clinical Microbiology and Infectious Diseases.

Single versus double blade technique for skin incision and deep dissection in surgery for closed fracture: a prospective randomised control study.

PubMed

Trikha, V; Saini, P; Mathur, P; Agarwal, A; Kumar, S V; Choudhary, B

2016-04-01

To compare blade cultures in surgery for closed fracture using a single or double blade technique to determine whether the current practice of double blade technique is justified. 155 men and 29 women aged 20 to 60 (mean, 35) years who underwent surgery for closed fracture with healthy skin at the incision site were included. Patients were block randomised to the single (n=92) or double (n=92) blade technique. Blades were sent for bacteriological analysis. Outcome measures were early surgical site infection (SSI) within 30 days and cultures from the blades. The 2 groups were comparable in baseline characteristics. In the single blade group, 6 surgical blades and 2 control blades showed positive cultures; 4 patients developed SSI, but only one had a positive culture from the surgical blade (with different organism isolated from the wound culture). In the double blade group, 6 skin blades, 7 deep blades, and 0 control blade showed positive culture; only 2 patients had the same bacteria grown from both skin and deep blade. Five patients developed SSI, but only one patient had a positive culture from the deep blade (with different organism isolated from the wound culture). The difference in incidence of culture-positive blade or SSI between the 2 groups was not significant. The relative risk of SSI in the single blade group was 0.8. Positive blade culture was not associated with SSI in the single or double blade group. The practice of changing blade following skin incision has no effect on reducing early SSI in surgery for closed fracture in healthy patients with healthy skin.

Surgical site infection: an observer-blind, randomized trial comparing electrocautery and conventional scalpel.

PubMed

Rongetti, Regiane Ladislau; Oliveira e Castro, Paulo de Tarso; Vieira, Renê Aloisio da Costa; Serrano, Sérgio Vicente; Mengatto, Mariana Fabro; Fregnani, José Humberto Tavares Guerreiro

2014-01-01

To evaluate the incidence of surgical site infection (SSI) based on the type of scalpel used for incisions in the skin and in subcutaneous tissues. Observer-blind, randomized equivalence clinical trial with two arms (electrocautery versus conventional scalpel) which evaluated 133 women undergoing elective abdominal gynecologic oncology surgery. A simple randomization stratified by body mass index (BMI: 30 kg/m(2)) was carried out. Women were evaluated at 14 and 30 days following the operation. A multivariate analysis was performed in order to check whether the type of scalpel would be a risk factor for SSI. Group arms were balanced for all variables, excepted for surgical time, which was significantly higher in the electrocautery group (mean: 161.1 versus 203.5 min, P = 0.029). The rates of SSI were 7.4% and 9.7%, respectively, for the conventional scalpel and electrocautery groups (P = 0.756). The exploratory multivariate model identified body mass index ≥30 kg/m(2) (OR = 24.2, 95% CI: 2.8-212.1) and transverse surgical incision (OR = 8.1, 95% CI: 1.5-42.6) as independent risk factors for SSI. The type of scalpel used in surgery, when adjusted for these variables and the surgery time, was not a risk factor for SSI. This study showed that the SSI rates for conventional scalpel and electrocautery were not significantly different. These results were consistent with others reported in the literature and would not allow a surgeon to justify scalpel choice based on SSI. NCT01410175 (Clinical Trials - NIH). Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Failure to Redose Antibiotic Prophylaxis in Long Surgery Increases Risk of Surgical Site Infection.

PubMed

Kasatpibal, Nongyao; Whitney, Joanne D; Dellinger, E Patchen; Nair, Bala G; Pike, Kenneth C

Antibiotic prophylaxis is a key component of the prevention of surgical site infection (SSI). Failure to manage antibiotic prophylaxis effectively may increase the risk of SSI. This study aimed to examine the effects of antibiotic prophylaxis on SSI risk. A retrospective cohort study was conducted among patients having general surgery between May 2012 and June 2015 at the University of Washington Medical Center. Peri-operative data extracted from hospital databases included patient and operation characteristics, intra-operative medication and fluid administration, and survival outcome. The effects of antibiotic prophylaxis and potential factors on SSI risk were estimated using multiple logistic regression and were expressed as risk ratios (RRs). A total of 4,078 patients were eligible for analysis. Of these, 180 had an SSI. Mortality rates within and after 30 days were 0.8% and 0.3%, respectively. Improper antibiotic redosing increased the risk of SSI (RR 4.61; 95% confidence interval [CI] 1.33-15.91). Other risk factors were in-patient status (RR 4.05; 95% CI 1.69-9.66), smoking (RR 1.63; 95% CI 1.03-2.55), emergency surgery (RR 1.97; 95% CI 1.26-3.08), colectomy (RR 3.31; 95% CI 1.19-9.23), pancreatectomy (RR 4.52; 95% CI 1.53-13.39), proctectomy (RR 5.02; 95% CI 1.72-14.67), small bowel surgery (RR 6.16; 95% CI 2.13-17.79), intra-operative blood transfusion >500 mL (RR 2.76; 95% CI 1.45-5.26), and multiple procedures (RR 1.40; 95% CI 1.01-1.95). These data demonstrate that failure to redose prophylactic antibiotic during long operations increases the risk of SSI. Strengthening a collaborative surgical quality improvement program may help to eradicate this risk.

The Association Between Operating Room Personnel and Turnover With Surgical Site Infection in More Than 12 000 Neurosurgical Cases.

PubMed

Wathen, Connor; Kshettry, Varun R; Krishnaney, Ajit; Gordon, Steven M; Fraser, Thomas; Benzel, Edward C; Modic, Michael T; Butler, Sam; Machado, Andre G

2016-12-01

Surgical site infection (SSI) contributes significantly to postoperative morbidity and mortality and greatly increases the cost of care. To identify the impact of workflow and personnel-related risk factors contributing to the incidence of SSIs in a large sample of neurological surgeries. Data were obtained using an enterprisewide electronic health record system, operating room, and anesthesia records for neurological procedures conducted between January 1, 2009, and November 30, 2012. SSI data were obtained from prospective surveillance by infection preventionists using Centers for Disease Control and Prevention definitions. A multivariate model was constructed and refined using backward elimination logistic regression methods. The analysis included 12 528 procedures. Most cases were elective (94.5%), and the average procedure length was 4.8 hours. The average number of people present in the operating room at any time during the procedure was 10.0. The overall infection rate was 2.3%. Patient body mass index (odds ratio, 1.03; 95% confidence interval [CI], 1.01-1.04) and sex (odds ratio, 1.36; 95% CI, 1.07-1.72) as well as procedure length (odds ratio, 1.19 per additional hour; 95% CI, 1.15-1.23) and nursing staff turnovers (odds ratio, 1.095 per additional turnover; 95% CI, 1.02-1.21) were significantly correlated with the risk of SSI. This study found that patient body mass index and male sex were associated with an increased risk of SSI. Operating room personnel turnover, a modifiable, work flow-related factor, was an independent variable positively correlated with SSI. This study suggests that efforts to reduce operating room turnover may be effective in preventing SSI. OR, operating roomSSI, surgical site infection.

Stochastic subspace identification for operational modal analysis of an arch bridge

NASA Astrophysics Data System (ADS)

Loh, Chin-Hsiung; Chen, Ming-Che; Chao, Shu-Hsien

2012-04-01

In this paer the application of output-only system identification technique, known as Stochastic Subspace Identification (SSI) algorithms, for civil infrastructures is carried out. The ability of covariance driven stochastic subspace identification (SSI-COV) was proved through the analysis of the ambient data of an arch bridge under operational condition. A newly developed signal processing technique, Singular Spectrum analysis (SSA), capable to smooth noisy signals, is adopted for pre-processing the recorded data before the SSI. The conjunction of SSA and SSICOV provides a useful criterion for the system order determination. With the aim of estimating accurate modal parameters of the structure in off-line analysis, a stabilization diagram is constructed by plotting the identified poles of the system with increasing the size of data Hankel matrix. Identification task of a real structure, Guandu Bridge, is carried out to identify the system natural frequencies and mode shapes. The uncertainty of the identified model parameters from output-only measurement of the bridge under operation condition, such as temperature and traffic loading conditions, is discussed.

Building Worlds and Learning Astronomy on Facebook Part III: Testing, Launch, and Evaluation

NASA Astrophysics Data System (ADS)

Harold, J.; Hines, D.; Vidugiris, E.; Goldman, K. H.

2015-11-01

James Harold (SSI), Dean Hines (STScI/SSI) and a team at the National Center for Interactive Learning at the Space Science Institute are developing Starchitect, an end-to-end stellar and planetary evolution game for the Facebook platform. Supported by NSF and NASA, and based in part on a prototype presented at ASP several years ago, Starchitect uses the “sporadic play” model of games such as Farmville, where players might only take actions a few times a day, but may continue playing for months. This paper is an update to a presentation at last year's ASP conference.

Prospective comparison among transient elastography, supersonic shear imaging, and ARFI imaging for predicting fibrosis in nonalcoholic fatty liver disease

PubMed Central

Joo, Sae Kyung; Woo, Hyunsik; Lee, Dong Hyeon; Jung, Yong Jin; Kim, Byeong Gwan; Lee, Kook Lae

2017-01-01

The diagnostic performance of supersonic shear imaging (SSI) in comparison with those of transient elastography (TE) and acoustic radiation force impulse imaging (ARFI) for staging fibrosis in nonalcoholic fatty liver disease (NAFLD) patients has not been fully assessed, especially in Asian populations with relatively lean NAFLD compared to white populations. Thus, we focused on comparing the diagnostic performances of TE, ARFI, and SSI for staging fibrosis in a head-to-head manner, and identifying the clinical, anthropometric, biochemical, and histological features which might affect liver stiffness measurement (LSM) in our prospective biopsy-proven NAFLD cohort. In this study, ninety-four patients with biopsy-proven NAFLD were included prospectively. Liver stiffness was measured using TE, SSI, and ARFI within 1 month of liver biopsy. The diagnostic performance for staging fibrosis was assessed using receiver operating characteristic (ROC) analysis. Anthropometric data were evaluated as covariates influencing LSM by regression analyses. Liver stiffness correlated with fibrosis stage (p < 0.05); the area under the ROC curve of TE (kPa), SSI (kPa), and ARFI (m/s) were as follows: 0.757, 0.759, and 0.657 for significant fibrosis and 0.870, 0.809, and 0.873 for advanced fibrosis. Anthropometric traits were significant confounders affecting SSI, while serum liver injury markers significantly confounded TE and ARFI. In conclusion, the LSM methods had similar diagnostic performance for staging fibrosis in patients with NAFLD. Pre-LSM anthropometric evaluation may help predict the reliability of SSI. PMID:29176844

Risk factors of neurosurgical site infection after craniotomy: A systematic review and meta-analysis.

PubMed

Fang, Chenyan; Zhu, Tao; Zhang, Ping; Xia, Liang; Sun, Caixing

2017-11-01

Neurosurgical site infection (SSI) is a complication related to craniotomy, which may lead to severe morbidity and higher hospital costs during the postoperative period. Retrospective cohorts, case-control studies, or prospective investigations addressing risk factors of SSI updated until January 2017 were systematically searched in 2 databases (PubMed and Embase). The Newcastle-Ottawa Scale was used to evaluate quality of the included studies, heterogeneity was assessed by I 2 tests, and a funnel plot and Egger test were used for the evaluation of publication bias. There were 26 studies in total enrolled in this review. The results showed that the risk factors which had relation with SSI were other infection (odds ratio [OR], 5.42; 95% confidence interval [CI], 2.8-10.49), number of operations (>1) (OR, 2.352; 95% CI, 1.142-4.847), cerebrospinal fluid (CSF) leak (OR, 7.817; 95% CI, 2.573-23.751), CSF drainage (OR, 2.55; 95% CI, 1.58-4.11), duration of operation (>4 hours) (as for retrospective cohort studies) (OR, 1.766; 95% CI, 1.110-2.809), venous sinus entry (OR, 4.015; 95% CI, 1.468-10.982), American Society of Anesthesiologists score (>2) (OR, 1.398; 95% CI, 1.098-1.78), sex (male) (as for prospective investigations) (OR, 1.474; 95% CI, 1.013-2.145), and surgical reasons (nontraumatic) (OR, 2.137; 95% CI, 1.106-4.129). According to the current analysis, all the factors mentioned were the risk factors for SSI after craniotomy. Patients with these risk factors should be paid more attention to prevent SSI. More evidence provided by high-quality studies is still needed to further investigate the risk factors of SSI. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Navigating the Complexity of Socio-scientific Controversies—How Students Make Multiple Voices Present in Discourse

NASA Astrophysics Data System (ADS)

Solli, Anne; Hillman, Thomas; Mäkitalo, Åsa

2017-10-01

In this article, we argue that students' unfolding discourse on socio-scientific issues (SSI) can be fruitfully analyzed by using dialogical theories of language and communication (Bakhtin 1986; Linell 2009). While research in science education often reports on how individual reasoning changes when bringing SSI into the classroom, we argue for the relevance of analyzing how the individual is "in dialogue" with present as well as remote interlocutors and contexts on the internet. We suggest that the analytical approach is particularly sensitized to illuminate how students' handle multiple perspectives. A dialogical perspective takes as its premise that SSI are part of society, where politicians, interest groups, and scientists engage in debates and offer perspectives that are often in conflict. Rather than assuming that the individual student is the primary unit for analysis, a dialogical approach is premised on an analysis that incorporates several perspectives and voices—a multivocality that also resides with the individual. Arguing for the relevance of this analytical approach to studies of SSI in the classroom, we analyze a group of students in upper secondary school as they discuss hydraulic fracturing after having worked with online data. The results illuminate how students discursively manage multivocality and multimodality inherent in the following SSI online. We describe a set of discursive means that the students use to handle the many perspectives involved when communicating about the issue. In addition, we describe and articulate what kind of communicative competences that are involved and, hence, could be cultivated through education, when engaging in public debates.

Efficacy of prophylactic probiotics in combination with antibiotics versus antibiotics alone for colorectal surgery: A meta-analysis of randomized controlled trials.

PubMed

Wu, Xiang-Dong; Xu, Wei; Liu, Meng-Meng; Hu, Ke-Jia; Sun, Ya-Ying; Yang, Xue-Fei; Zhu, Gui-Qi; Wang, Zi-Wei; Huang, Wei

2018-03-24

This meta-analysis aimed to determine whether prophylactic probiotics in combination with antibiotics are superior to antibiotics alone in the prevention of surgical site infection (SSI) after colorectal surgery. Fourteen trials involving 1524 participants were included. Compared with antibiotics alone, prophylactic probiotics in combination with antibiotics reduced the risk of SSI as well as other complications, shortened the cumulative duration of antibiotic therapy. Current evidence suggested that probiotics in combination with antibiotics could be recommended. © 2018 Wiley Periodicals, Inc.

Effect of a preoperative decontamination protocol on surgical site infections in patients undergoing elective orthopedic surgery with hardware implantation.

PubMed

Bebko, Serge P; Green, David M; Awad, Samir S

2015-05-01

Surgical site infections (SSIs), commonly caused by methicillin-resistant Staphylococcus aureus (MRSA), are associated with significant morbidity and mortality, specifically when hardware is implanted in the patient. Previously, we have demonstrated that a preoperative decontamination protocol using chlorhexidine gluconate washcloths and intranasal antiseptic ointment is effective in eradicating MRSA in the nose and on the skin of patients. To examine the effect of a decontamination protocol on SSIs in patients undergoing elective orthopedic surgery with hardware implantation. A prospective database of patients undergoing elective orthopedic surgery with hardware implantation at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, was analyzed from October 1, 2012, to December 31, 2013. Cohort groups before and after the intervention were compared. Starting in May 2013, during their preoperative visit, all of the patients watched an educational video about MRSA decontamination and were given chlorhexidine washcloths and oral rinse and nasal povidone-iodine solution to be used the night before and the morning of scheduled surgery. Thirty-day SSI rates were collected according to the definitions of the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance. Data on demographics, comorbidities such as chronic obstructive pulmonary disease and coronary artery disease, tobacco use, alcohol use, and body mass index were also collected. Univariate analysis was performed between the 2 groups of patients. Multivariate analysis was used to identify independent predictors of SSI. A total of 709 patients were analyzed (344 controls and 365 patients who were decolonized). Both groups were well matched with no significant differences in age, body mass index, sex, or comorbidities. All of the patients (100%) completed the MRSA decontamination protocol. The SSI rate in the intervention group was significantly lower (1.1%; 4 of 365 patients developed an SSI) than the SSI rate in the control group (3.8%; 13 of 344 patients developed an SSI) (P = .02). Multivariate logistic regression identified MRSA decontamination as an independent predictor of not developing an SSI (adjusted odds ratio, 0.24 [95% CI, 0.08-0.77]; P = .02). Our study demonstrates that preoperative MRSA decontamination with chlorhexidine washcloths and oral rinse and intranasal povidone-iodine decreased the SSI rate by more than 50% among patients undergoing elective orthopedic surgery with hardware implantation. Universal decontamination using this low-cost protocol may be considered as an additional prevention strategy for SSIs in patients undergoing orthopedic surgery with hardware implantation and warrants further study.

Agreement among health care professionals in diagnosing case Vignette-based surgical site infections.

PubMed

Lepelletier, Didier; Ravaud, Philippe; Baron, Gabriel; Lucet, Jean-Christophe

2012-01-01

To assess agreement in diagnosing surgical site infection (SSI) among healthcare professionals involved in SSI surveillance. Case-vignette study done in 2009 in 140 healthcare professionals from seven specialties (20 in each specialty, Anesthesiologists, Surgeons, Public health specialists, Infection control physicians, Infection control nurses, Infectious diseases specialists, Microbiologists) in 29 University and 36 non-University hospitals in France. We developed 40 case-vignettes based on cardiac and gastrointestinal surgery patients with suspected SSI. Each participant scored six randomly assigned case-vignettes before and after reading the SSI definition on an online secure relational database. The intraclass correlation coefficient (ICC) was used to assess agreement regarding SSI diagnosis on a seven-point Likert scale and the kappa coefficient to assess agreement for superficial or deep SSI on a three-point scale. Based on a consensus, SSI was present in 21 of 40 vignettes (52.5%). Intraspecialty agreement for SSI diagnosis ranged across specialties from 0.15 (95% confidence interval, 0.00-0.59) (anesthesiologists and infection control nurses) to 0.73 (0.32-0.90) (infectious diseases specialists). Reading the SSI definition improved agreement in the specialties with poor initial agreement. Intraspecialty agreement for superficial or deep SSI ranged from 0.10 (-0.19-0.38) to 0.54 (0.25-0.83) (surgeons) and increased after reading the SSI definition only among the infection control nurses from 0.10 (-0.19-0.38) to 0.41 (-0.09-0.72). Interspecialty agreement for SSI diagnosis was 0.36 (0.22-0.54) and increased to 0.47 (0.31-0.64) after reading the SSI definition. Among healthcare professionals evaluating case-vignettes for possible surgical site infection, there was large disagreement in diagnosis that varied both between and within specialties.

A Persian-version of the stuttering severity instrument-version four (SSI-4): How the new additions to SSI-4 complement its stuttering severity score?

PubMed

Tahmasebi, Neda; Shafie, Bijan; Karimi, Hamid; Mazaheri, Masood

The fourth version of the Stuttering Severity Instrument (SSI-4) has been available since 2009. It has some modifications and new features which make it more appropriate at least for clinical practice, although further documentation is needed. The objective of the current research was to translate SSI-4 into Persian language and to discuss its relative and absolute reliability as well as its criterion validity for Persian adults who stutter (PWS). We also aimed to study how the new subjective self-reports of the SSI-4 complement the stuttering severity score obtained from the SSI-3 or the SSI-4. The cross-cultural guideline recommended by the International Quality of Life Assessment project was used to translate the SSI-4 into Persian language. Thirty five PWS from ages 17 to 42 were recruited and 10 speech and language pathologists assessed their stuttering severity using either the SSI-4 or stuttering severity ratings (SR) to test validity and reliability of the Persian translated version. A very high inter-judge relative reliability along with a poor absolute inter-judge reliability was found for the SSI-4 scores. The results were more promising for the intra-judge absolute reliability. Test-retest reliability of the complementary questions to the SSI-4 was also found acceptable. However, no strong relationship was found between the SSI-4 scores and its complementary questions. The Persian version of the SSI-4 can be used reliably by trained SLPs for research and clinical purposes, but not to document small changes in stuttering severity. We argue that the response of participants to the complementary self-report questions should also be considered in calculating their stuttering severity score. Copyright © 2018 Elsevier Inc. All rights reserved.

The Separate Spheres Model of Gendered Inequality.

PubMed

Miller, Andrea L; Borgida, Eugene

2016-01-01

Research on role congruity theory and descriptive and prescriptive stereotypes has established that when men and women violate gender stereotypes by crossing spheres, with women pursuing career success and men contributing to domestic labor, they face backlash and economic penalties. Less is known, however, about the types of individuals who are most likely to engage in these forms of discrimination and the types of situations in which this is most likely to occur. We propose that psychological research will benefit from supplementing existing research approaches with an individual differences model of support for separate spheres for men and women. This model allows psychologists to examine individual differences in support for separate spheres as they interact with situational and contextual forces. The separate spheres ideology (SSI) has existed as a cultural idea for many years but has not been operationalized or modeled in social psychology. The Separate Spheres Model presents the SSI as a new psychological construct characterized by individual differences and a motivated system-justifying function, operationalizes the ideology with a new scale measure, and models the ideology as a predictor of some important gendered outcomes in society. As a first step toward developing the Separate Spheres Model, we develop a new measure of individuals' endorsement of the SSI and demonstrate its reliability, convergent validity, and incremental predictive validity. We provide support for the novel hypotheses that the SSI predicts attitudes regarding workplace flexibility accommodations, income distribution within families between male and female partners, distribution of labor between work and family spheres, and discriminatory workplace behaviors. Finally, we provide experimental support for the hypothesis that the SSI is a motivated, system-justifying ideology.

The Separate Spheres Model of Gendered Inequality

PubMed Central

Miller, Andrea L.; Borgida, Eugene

2016-01-01

Research on role congruity theory and descriptive and prescriptive stereotypes has established that when men and women violate gender stereotypes by crossing spheres, with women pursuing career success and men contributing to domestic labor, they face backlash and economic penalties. Less is known, however, about the types of individuals who are most likely to engage in these forms of discrimination and the types of situations in which this is most likely to occur. We propose that psychological research will benefit from supplementing existing research approaches with an individual differences model of support for separate spheres for men and women. This model allows psychologists to examine individual differences in support for separate spheres as they interact with situational and contextual forces. The separate spheres ideology (SSI) has existed as a cultural idea for many years but has not been operationalized or modeled in social psychology. The Separate Spheres Model presents the SSI as a new psychological construct characterized by individual differences and a motivated system-justifying function, operationalizes the ideology with a new scale measure, and models the ideology as a predictor of some important gendered outcomes in society. As a first step toward developing the Separate Spheres Model, we develop a new measure of individuals’ endorsement of the SSI and demonstrate its reliability, convergent validity, and incremental predictive validity. We provide support for the novel hypotheses that the SSI predicts attitudes regarding workplace flexibility accommodations, income distribution within families between male and female partners, distribution of labor between work and family spheres, and discriminatory workplace behaviors. Finally, we provide experimental support for the hypothesis that the SSI is a motivated, system-justifying ideology. PMID:26800454

Diabetes and Risk of Surgical Site Infection: A systematic review and meta-analysis

PubMed Central

Kaye, Keith S.; Knott, Caitlin; Nguyen, Huong; Santarossa, Maressa; Evans, Richard; Bertran, Elizabeth; Jaber, Linda

2016-01-01

Objective To determine the independent association between diabetes and SSI across multiple surgical procedures. Design Systematic review and meta-analysis. Methods Studies indexed in PubMed published between December 1985 and through July 2015 were identified through the search terms “risk factors” or “glucose” and “surgical site infection”. A total of 3,631 abstracts were identified through the initial search terms. Full texts were reviewed for 522 articles. Of these, 94 articles met the criteria for inclusion. Standardized data collection forms were used to extract study-specific estimates for diabetes, blood glucose levels, and body mass index (BMI). Random-effects meta-analysis was used to generate pooled estimates and meta-regression was used to evaluate specific hypothesized sources of heterogeneity. Results The primary outcome was SSI, as defined by the Centers for Disease Control and Prevention surveillance criteria. The overall effect size for the association between diabetes and SSI was OR=1.53 (95% Predictive Interval 1.11, 2.12, I2: 57.2%). SSI class, study design, or patient BMI did not significantly impact study results in a meta-regression model. The association was higher for cardiac surgery 2.03 (95% Predictive Interval 1.13, 4.05) compared to surgeries of other types (p=0.001). Conclusion These results support the consideration of diabetes as an independent risk factor for SSIs for multiple surgical procedure types. Continued efforts are needed to improve surgical outcomes for diabetic patients. PMID:26503187

Agreement among healthcare professionals in ten European countries in diagnosing case-vignettes of surgical-site infections.

PubMed

Birgand, Gabriel; Lepelletier, Didier; Baron, Gabriel; Barrett, Steve; Breier, Ann-Christin; Buke, Cagri; Markovic-Denic, Ljiljana; Gastmeier, Petra; Kluytmans, Jan; Lyytikainen, Outi; Sheridan, Elizabeth; Szilagyi, Emese; Tacconelli, Evelina; Troillet, Nicolas; Ravaud, Philippe; Lucet, Jean-Christophe

2013-01-01

Although surgical-site infection (SSI) rates are advocated as a major evaluation criterion, the reproducibility of SSI diagnosis is unknown. We assessed agreement in diagnosing SSI among specialists involved in SSI surveillance in Europe. Twelve case-vignettes based on suspected SSI were submitted to 100 infection-control physicians (ICPs) and 86 surgeons in 10 European countries. Each participant scored eight randomly-assigned case-vignettes on a secure online relational database. The intra-class correlation coefficient (ICC) was used to assess agreement for SSI diagnosis on a 7-point Likert scale and the kappa coefficient to assess agreement for SSI depth on a three-point scale. Intra-specialty agreement for SSI diagnosis ranged across countries and specialties from 0.00 (95%CI, 0.00-0.35) to 0.65 (0.45-0.82). Inter-specialty agreement varied from 0.04 (0.00-0.62) in to 0.55 (0.37-0.74) in Germany. For all countries pooled, intra-specialty agreement was poor for surgeons (0.24, 0.14-0.42) and good for ICPs (0.41, 0.28-0.61). Reading SSI definitions improved agreement among ICPs (0.57) but not surgeons (0.09). Intra-specialty agreement for SSI depth ranged across countries and specialties from 0.05 (0.00-0.10) to 0.50 (0.45-0.55) and was not improved by reading SSI definition. Among ICPs and surgeons evaluating case-vignettes of suspected SSI, considerable disagreement occurred regarding the diagnosis, with variations across specialties and countries.

Agreement among Healthcare Professionals in Ten European Countries in Diagnosing Case-Vignettes of Surgical-Site Infections

PubMed Central

Birgand, Gabriel; Lepelletier, Didier; Baron, Gabriel; Barrett, Steve; Breier, Ann-Christin; Buke, Cagri; Markovic-Denic, Ljiljana; Gastmeier, Petra; Kluytmans, Jan; Lyytikainen, Outi; Sheridan, Elizabeth; Szilagyi, Emese; Tacconelli, Evelina; Troillet, Nicolas; Ravaud, Philippe; Lucet, Jean-Christophe

2013-01-01

Objective Although surgical-site infection (SSI) rates are advocated as a major evaluation criterion, the reproducibility of SSI diagnosis is unknown. We assessed agreement in diagnosing SSI among specialists involved in SSI surveillance in Europe. Methods Twelve case-vignettes based on suspected SSI were submitted to 100 infection-control physicians (ICPs) and 86 surgeons in 10 European countries. Each participant scored eight randomly-assigned case-vignettes on a secure online relational database. The intra-class correlation coefficient (ICC) was used to assess agreement for SSI diagnosis on a 7-point Likert scale and the kappa coefficient to assess agreement for SSI depth on a three-point scale. Results Intra-specialty agreement for SSI diagnosis ranged across countries and specialties from 0.00 (95%CI, 0.00–0.35) to 0.65 (0.45–0.82). Inter-specialty agreement varied from 0.04 (0.00–0.62) in to 0.55 (0.37–0.74) in Germany. For all countries pooled, intra-specialty agreement was poor for surgeons (0.24, 0.14–0.42) and good for ICPs (0.41, 0.28–0.61). Reading SSI definitions improved agreement among ICPs (0.57) but not surgeons (0.09). Intra-specialty agreement for SSI depth ranged across countries and specialties from 0.05 (0.00–0.10) to 0.50 (0.45–0.55) and was not improved by reading SSI definition. Conclusion Among ICPs and surgeons evaluating case-vignettes of suspected SSI, considerable disagreement occurred regarding the diagnosis, with variations across specialties and countries. PMID:23874690

Development of a surgical site infection (SSI) surveillance system, calculation of SSI rates and specification of important factors affecting SSI in a digestive organ surgical department.

PubMed

Kimura, Koji; Sawa, Akihiro; Akagi, Shinji; Kihira, Kenji

2007-06-01

We have developed an original system to conduct surgical site infection (SSI) surveillance. This system accumulates SSI surveillance information based on the National Nosocomial Infections Surveillance (NNIS) System and the Japanese Nosocomial Infections Surveillance (JNIS) System. The features of this system are as follows: easy input of data, high generality, data accuracy, SSI rate by operative procedure and risk index category (RIC) can be promptly calculated and compared with the current NNIS SSI rate, and the SSI rates and accumulated data can be exported electronically. Using this system, we monitored 798 patients in 24 operative procedure categories in the Digestive Organs Surgery Department of Mazda Hospital, Mazda Motor Corporation, from January 2004 through December 2005. The total number and rate of SSI were 47 and 5.89%, respectively. The SSI rates of 777 patients were calculated based on 15 operative procedure categories and Risk Index Categories (RIC). The highest SSI rate was observed in the rectum surgery of RIC 1 (30%), followed by the colon surgery of RIC3 (28.57%). About 30% of the isolated infecting bacteria were Enterococcus faecalis, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli. Using quantification theory type 2, the American Society of Anesthesiology score (4.531), volume of hemorrhage under operation (3.075), wound classification (1.76), operation time (1.352), and history of diabetes (0.989) increased to higher ranks as factors for SSI. Therefore, we evaluated this system as a useful tool in safety control for operative procedures.

Intraoperative red blood cell transfusion, delayed graft function, and infection after kidney transplant: an observational cohort study.

PubMed

Mazzeffi, Michael; Jonna, Srikar; Blanco, Natalia; Mavrothalassitis, Orestes; Odekwu, Obi; Fontaine, Magali; Rock, Peter; Tanaka, Kenichi; Thom, Kerri

2018-06-01

Kidney transplant patients are frequently anemic and at risk for red blood cell (RBC) transfusion. Previous studies suggest that pre-transplant RBC transfusion may improve kidney transplant outcomes; however, RBC transfusion is also associated with infection. The purpose of our study was to characterize the relationships between intraoperative RBC transfusion, delayed graft function (DGF), postoperative surgical site infection (SSI), and sepsis. Analysis was performed on a historical cohort of adult kidney transplant patients from a single medical center during a two-year period. Crude odds ratios for DGF, superficial and deep SSI, and sepsis were calculated for transfused patients and multivariate regression was used to control for potential confounders when significant relationships were identified. Four hundred forty-one patients had kidney transplant during the study period; 27.0% had RBC transfusion, 38.8% had DGF, 7.0% had superficial SSI, 7.9% had deep SSI, and 1.8% had sepsis. High dose RBC transfusion was associated with improved graft function, but this was negated after adjusting for confounders (OR = 0.86, 95% CI  0.26 to 2.88). There was no association between RBC transfusion and SSI. RBC transfusion was independently associated with sepsis (OR = 8.98, 95% CI  1.52 to 53.22), but the confidence interval was wide. Intraoperative RBC transfusion during kidney transplant is not associated with improved allograft function or incisional SSI, but is associated with postoperative sepsis. RBCs should not be liberally transfused during kidney transplant surgery to improve graft outcomes.

Cost-benefit analysis of craniocerebral surgical site infection control in tertiary hospitals in China.

PubMed

Zhou, Jiong; Ma, Xiaojun

2015-02-19

Surgical site infection (SSI) is one of the most common postoperative complications. This study aimed to determine the cost of SSIs and to evaluate whether SSI control can reduce medical costs under the current medical payment system and wage rates in China. Prospective surveillance of craniocerebral surgery was conducted between July 2009 and June 2012. SSI patients and non-SSI patients were matched with a ratio of 1:2. Terms such as medical costs and length of hospital stay were compared between the two groups. Based on the economic loss of hospital infection, which causes additional expenditures and a reduction in the number of patients treated, the benefits of hospital infection control were estimated. The costs of human resources and materials of hospital infection surveillance and control were also estimated. Finally, the cost-benefit rates in different medical contexts and with different SSI-case ratios were calculated. The incidence of SSIs in this study was 4%. SSIs significantly prolonged hospital stay by 11.75 days (95% CI: 6.24-22.52), increased medical costs by US $3,412.48 (95% CI: $1,680.65-$5,879.89). The direct economic loss was $114,903 in a 40-bed ward. The cost of implementing infection control in such a unit was calculated to be approximately $5,555.47 CONCLUSIONS: Under the current fee-for-service healthcare model in China, the control of SSIs can hardly yield direct economic benefits, but can yield social benefits. With the implementation of a total medical cost pre-payment system, SSI control will present a remarkable benefit-cost ratio for hospitals.

Tailoring the operative approach for appendicitis to the patient: a prediction model from national surgical quality improvement program data.

PubMed

Senekjian, Lara; Nirula, Raminder

2013-01-01

Laparoscopic appendectomy (LA) is increasingly being performed in the United States, despite controversy about differences in infectious complication rates compared with open appendectomy (OA). Subpopulations exist in which infectious complication rates, both surgical site and organ space, differ with respect to LA compared with OA. All appendectomies in the National Surgical Quality Improvement Program database were analyzed with respect to surgical site infection (SSI) and organ space infection (OSI). Multivariate logistic regression analysis identified independent predictors of SSI or OSI. Probabilities of SSI or OSI were determined for subpopulations to identify when LA was superior to OA. From 2005 to 2009, there were 61,830 appendectomies performed (77.5% LA), of which 9,998 (16.2%) were complicated (58.7% LA). The risk of SSI was considerably lower for LA in both noncomplicated and complicated appendicitis. Across all ages, body mass index, renal function, and WBCs, LA was associated with a lower probability of SSI. The risk of OSI was considerably greater for LA in both noncomplicated and complicated appendicitis. In complicated appendicitis, OA was associated with a lower probability of OSI in patients with WBC >12 cells × 10(3)/μL. In noncomplicated appendicitis, OA was associated with a lower probability of OSI in patients with a body mass index <37.5 when compared with LA. Subpopulations exist in which OA is superior to LA in terms of OSI, however, SSI is consistently lower in LA patients. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

SSI-bridge : soil bridge interaction during long-duration earthquake motions.

DOT National Transportation Integrated Search

2014-09-01

The seismic response of a complete soil-bridge system during shallow, crustal and subduction zone earthquakes is the topic of this report. Specifically, the effects of earthquake duration on the seismic performance of soil-bridge systems are examined...

A Comparison Study of Augmented Reality versus Interactive Simulation Technology to Support Student Learning of a Socio-Scientific Issue

ERIC Educational Resources Information Center

Chang, Hsin-Yi; Hsu, Ying-Shao; Wu, Hsin-Kai

2016-01-01

We investigated the impact of an augmented reality (AR) versus interactive simulation (IS) activity incorporated in a computer learning environment to facilitate students' learning of a socio-scientific issue (SSI) on nuclear power plants and radiation pollution. We employed a quasi-experimental research design. Two classes (a total of 45…

Point shear wave ultrasound elastography with Esaote compared to real-time 2D shear wave elastography with supersonic imagine for the quantification of liver stiffness.

PubMed

Mulazzani, L; Salvatore, V; Ravaioli, F; Allegretti, G; Matassoni, F; Granata, R; Ferrarini, A; Stefanescu, H; Piscaglia, Fabio

2017-09-01

Different shear wave elastography (SWE) machines able to quantify liver stiffness (LS) have been recently introduced by various companies. The aim of this study was to investigate the agreement between point SWE with Esaote MyLab Twice (pSWE.ESA) and 2D SWE with Aixplorer SuperSonic (2D SWE.SSI). Moreover, we assessed the correlation of these machines with Fibroscan in a subgroup of patients. A total of 81 liver disease patients and 27 subjects without liver disease accessing the ultrasound lab were considered. Exclusion criteria were liver nodules, BMI >35, and severe comorbidities. LS was sampled from the same intercostal space with both pSWE.ESA and 2D SWE.SSI and values were tested with Lin's analysis and Bland-Altman analysis (B&A). Agreement between each SWE machine and Fibroscan was assessed in 26 liver disease patients with Spearman correlation. Precision and accuracy between pSWE.ESA and 2D SWE.SSI were, respectively, 0.839 and 0.999. B&A showed a mean of only -0.2 kPa, with no systematic deviation between the techniques and limits of agreement at -11.6 and 11.3 kPa. Spearman's rho correlation versus Fibroscan was 0.849 for pSWE.ESA and 0.878 for 2D SWE.SSI. The relationship became less strict in the higher range of LS (≥15.2 kPa), corresponding to cirrhosis. The overall degree of concordance of pSWE.ESA and 2D SWE.SSI in measuring LS resulted remarkable, also when compared with Fibroscan. The less strict correlation for patients with LS in the higher range would not affect the staging of disease as such patients are anyhow classified as cirrhotic.

Surgical Outcomes in Vedolizumab-Treated Patients with Ulcerative Colitis.

PubMed

Lightner, Amy L; McKenna, Nicholas P; Moncrief, Sara; Pemberton, John H; Raffals, Laura E; Mathis, Kellie L

2017-12-01

Surgical outcomes and pouch outcomes in the setting of vedolizumab remains poorly understood. We sought to determine the rate of 30-day postoperative surgical infectious complications and pouch-specific complications among patients with ulcerative colitis (UC) who received vedolizumab within 12 weeks of surgery. A retrospective chart review between 5/1/2014 and 12/31/2016 of all adult patients with UC who underwent an abdominal operation was performed. Patients with UC who received vedolizumab within 12 weeks of their abdominal operation were compared with patients with UC on anti-TNFα treatment. Eighty-eight patients received vedolizumab and 62 received anti-TNFα within 12 weeks of surgery. More vedolizumab-treated patients had superficial surgical site infections (P = 0.047) and mucocutaneous separation at the ileostomy (P = 0.047), but there was no difference in the overall surgical infectious complication rate, deep space SSI, 30-day hospital readmission or return to the operating room. On univariate analysis of SSI among patients with UC, exposure to vedolizumab was not a significant predictor of SSI (P = 0.27), but steroids were predictive of SSI on univariate (P = 0.02) and multivariable analysis (P = 0.02). After ileal pouch anal anastomosis, there was a higher rate of intra-abdominal abscesses (31.3% versus 5.9%) and mucocutaneous separation (18.8% versus 0%) in the vedolizumab group compared with the anti-TNFα group, but statistical significance was not reached. Vedolizumab patients had significantly increased rates of superficial SSI, but not overall infectious complications. Among ileal pouch anal anastomosis patients, peripouch abscess rates were increased among vedolizumab-treated patients, but this did not reach statistical significance. Vedolizumab seems safe in the perioperative period for patients with UC.

Supersonic shear imaging for the diagnosis of liver fibrosis and portal hypertension in liver diseases: a meta-analysis.

PubMed

Deng, Han; Qi, Xingshun; Zhang, Tiansong; Qi, Xiaolong; Yoshida, Eric M; Guo, Xiaozhong

2018-01-01

The meta-analysis aimed to summarize the technical success rate of supersonic shear imaging (SSI) and to evaluate the diagnostic performance of liver and spleen stiffness measurement (LSM and SSM) with SSI for the detection of liver fibrosis, portal hypertension, and gastroesophageal varices in liver diseases. PubMed, EMBASE, and Cochrane Library databases were searched. Technical success rate of SSI was pooled. Area under curve (AUC), sensitivity, and specificity with corresponding 95% confidence interval (CI) were calculated. Included studies regarding the diagnostic performance of SSI for liver fibrosis, portal hypertension, and esophageal varices numbered 28, 4, and 4 respectively. The pooled technical success rates of LSM and SSM were 95.3% and 75.5%, respectively. The AUC, sensitivity, and specificity of LSM/SSM for different stages of liver fibrosis were 0.85-0.94, 0.7-0.89, and 0.82-0.92, respectively. The AUC, sensitivity, and specificity of LSM were 0.84 (95%CI = 0.8-0.86), 0.79 (95%CI = 0.7-0.85), and 0.82 (95%CI = 0.72-0.88) for clinically significant portal hypertension, 0.85 (95%CI = 0.82-0.88), 0.8 (95%CI = 0.68-0.88), and 0.8 (95%CI = 0.6-0.92) for any varices, and 0.86 (95%CI = 0.83-0.89), 0.86 (95%CI = 0.76-0.92), and 0.61 (95%CI = 0.35-0.83) for high-risk varices, respectively. LSM with SSI had a high diagnostic accuracy for liver fibrosis, but a moderate diagnostic accuracy for portal hypertension and esophageal varices.

Surgical site infection after breast surgery: impact of 2010 CDC reporting guidelines.

PubMed

Degnim, Amy C; Throckmorton, Alyssa D; Boostrom, Sarah Y; Boughey, Judy C; Holifield, Andrea; Baddour, Larry M; Hoskin, Tanya L

2012-12-01

Reported surgical site infection (SSI) rates after breast operations ranges 0.8-26 % in the literature. The aims of the present study were to characterize SSI after breast/axillary operations and determine the impact on the SSI rate of the 2010 Centers for Disease Control and Prevention (CDC) reporting guidelines that now specifically exclude cellulitis. Retrospective chart review identified 368 patients with 449 operated sides between July 2004 and June 2006. SSI was defined by CDC criteria: purulent drainage (category 1), positive aseptically collected culture (category 2), signs of inflammation with opening of incision and absence of negative culture (category 3), and physician diagnosis of infection (category 4). The impact of excluding cellulitis was assessed. Prior CDC reporting guidelines revealed that among 368 patients, 32 (8.7 %) experienced SSI in 33 (7.3 %) of 449 operated sides. Of these, 11 (33 %) met CDC criteria 1-3, while 22 (67 %) met CDC criterion 4. Excluding cellulitis cases per 2010 CDC SSI reporting guidelines eliminates 21 of the 22 infections previously meeting CDC criterion 4. Under the new reporting guidelines, the SSI rate is 12 (2.7 %) of 449 operated sides. SSI rates varied by procedure, but these differences were not statistically significant. Cellulitis after breast and axillary surgery is much more common than other criteria for SSI, and SSI rates are reduced almost threefold if cellulitis cases are excluded. Recently revised CDC reporting guidelines may result in underestimates of the clinical burden of SSI after breast/axillary surgery.

Cesium Speciation in Dust from Municipal Solid Waste and Sewage Sludge Incineration by Synchrotron Radiation Micro-X-ray Analysis.

PubMed

Shiota, Kenji; Takaoka, Masaki; Fujimori, Takashi; Oshita, Kazuyuki; Terada, Yasuko

2015-11-17

The chemical behavior of Cs in waste incineration processes is important to consider when disposing of radionuclide-contaminated waste from the Fukushima Daiichi nuclear power plant accident in Japan. To determine the speciation of Cs, we attempted the direct speciation of trace amounts of stable Cs in the dust from municipal solid waste incineration (MSWI) and sewage sludge incineration (SSI) by micro-X-ray fluorescence (μ-XRF) and micro-X-ray absorption fine structure (μ-XAFS) at the SPring-8 facility. The μ-XRF results revealed that locally produced Cs was present in MSWI and SSI dust within the cluster size range of 2-10 μm. The μ-XAFS analysis confirmed that the speciation of Cs in MSWI dust was similar to that of CsCl, while in SSI dusts it was similar to pollucite. The solubility of Cs was considered to be influenced by the exact Cs species present in incineration residue.

Application of higher order SVD to vibration-based system identification and damage detection

NASA Astrophysics Data System (ADS)

Chao, Shu-Hsien; Loh, Chin-Hsiung; Weng, Jian-Huang

2012-04-01

Singular value decomposition (SVD) is a powerful linear algebra tool. It is widely used in many different signal processing methods, such principal component analysis (PCA), singular spectrum analysis (SSA), frequency domain decomposition (FDD), subspace identification and stochastic subspace identification method ( SI and SSI ). In each case, the data is arranged appropriately in matrix form and SVD is used to extract the feature of the data set. In this study three different algorithms on signal processing and system identification are proposed: SSA, SSI-COV and SSI-DATA. Based on the extracted subspace and null-space from SVD of data matrix, damage detection algorithms can be developed. The proposed algorithm is used to process the shaking table test data of the 6-story steel frame. Features contained in the vibration data are extracted by the proposed method. Damage detection can then be investigated from the test data of the frame structure through subspace-based and nullspace-based damage indices.

Is Intraoperative Local Vancomycin Powder the Answer to Surgical Site Infections in Spine Surgery?

PubMed

Hey, Hwee Weng Dennis; Thiam, Desmond Wei; Koh, Zhi Seng Darren; Thambiah, Joseph Shantakumar; Kumar, Naresh; Lau, Leok-Lim; Liu, Ka-Po Gabriel; Wong, Hee-Kit

2017-02-15

This is a retrospective cohort comparative study of all patients who underwent instrumented spine surgery at a single institution. To compare the rate of surgical site infection (SSI) between the treatment (vancomycin) and the control group (no vancomycin) in patients undergoing instrumented spine surgery. SSI after spine surgery is a dreaded complication associated with increased morbidity and mortality. Prophylactic intraoperative local vancomycin powder to the wound has been recently adopted as a strategy to reduce SSI but results have been variable. In the present study, there were 117 (30%) patients in the treatment group and 272 (70%) patients in the comparison cohort. All patients received identical standard operative and postoperative care procedures based on protocolized department guidelines. The present study compared the rate of SSI with and without the use of prophylactic intraoperative local vancomycin powder in patients undergoing various instrumented spine surgery, adjusted for confounders. The overall rate of SSI was 4.7% with a decrease in infection rate found in the treatment group (0.9% vs. 6.3%). This was statistically significant (P = 0.049) with an odds ratio of 0.13 (95% confidence interval 0.02-0.99). The treatment group had a significantly shorter onset of infection (5 vs. 16.7 days; P < 0.001) and shorter duration of infection (8.5 vs. 26.8 days; P < 0.001). The most common causative organism was Pseudomonas aeruginosa (35.2%). Patient diagnosis, surgical approach, and intraoperative blood loss were significant risk factors for SSI after multivariable analysis. Prophylactic Intraoperative local vancomycin powder reduces the risk and morbidity of SSI in patients undergoing instrumented spine surgery. P. aeruginosa infection is common in the treatment arm. Future prospective randomized controlled trials in larger populations involving other spine surgeries with a long-term follow-up duration are recommended. 3.

Post-discharge surgical site infections after uncomplicated elective colorectal surgery: impact and risk factors. The experience of the VINCat Program.

PubMed

Limón, E; Shaw, E; Badia, J M; Piriz, M; Escofet, R; Gudiol, F; Pujol, M

2014-02-01

Surgical site infection (SSI) after colorectal procedures represents a measurable quality indicator of a healthcare system. There is an increasing interest in comparing SSI rates between different hospitals and countries: however, the variability of the data regarding the incidence of SSI makes this comparison difficult. For the purposes of evaluation, data collection must be standardized and must include reliable post-discharge surveillance (PDS). To determine impact and risk factors for PDS SSI after elective colorectal surgery. VINCat is a nosocomial infection surveillance programme in Catalonia, Spain. Between 2007 and 2011, 52 hospitals joined the programme. Hospitals performed active, prospective, standardized surveillance of elective colorectal resection. PDS was implemented by a multimodal approach and was mandatory within the first 30 days after surgery. During the study period, 13,661 elective colorectal procedures were included. SSI was diagnosed in 2826 (20.7%) patients, of whom 22.5% during PDS; of these, 52% required readmission. Patients with PDS SSI were younger (odds ratio: 1.57; 95% confidence interval: 1.29-1.91), predominantly female (1.40; 1.16-1.69), had more frequently undergone endoscopic procedures (1.56; 1.30-1.88) and had more incisional SSI (1.88; 1.54-2.28) than patients with in-hospital SSI. SSI rates in elective colorectal procedures at VINCat hospitals were inside the higher range of those reported by other national programmes. PDS SSI increased the overall rate of SSI, had a significant clinical impact, and accounted for almost a quarter of SSI. Younger age and laparoscopic procedures were the most relevant risk factors. Standardized multimodal PDS should be implemented for hospitals performing surveillance of colorectal surgery. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Reduction of medication errors related to sliding scale insulin by the introduction of a standardized order sheet.

PubMed

Harada, Saki; Suzuki, Akio; Nishida, Shohei; Kobayashi, Ryo; Tamai, Sayuri; Kumada, Keisuke; Murakami, Nobuo; Itoh, Yoshinori

2017-06-01

Insulin is frequently used for glycemic control. Medication errors related to insulin are a common problem for medical institutions. Here, we prepared a standardized sliding scale insulin (SSI) order sheet and assessed the effect of its introduction. Observations before and after the introduction of the standardized SSI template were conducted at Gifu University Hospital. The incidence of medication errors, hyperglycemia, and hypoglycemia related to SSI were obtained from the electronic medical records. The introduction of the standardized SSI order sheet significantly reduced the incidence of medication errors related to SSI compared with that prior to its introduction (12/165 [7.3%] vs 4/159 [2.1%], P = .048). However, the incidence of hyperglycemia (≥250 mg/dL) and hypoglycemia (≤50 mg/dL) in patients who received SSI was not significantly different between the 2 groups. The introduction of the standardized SSI order sheet reduced the incidence of medication errors related to SSI. © 2016 John Wiley & Sons, Ltd.

Analysis of 162 colon injuries in patients with penetrating abdominal trauma: concomitant stomach injury results in a higher rate of infection.

PubMed

O'Neill, Patricia A; Kirton, Orlando C; Dresner, Lisa S; Tortella, Bartholomew; Kestner, Mark M

2004-02-01

Fecal contamination from colon injury has been thought to be the most significant factor for the development of surgical site infection (SSI) after trauma. However, there are increasing data to suggest that other factors may play a role in the development of postinjury infection in patients after colon injury. The purpose of this study was to determine the impact of gastric wounding on the development of SSI and nonsurgical site infection (NSSI) in patients with colon injury. Post hoc analysis was performed on data prospectively collected for 317 patients presenting with penetrating hollow viscus injury. One hundred sixty-two patients with colon injury were subdivided into one of three groups: patients with isolated colon wounds (C), patients with colon and stomach wounds with or without other organ injury (C+S), and patients with colon and other organ injury but no stomach injury (C-S) and assessed for the development of SSI and NSSI. Infection rates were also determined for patients who sustained isolated gastric injury (S) and gastric injury in combination with other injuries other than colon (S-C). Penetrating Abdominal Trauma Index, operative times, and transfusion were assessed. Discrete variables were analyzed by Cochran-Mantel-Haenszel chi2 test and Fisher's exact test. Risk factor analysis was performed by multivariate logistic regression. C+S patients had a higher rate of SSI infection (31%) than C patients (3.6%) (p=0.008) and C-S patients (13%) (p=0.021). Similarly, the incidence of NSSI was also significantly greater in the C+S group (37%) compared with the C patients (7.5%) (p=0.07) and the C-S patients (17%) (p=0.019). There was no difference in the rate of SSI or NSSI between the C and C-S groups (p=0.3 and p=0.24, respectively). The rate of SSI was significantly greater in the C+S patients when compared with the S-C patients (31% vs. 10%, p=0.008), but there was no statistical difference in the rate of NSSI in the C+S group and the S-C group (37% vs. 24%, p=0.15). The addition of a gastric injury to a colon injury has a synergistic effect on the rate of postoperative infection.

Snow Physics and Meltwater Hydrology of the SSiB Model Employed for Climate Simulation Studies with GEOS 2 GCM

NASA Technical Reports Server (NTRS)

Mocko, David M.; Sud, Y. C.; Einaudi, Franco (Technical Monitor)

2000-01-01

Present-day climate models produce large climate drifts that interfere with the climate signals simulated in modelling studies. The simplifying assumptions of the physical parameterization of snow and ice processes lead to large biases in the annual cycles of surface temperature, evapotranspiration, and the water budget, which in turn causes erroneous land-atmosphere interactions. Since land processes are vital for climate prediction, and snow and snowmelt processes have been shown to affect Indian monsoons and North American rainfall and hydrology, special attention is now being given to cold land processes and their influence on the simulated annual cycle in GCMs. The snow model of the SSiB land-surface model being used at Goddard has evolved from a unified single snow-soil layer interacting with a deep soil layer through a force-restore procedure to a two-layer snow model atop a ground layer separated by a snow-ground interface. When the snow cover is deep, force-restore occurs within the snow layers. However, several other simplifying assumptions such as homogeneous snow cover, an empirical depth related surface albedo, snowmelt and melt-freeze in the diurnal cycles, and neglect of latent heat of soil freezing and thawing still remain as nagging problems. Several important influences of these assumptions will be discussed with the goal of improving them to better simulate the snowmelt and meltwater hydrology. Nevertheless, the current snow model (Mocko and Sud, 2000, submitted) better simulates cold land processes as compared to the original SSiB. This was confirmed against observations of soil moisture, runoff, and snow cover in global GSWP (Sud and Mocko, 1999) and point-scale Valdai simulations over seasonal snow regions. New results from the current snow model SSiB from the 10-year PILPS 2e intercomparison in northern Scandinavia will be presented.

The role of oral antibiotics prophylaxis in prevention of surgical site infection in colorectal surgery.

PubMed

Koullouros, Michalis; Khan, Nadir; Aly, Emad H

2017-01-01

Surgical site infection (SSI) continues to be a challenge in colorectal surgery. Over the years, various modalities have been used in an attempt to reduce SSI risk in elective colorectal surgery, which include mechanical bowel preparation before surgery, oral antibiotics and intravenous antibiotic prophylaxis at induction of surgery. Even though IV antibiotics have become standard practice, there has been a debate on the exact role of oral antibiotics. The primary aim was to identify the role of oral antibiotics in reduction of SSI in elective colorectal surgery. The secondary aim was to explore any potential benefit in the use of mechanical bowel preparation (MBP) in relation to SSI in elective colorectal surgery. Medline, Embase and the Cochrane Library were searched. Any randomised controlled trials (RCTs) or cohort studies after 1980, which investigated the effectiveness of oral antibiotic prophylaxis and/or MBP in preventing SSIs in elective colorectal surgery were included. Twenty-three RCTs and eight cohorts were included. The results indicate a statistically significant advantage in preventing SSIs with the combined usage of oral and systemic antibiotic prophylaxis. Furthermore, our analysis of the cohort studies shows no benefits in the use of MBP in prevention of SSIs. The addition of oral antibiotics to systemic antibiotics could potentially reduce the risk of SSIs in elective colorectal surgery. Additionally, MBP does not seem to provide a clear benefit with regard to SSI prevention.

Non-observance of guidelines for surgical antimicrobial prophylaxis and surgical-site infections.

PubMed

Lallemand, S; Thouverez, M; Bailly, P; Bertrand, X; Talon, D

2002-06-01

A prospective multicentre study was conducted to assess major aspects of surgical prophylaxis and to determine whether inappropriate antimicrobial prophylaxis was a factor associated (risk or protective factor) with surgical site infection (SSI). Surgical prophylaxis practices were assessed by analysing four variables: indication, antimicrobial agent, timing and duration. Univariate and multivariate analyses were carried out to identify predictors of SSI among patient-specific, operation-specific and antimicrobial prophylaxis-specific factors. The frequency of SSI was 2.7% (13 SSI in 474 observations). Total compliance of the prescription with guidelines was observed in 41.1% of cases (195 prescriptions). Of the 139 patients who received an inappropriate drug, 126 (90.6%) received a drug with a broader spectrum than the recommended drug. Prophylaxis was prolonged in 71 (87.7%) of the 81 patients who received prophylaxis for inappropriate lengths of time and 43 (61.4%) of the 70 patients who did not receive prophylaxis at the optimal moment were treated too late. Multivariate analysis clearly demonstrated that SSI was associated with multiple procedures (relative risk 8.5), short duration of prophylaxis (relative risk 12.7) and long-term therapy with antimicrobial agents during the previous year (relative risk 8.8). The ecological risk of the emergence of resistance associated with the frequent use of broad-spectrum antibiotics and prophylaxis for longer periods was not offset by individual benefit to the patients who received inappropriate prophylaxis.

Optical Extinction Measurements of Laser Side-Scatter During Tropical Storm Colin

NASA Technical Reports Server (NTRS)

Lane, John E.; Kasparis, Takis; Metzger, Philip; Michaelides, Silas

2017-01-01

A side-scatter imaging (SSI) technique using a 447 nm, 500 mW laser and a Nikon D80 camera was tested at Kennedy Space Center, Florida during the passing of a rain band associated with Tropical Storm Colin. The June 6, 2016, 22:00 GMT rain event was intense but short-lived owing to the strong west-to-east advection of the rain band. An effort to validate the optical extinction measurement was conducted by setting up a line of three tipping rain gauges along an 80 m east-west path and below the laser beam. Differences between tipping bucket measurements were correlated to the extinction coefficient profile along the lasers path, as determined by the SSI measurement. In order to compare the tipping bucket to the optical extinction data, a Marshall-Palmer DSD model was assumed. Since this was a daytime event, the laser beam was difficult to detect in the camera images, pointing out an important limitation of SSI measurements: the practical limit of DSD density that can be effectively detected and analyzed under daylight conditions using this laser and camera, corresponds to a fairly moderate rainfall rate on the order of 20 mmh (night measurements achieve a much improved sensitivity). The SSI analysis model under test produced promising results, but in order to use the SSI method for routine meteorological studies, improvements to the math model will be required.

20 CFR 416.2097 - Combined supplementary/SSI payment levels.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Combined supplementary/SSI payment levels... Combined supplementary/SSI payment levels. (a) Other than the level for residents of Medicaid facilities (see paragraph (d) of this section), the combined supplementary/SSI payment level for each payment...

Identifying the Infection Control Areas Requiring Modifications in Thoracic Surgery Units: Results of a Two-Year Surveillance of Surgical Site Infections in Hospitals in Southern Poland.

PubMed

Dubiel, Grzegorz; Rogoziński, Paweł; Żaloudik, Elżbieta; Bruliński, Krzysztof; Różańska, Anna; Wójkowska-Mach, Jadwiga

2017-10-01

Surgical site infection (SSI) is considered to be a priority in infection control. The objective of this study is the analysis of results of active targeted surveillance conducted over a two-year period in the Department of Thoracic Surgery at the Pulmonology and Thoracic Surgery Center in Bystra, in southern Poland. The retrospective analysis was carried out on the basis of results of active monitoring of SSI in the 45-bed Department of Thoracic Surgery at the Pulmonology and Thoracic Surgery Center in Bystra between April 1, 2014 and April 30, 2016. Surgical site infections were identified based on the definitions of the European Centre for Disease Prevention and Control (ECDC) taking into account the time of symptom onset, specifically, whether the symptoms occurred within 30 d after the surgical procedure. Detection of SSI relied on daily inspection of incisions by a trained nurse, analysis of medical and nursing entries in the computer system, and analysis of all results of microbiologic tests taken in the unit and in the operating room. In the study period, data were collected regarding 1,387 treatment procedures meeting the registration criteria. Forty cases of SSI were detected yielding an incidence rate of 3%. Most cases (55%) were found in the course of hospitalization and 45% were detected after the patient's discharge. The SSIs were classified as follows: superficial, 37.5%; deep infections, 7.5%; and organ/space infection, 55%. Among patients who were diagnosed with SSI, most were male (77.5%). For patients with an American Society of Anesthesiologists (ASA) score I-II the incidence rate was 2%; ASA score III or more, 3.7%. The incidence rate varied from 0.3% in clean surgical site to 6.5% in clean-contaminated site. The study validated the usefulness of targeted surveillance in monitoring SSIs in patients hospitalized in thoracic surgery departments. Surgical site infection surveillance identified areas of care requiring modifications, namely, organization of post-discharge and microbiologic diagnostics of infection cases.

Proposal for a sub-classification of hepato-biliary-pancreatic operations for surgical site infection surveillance following assessment of results of prospective multicenter data.

PubMed

Nakahira, Shin; Shimizu, Junzo; Miyamoto, Atsushi; Kobayashi, Shogo; Umeshita, Koji; Ito, Toshinori; Monden, Morito; Doki, Yuichiro; Mori, Masaki

2013-06-01

Surgical site infection (SSI) surveillance in Japan is based on the National Nosocomial Infection Surveillance system, which categorizes all hepato-biliary-pancreatic surgeries, except for cholecystectomy, into "BILI." We evaluated differences among BILI procedures to determine the optimal subdivision for SSI surveillance. We conducted multicenter SSI surveillance at 20 hospitals. BILI was subdivided into choledochectomy, pancreatoduodenectomy, hepatectomy, hepatectomy with biliary reconstruction, pancreatoduodenectomy with hepatectomy, distal pancreatectomy and total pancreatectomy to determine the optimal subdivision. The outcome of interest was SSI. Univariate and multivariate analyses were performed to determine the predictive significance of variables in each type of surgery. 1,926 BILI cases were included in this study. SSI rates were 23.2 % for all BILI; for choledochectomy 23.6 %, pancreatoduodenectomy 39.3 %, hepatectomy 12.8 %, hepatectomy with biliary reconstruction 41.9 %, pancreatoduodenectomy with hepatectomy 27.3 %, distal pancreatectomy 31.8 %, and total pancreatectomy 20.0 %. SSI rates for hepatectomy were significantly lower than those for non-hepatectomy BILI. Risk factors for developing SSI with hepatectomy were drain placement and long operative duration, while for non-hepatectomy BILI, risk factors were use of intra-abdominal silk sutures, SSI risk index and long operative duration. Hepatectomy and non-hepatectomy BILI differ with regard to the incidence of and risk factors for developing SSI. These surgeries should be assessed separately when conducting SSI surveillance.

FT4 Data Analysis Summary (SSI-ARC)

NASA Technical Reports Server (NTRS)

Isaacson, Douglas R.; Gong, Chester; Reardon, Scott Edward; Santiago, Confesor

2016-01-01

Standards for Unmanned Aircraft System (UAS) Detect-and-Avoid (DAA) systems are currently being developed under the auspices of the RTCA Special Committee 228 (SC-228). To support the development of these standards, a series of flight tests has been conducted at NASAs Armstrong Flight Research Center (NASA-AFRC). The fourth in this series of flight test activities (Flight Test 4, or simply FT4) was conducted during the Spring and Summer of 2016. FT4 supported the objectives of numerous organizations working toward UAS DAA Minimum Operational Performance Standards (MOPS) and UAS DAA Radar MOPS. The summary provided herein is limited to the objectives, analysis and conclusions of the NASA Ames Research Center (NASA-ARC) SSI team toward the refinement of UAS DAA MOPS. This document provides a high-level overview of FT4 and the SSI-ARC objectives, a summary of the data analysis methodology and recommendations for UAS DAA MOPS refinements based on the data analysis results. A total of 72 encounters were flown to support SSI-ARC objectives. Test results were generally consistent with acceptable UAS DAA system performance and will be considered in broader SC-228 requirements validation efforts. Observed alert lead times indicated acceptable UAS DAA alerting performance. Effective interoperability between the UAS DAA system and the Traffic Alert and Collision Avoidance System (TCAS) was observed with one notable exception: TCAS Resolutions Advisories (RA) were observed in the absence of any DAA alert on two occasions, indicating the need for alert parameter refinement. Findings further indicated the need for continued work in the areas of DAA Well Clear Recovery logic and alert stability for Mode-C-only intruders. Finally, results demonstrated a high level of compliance with a set of evaluation criteria designed to provide anecdotal evidence of acceptable UAS DAA system performance.

Antibiotic and Duration of Perioperative Prophylaxis Predicts Surgical Site Infection in Head and Neck Surgery.

PubMed

Langerman, Alexander; Thisted, Ronald; Hohmann, Samuel; Howell, Michael

2016-06-01

To examine the effect of giving antibiotics on the day of surgery (DOS) vs DOS and first postoperative day (DOS+1) for prophylaxis against surgical site infection (SSI) in clean-contaminated head and neck surgery (CCHNS). Retrospective multi-institution analysis using University HealthSystem Consortium data. A multivariate logistic regression model of 8836 discharge records from patients undergoing CCHNS was used to determine the odds of SSI for antibiotic agent/duration combinations. Ninety-two academic and affiliated medical centers from 2008 to 2011. Ampicillin/sulbactam, clindamycin, cefazolin + metronidazole, and cefazolin alone were the most common antibiotics. For patients receiving antibiotics only on DOS, there was no significant difference in odds of SSI based on antibiotic choice. When given on the DOS and DOS+1, patients receiving ampicillin/sulbactam had a reduction in odds of SSI by over two-thirds (odds ratio [OR], 0.28 [95% confidence interval, 0.13-0.61], P = .001, compared with ampicillin/sulbactam on DOS only), whereas this effect was not seen with clindamycin (1.82 [0.93-3.56], P = .078, compared with clindamycin on DOS only). Prolonging clindamycin beyond the DOS was associated with a higher odds of SSI compared with DOS-only ampicillin/sulbactam (OR, 2.66; 95% CI, 1.33-5.30; P = .006). These relationships held in a subset of physicians and hospitals that used multiple different regimens. DOS+1 regimens were not associated with an increased odds of antibiotic-induced complications. Prolonging ampicillin/sulbactam beyond the day of surgery may have a protective effect against SSI, and 1 or more days of ampicillin/sulbactam may be preferable to multiple days of clindamycin. New randomized trials are needed to define the ideal regimen for CCHNS. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Surveillance, control, and prevention of surgical site infections in breast cancer surgery: a 5-year experience.

PubMed

Vilar-Compte, Diana; Rosales, Samuel; Hernandez-Mello, Norma; Maafs, Eduardo; Volkow, Patricia

2009-10-01

We analyzed variations in surgical site infections (SSIs) during 5 years of a prospective surveillance program and investigated possible contributors to SSIs in a cohort of patients who underwent surgery for breast cancer. All breast surgeries performed between January 2001 and December 2005 were registered. Patients were followed-up by direct observation for at least 30 days under standardized conditions. The main outcome studied was SSI. A case-control analysis was conducted to identify SSI-associated risk factors and to evaluate SSI variations by means of a control chart. During the study period, a total of 2338 breast cancer surgeries were recorded, and 441 SSIs (18.9%) were diagnosed. SSI frequency varied across the 5-year period, with a sharp decline seen after the introduction of preventive policies. After 2002, 3 out-of-confidence limits of SSIs were observed, 2 related to the use of evacuation systems and 1 associated with a group of rotating residents. Concomitant preoperative chemoradiation (odds ratio [OR]=3.47; 95% confidence interval [CI]=2.51 to 4.80), hematoma (OR=3.05; 95% CI=1.70 to 5.52), age > or = 58 years (OR=1.83; 95% CI=1.27 to 2.65), body mass index > or = 30.8 (OR=1.58; 95% CI=1.14 to 2.18), and duration of surgery > or = 160 minutes (OR=1.73; 95% CI=1.20 to 2.50) were found to be SSI-associated risk factors. After 5 years of a continuous prospective surveillance program, we were able to decrease the rate of SSIs in patients undergoing breast cancer surgery (from 33.3% in 2000 to 18.9% in 2005), identify SSI-associated risk factors, and improve the quality of care delivered to these patients.

Is There Room for Prevention? Examining the Effect of Outpatient Facility Type on the Risk of Surgical Site Infection.

PubMed

Parikh, Rishi; Pollock, Daniel; Sharma, Jyotirmay; Edwards, Jonathan

2016-10-01

OBJECTIVE We compared risk for surgical site infection (SSI) following surgical breast procedures among 2 patient groups: those whose procedures were performed in ambulatory surgery centers (ASCs) and those whose procedures were performed in hospital-based outpatient facilities. DESIGN Cohort study using National Healthcare Safety Network (NHSN) SSI data for breast procedures performed from 2010 to 2014. METHODS Unconditional multivariate logistic regression was used to examine the association between facility type and breast SSI, adjusting for American Society of Anesthesiologists (ASA) Physical Status Classification, patient age, and duration of procedure. Other potential adjustment factors examined were wound classification, anesthesia use, and gender. RESULTS Among 124,021 total outpatient breast procedures performed between 2010 and 2014, 110,987 procedure reports submitted to the NHSN provided complete covariate data and were included in the analysis. Breast procedures performed in ASCs carried a lower risk of SSI compared with those performed in hospital-based outpatient settings. For patients aged ≤51 years, the adjusted risk ratio was 0.36 (95% CI, 0.25-0.50) and for patients >51 years old, the adjusted risk ratio was 0.32 (95% CI, 0.21-0.49). CONCLUSIONS SSI risk following breast procedures was significantly lower among ASC patients than among hospital-based outpatients. These findings should be placed in the context of study limitations, including the possibility of incomplete ascertainment of SSIs and shortcomings in the data available to control for differences in patient case mix. Additional studies are needed to better understand the role of procedural settings in SSI risk following breast procedures and to identify prevention opportunities. Infect Control Hosp Epidemiol 2016;1-7.

Financial impact of surgical site infections on hospitals: the hospital management perspective.

PubMed

Shepard, John; Ward, William; Milstone, Aaron; Carlson, Taylor; Frederick, John; Hadhazy, Eric; Perl, Trish

2013-10-01

Surgical site infections (SSIs) may increase health care costs, but few studies have conducted an analysis from the perspective of hospital administrators. To determine the change in hospital profit due to SSIs. Retrospective study of data from January 1, 2007, to December 31, 2010. The study was performed at 4 of The Johns Hopkins Health System acute care hospitals in Maryland: Johns Hopkins Bayview (560 beds); Howard County General Hospital (238 beds); The Johns Hopkins Hospital (946 beds); and Suburban Hospital (229 beds). Eligible patients for the study included those patients admitted to the 4 hospitals between January 1, 2007, and December 31, 2010, with complete data and the correct International Classification of Diseases, Ninth Revision code, as determined by the infection preventionist. Infection preventionists performed complete medical record review using National Healthcare Safety Network definitions to identify SSIs. Patients were stratified using the All Patient Refined Diagnosis Related Groups to estimate the change in hospital profit due to SSIs. Surgical site infections. The outcomes of the study were the difference in daily total charges, length of stay (LOS), 30-day readmission rate, and profit for patients with an SSI when compared with patients without an SSI. The hypothesis, formulated prior to data collection, that patients with an SSI have higher daily total costs, a longer LOS, and higher 30-day readmission rates than patients without an SSI, was tested using a nonpaired Mann-Whitney U test, an analysis of covariance, and a Pearson χ2 test. Hospital charges were used as a proxy for hospital cost. RESULTS The daily total charges, mean LOS, and 30-day readmission rate for patients with an SSI compared with patients without an SSI were $7493 vs $7924 (P = .99); 10.56 days vs 5.64 days (P < .001); and 51.94 vs 8.19 readmissions per 100 procedures (P < .001). The change in profit due SSIs was $2 268 589. The data suggest that hospitals have a financial incentive to reduce SSIs, but hospitals should expect to see an increase in both cost and revenue when SSIs are reduced.

Performance of shear wave elastography for differentiation of benign and malignant solid breast masses.

PubMed

Li, Guiling; Li, De-Wei; Fang, Yu-Xiao; Song, Yi-Jiang; Deng, Zhu-Jun; Gao, Jian; Xie, Yan; Yin, Tian-Sheng; Ying, Li; Tang, Kai-Fu

2013-01-01

To perform a meta-analysis assessing the ability of shear wave elastography (SWE) to identify malignant breast masses. PubMed, the Cochrane Library, and the ISI Web of Knowledge were searched for studies evaluating the accuracy of SWE for identifying malignant breast masses. The diagnostic accuracy of SWE was evaluated according to sensitivity, specificity, and hierarchical summary receiver operating characteristic (HSROC) curves. An analysis was also performed according to the SWE mode used: supersonic shear imaging (SSI) and the acoustic radiation force impulse (ARFI) technique. The clinical utility of SWE for identifying malignant breast masses was evaluated using analysis of Fagan plot. A total of 9 studies, including 1888 women and 2000 breast masses, were analyzed. Summary sensitivities and specificities were 0.91 (95% confidence interval [CI], 0.88-0.94) and 0.82 (95% CI, 0.75-0.87) by SSI and 0.89 (95% CI, 0.81-0.94) and 0.91 (95% CI, 0.84-0.95) by ARFI, respectively. The HSROCs for SSI and ARFI were 0.92 (95% CI, 0.90-0.94) and 0.96 (95% CI, 0.93-0.97), respectively. SSI and ARFI were both very informative, with probabilities of 83% and 91%, respectively, for correctly differentiating between benign and malignant breast masses following a "positive" measurement (over the threshold value) and probabilities of disease as low as 10% and 11%, respectively, following a "negative" measurement (below the threshold value) when the pre-test probability was 50%. SWE could be used as a good identification tool for the classification of breast masses.

Iodine-122-labeled amphetamine derivative with potential for PET brain blood-flow studies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mathis, C.A.; Sargent, T. 3d.; Shulgin, A.T.

1985-11-01

The positron emitter SSI (t1/2 3.6 min) was collected from a xenon- SS/iodine- SS ( SSXe/ SSI) generator and incorporated into an amphetamine analog, 2,4-dimethoxy-N,N-dimethyl-5-( SSI)iodophenylisopropylamine (5-( SSI)-2,4-DNNA). The remote synthesis was achieved in 3 min with a 50% radioincorporation yield and a product radiopurity of greater than 98%. 5-( SSI)-2,4-DNNA was injected into a beagle dog and a brain section imaged with positron emission tomography (PET). The uptake and retention of 5-( SSI)-2,4-DNNA was compared to that of YSRb in the same animal. Dynamic PET activity data were obtained 0-20 min postinjection of 5-( SSI)-2,4-DNNA and showed rapid uptakemore » by brain and good cerebral/extracerebral tissue distinction. A whole-body scan of a dog was also obtained with 5-123I-2,4-DNNA showing uptake in brain, lung, and other body organs. The feasibility of incorporating SSI into an extracted brain perfusion agent for use with PET is demonstrated.« less

Reliability-based design optimization of reinforced concrete structures including soil-structure interaction using a discrete gravitational search algorithm and a proposed metamodel

NASA Astrophysics Data System (ADS)

Khatibinia, M.; Salajegheh, E.; Salajegheh, J.; Fadaee, M. J.

2013-10-01

A new discrete gravitational search algorithm (DGSA) and a metamodelling framework are introduced for reliability-based design optimization (RBDO) of reinforced concrete structures. The RBDO of structures with soil-structure interaction (SSI) effects is investigated in accordance with performance-based design. The proposed DGSA is based on the standard gravitational search algorithm (GSA) to optimize the structural cost under deterministic and probabilistic constraints. The Monte-Carlo simulation (MCS) method is considered as the most reliable method for estimating the probabilities of reliability. In order to reduce the computational time of MCS, the proposed metamodelling framework is employed to predict the responses of the SSI system in the RBDO procedure. The metamodel consists of a weighted least squares support vector machine (WLS-SVM) and a wavelet kernel function, which is called WWLS-SVM. Numerical results demonstrate the efficiency and computational advantages of DGSA and the proposed metamodel for RBDO of reinforced concrete structures.

[Surveillance of surgical-site infections: results of the INCISO 1998 Network].

PubMed

Golliot, F; Astagneau, P; Brücker, G

1999-01-01

Surveillance of Surgical-Site Infection (SSI) in general and visceral surgical departments. Prospective cohort study. Inter-regional Co-ordinating Center for Nosocomial Infection Control (C.CLIN Paris-Nord). Regions of Ile de France, Haute Normandie, Nord-Pas de Calais and Picardie. From January 1 to April 1, 1998, each surgical department had included 200 consecutive operations. To diagnose SSI occurring after discharge, patients were followed during one month after surgery. SSI were defined according to standardized criteria. Overall, 16.506 surgeries were followed in 120 surgical units. The rate of postoperative SSI was 3.9% (95CI = [3.6%-4.2%]). The rate of SSI varied from 5.2% for digestive surgery to 0.9% for endocrine system, and 2.3% for cholecystectomy to 16.6% for peritonitis. According to the NNIS index, SSI rates increased from 2.2% for patients with a risk index of 0 to 26.7% for patients with a risk index of 3. The case fatality rate directly or indirectly attributable to SSI was 2.0% (95CI = [1.1%-3.5%]). The high incidence of SSI render crucial the implementation of SSI surveillance in surgery. Risk factors and type of surgical procedures are required to obtain standardized rates for comparisons between services.

Reduced Ssy1-Ptr3-Ssy5 (SPS) signaling extends replicative life span by enhancing NAD+ homeostasis in Saccharomyces cerevisiae.

PubMed

Tsang, Felicia; James, Christol; Kato, Michiko; Myers, Victoria; Ilyas, Irtqa; Tsang, Matthew; Lin, Su-Ju

2015-05-15

Attenuated nutrient signaling extends the life span in yeast and higher eukaryotes; however, the mechanisms are not completely understood. Here we identify the Ssy1-Ptr3-Ssy5 (SPS) amino acid sensing pathway as a novel longevity factor. A null mutation of SSY5 (ssy5Δ) increases replicative life span (RLS) by ∼50%. Our results demonstrate that several NAD(+) homeostasis factors play key roles in this life span extension. First, expression of the putative malate-pyruvate NADH shuttle increases in ssy5Δ cells, and deleting components of this shuttle, MAE1 and OAC1, largely abolishes RLS extension. Next, we show that Stp1, a transcription factor of the SPS pathway, directly binds to the promoter of MAE1 and OAC1 to regulate their expression. Additionally, deletion of SSY5 increases nicotinamide riboside (NR) levels and phosphate-responsive (PHO) signaling activity, suggesting that ssy5Δ increases NR salvaging. This increase contributes to NAD(+) homeostasis, partially ameliorating the NAD(+) deficiency and rescuing the short life span of the npt1Δ mutant. Moreover, we observed that vacuolar phosphatase, Pho8, is partially required for ssy5Δ-mediated NR increase and RLS extension. Together, our studies present evidence that supports SPS signaling is a novel NAD(+) homeostasis factor and ssy5Δ-mediated life span extension is likely due to concomitantly increased mitochondrial and vacuolar function. Our findings may contribute to understanding the molecular basis of NAD(+) metabolism, cellular life span, and diseases associated with NAD(+) deficiency and aging. © 2015 by The American Society for Biochemistry and Molecular Biology, Inc.

Suppression of the rice fatty-acid desaturase gene OsSSI2 enhances resistance to blast and leaf blight diseases in rice.

PubMed

Jiang, Chang-Jie; Shimono, Masaki; Maeda, Satoru; Inoue, Haruhiko; Mori, Masaki; Hasegawa, Morifumi; Sugano, Shoji; Takatsuji, Hiroshi

2009-07-01

Fatty acids and their derivatives play important signaling roles in plant defense responses. It has been shown that suppressing a gene for stearoyl acyl carrier protein fatty-acid desaturase (SACPD) enhances the resistance of Arabidopsis (SSI2) and soybean to multiple pathogens. In this study, we present functional analyses of a rice homolog of SSI2 (OsSSI2) in disease resistance of rice plants. A transposon insertion mutation (Osssi2-Tos17) and RNAi-mediated knockdown of OsSSI2 (OsSSI2-kd) reduced the oleic acid (18:1) level and increased that of stearic acid (18:0), indicating that OsSSI2 is responsible for fatty-acid desaturase activity. These plants displayed spontaneous lesion formation in leaf blades, retarded growth, slight increase in endogenous free salicylic acid (SA) levels, and SA/benzothiadiazole (BTH)-specific inducible genes, including WRKY45, a key regulator of SA/BTH-induced resistance, in rice. Moreover, the OsSSI2-kd plants showed markedly enhanced resistance to the blast fungus Magnaporthe grisea and leaf-blight bacteria Xanthomonas oryzae pv. oryzae. These results suggest that OsSSI2 is involved in the negative regulation of defense responses in rice, as are its Arabidopsis and soybean counterparts. Microarray analyses identified 406 genes that were differentially expressed (>or=2-fold) in OsSSI2-kd rice plants compared with wild-type rice and, of these, approximately 39% were BTH responsive. Taken together, our results suggest that induction of SA-responsive genes, including WRKY45, is likely responsible for enhanced disease resistance in OsSSI2-kd rice plants.

Does an information leaflet about surgical site infection (SSI) improve recollection of information and satisfaction of patients? A randomized trial in patients scheduled for digestive surgery.

PubMed

Merle, Véronique; Marini, Hélène; Rongère, Julie; Tavolacci, Marie-Pierre; Scotté, Michel; Czernichow, Pierre

2011-06-01

A previous study suggested that most surgical patients do not remember having received information about surgical site infection (SSI). In other fields, written information has been suggested to improve patient satisfaction and recollection of information. Our objective was to assess if providing patients with written information about SSI, in addition to oral information, could influence patient satisfaction, recall of information, and opinion regarding SSI. A total of 207 patients scheduled for digestive surgery at a university hospital were randomized between usual oral information about SSI, plus an information leaflet about SSI (group O/L), or usual oral information alone (group O). Patients were interviewed 5 weeks after surgery to assess their recall and satisfaction regarding information, opinion regarding SSI, and declared intention of seeking legal action in case of SSI. Surgeons and interviewer were blinded to patients' group allocation. Recruitment occurred between October 2005 and August 2006. Of the original 207 patients, 161 patients (O/L=87, O=74) underwent operation and were interviewed as scheduled. Satisfaction was higher in group O/L (67% vs. O: 43%; P=0.003). The recall of having received information (O/L: 39% vs. O: 31%; P=0.29), was similar between the two groups. Judging SSI as always preventable was more frequent in group O/L (28% vs. O: 9%; P=0.004) with a trend toward a more frequent intention of seeking legal action (O/L: 10% vs. O: 3%; P=0.055). The leaflet did not improve patient recall of information about SSI, but it was associated with an increased level of satisfaction. The association between the leaflet and judging SSI as always preventable was unexpected.

Population genetics of sporophytic self-incompatibility in Senecio squalidus L. (Asteraceae) II: a spatial autocorrelation approach to determining mating behaviour in the presence of low S allele diversity.

PubMed

Brennan, A C; Harris, S A; Hiscock, S J

2003-11-01

We recently estimated that as few as six S alleles represent the extent of S locus diversity in a British population of the self-incompatible (SI) coloniser Senecio squalidus (Oxford Ragwort). Despite the predicted constraints to mating imposed by such a low number of S alleles, S. squalidus maintains a strong sporophytic self-incompatibility (SSI) system and there is no evidence for a breakdown of SSI or any obvious negative reproductive consequences for this highly successful coloniser. The present paper assesses mating behaviour in an Oxford S. squalidus population through observations of its effect on spatial patterns of genetic diversity and thus the extent to which it is responsible for ameliorating the potentially detrimental reproductive consequences of low S allele diversity in British S. squalidus. A spatial autocorrelation (SA) treatment of S locus and allozyme polymorphism data for four loci indicates that mating events regularly occur at all the distance classes examined from 60 to 480 m throughout the entire sample population. Less SA is observed for S locus data than for allozyme data in accordance with the hypothesis that SSI and low diversity at the S locus are driving these large-scale mating events. The limited population structure at small distances of 60 m and less observed for SA analysis of the Me-2 locus and by F-statistics for all the allozyme data, is evidence of some local relatedness due to limited seed and pollen dispersal in S. squalidus. However, the overall impression of mating dynamics in this S. squalidus population is that of ample potential mating opportunities with many individuals at large population scales, indicating that reproductive success is not seriously affected by few S alleles available for mating interactions.

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study.

PubMed

2018-05-01

Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05-2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001). Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication. DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

20 CFR 416.202 - Who may get SSI benefits.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Who may get SSI benefits. 416.202 Section 416.202 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility General § 416.202 Who may get SSI benefits. You are eligible for SSI benefits if you meet all of the following...

Diagnosis and Treatment of Vascular Surgery Related Infection

PubMed Central

Zhang, Yong-Gan; Guo, Xue-Li; Song, Yan; Miao, Chao-Feng; Zhang, Chuang; Chen, Ning-Heng

2015-01-01

Surgical site infection (SSI) is an important component of infections acquired from hospital. The most significant feature of vascular surgery different from other surgeries is frequent application of artificial grafts. Once SSI occurs after vascular operations with grafts, it might results in a serious disaster. Staphylococcus aureus and coagulase-negative Staphylococcus are the most common pathogenic bacteria for SSI after vascular surgery. Although SSI in vascular surgery often lacks of typical clinical characters, some clinical symptoms, laboratory data and certain imaging procedures may help to diagnose. In most cases of SSI after vascular procedures, the artificial grafts must be removed and sensitive antibiotics should be administered. However, for different cases, personalized management plan should be made depending on the severity and location of SSI. PMID:26628937

Downward trends in surgical site and urinary tract infections after cesarean delivery in a French surveillance network, 1997-2003.

PubMed

Vincent, Agnès; Ayzac, Louis; Girard, Raphaële; Caillat-Vallet, Emmanuelle; Chapuis, Catherine; Depaix, Florence; Dumas, Anne-Marie; Gignoux, Chantal; Haond, Catherine; Lafarge-Leboucher, Joëlle; Launay, Carine; Tissot-Guerraz, Françoise; Fabry, Jacques

2008-03-01

To evaluate whether the adjusted rates of surgical site infection (SSI) and urinary tract infection (UTI) after cesarean delivery decrease in maternity units that perform active healthcare-associated infection surveillance. Trend analysis by means of multiple logistic regression. A total of 80 maternity units participating in the Mater Sud-Est surveillance network. A total of 37,074 cesarean deliveries were included in the surveillance from January 1, 1997, through December 31, 2003. We used a logistic regression model to estimate risk-adjusted post-cesarean delivery infection odds ratios. The variables included were the maternity units' annual rate of operative procedures, the level of dispensed neonatal care, the year of delivery, maternal risk factors, and the characteristics of cesarean delivery. The trend of risk-adjusted odds ratios for SSI and UTI during the study period was studied by linear regression. The crude rates of SSI and UTI after cesarean delivery were 1.5% (571 of 37,074 patients) and 1.8% (685 of 37,074 patients), respectively. During the study period, the decrease in SSI and UTI adjusted odds ratios was statistically significant (R=-0.823 [P=.023] and R=-0.906 [P=.005], respectively). Reductions of 48% in the SSI rate and 52% in the UTI rate were observed in the maternity units. These unbiased trends could be related to progress in preventive practices as a result of the increased dissemination of national standards and a collaborative surveillance with benchmarking of rates.

[Implementation of a post-discharge surgical site infection system in herniorrhaphy and mastectomy procedures].

PubMed

San Juan Sanz, Isabel; Díaz-Agero-Pérez, Cristina; Robustillo-Rodela, Ana; Pita López, María José; Oliva Iñiguez, Lourdes; Monge-Jodrá, Vicente

2014-10-01

Monitoring surgical site infection (SSI) performed during hospitalization can underestimate its rates due to the shortening in hospital stay. The aim of this study was to determine the actual rates of SSI using a post-discharge monitoring system. All patients who underwent herniorraphy or mastectomy in the Hospital Universitario Ramón y Cajal from 1 January 2011 to 31 December 2011 were included. SSI data were collected prospectively according to the continuous quality improvement indicators (Indicadores Clinicos de Mejora Continua de la Calidad [INCLIMECC]) monitoring system. Post-discharge follow-up was conducted by telephone survey. A total of 409patients were included in the study, of whom 299 underwent a herniorraphy procedure, and 110 underwent a mastectomy procedure. For herniorrhaphy, the SSI rate increased from 6.02% to 7.6% (the post-discharge survey detected 21.7% of SSI). For mastectomy, the SSI rate increased from 1.8% to 3.6% (the post-discharge survey detected 50% of SSI). Post-discharge monitoring showed an increased detection of SSI incidence. Post-discharge monitoring is useful to analyze the real trend of SSI, and evaluate improvement actions. Post-discharge follow-up methods need to standardised. Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Overweight is a risk factor for surgical site infection following distal gastrectomy for gastric cancer.

PubMed

Hirao, Motohiro; Tsujinaka, Toshimasa; Imamura, Hiroshi; Kurokawa, Yukinori; Inoue, Kentaro; Kimura, Yutaka; Shimokawa, Toshio; Furukawa, Hiroshi

2013-04-01

Our objective was to assess the risk factors for surgical site infections (SSIs) in gastric surgery using the results of the Osaka Gastrointestinal Cancer Chemotherapy Study Group (OGSG) 0501 phase 3 trial. The OGSG 0501 trial was conducted to compare standard prophylactic antibiotic administration versus extended prophylactic antibiotic administration in 355 patients who underwent open distal gastrectomy for gastric cancer. Various risk factors associated with the incidence of SSI following gastrectomy were analyzed from the results of this multi-institutional randomized controlled trial. Among the 355 patients, there were 24 SSIs, for an overall SSI rate of 7 %. Multivariate analysis using eight baseline factors (administration of antibiotics, age, sex, body mass index [BMI], prognostic nutritional index, tumor stage, lymph node dissection, reconstructive method) identified that BMI ≥ 25 kg/m(2) was an independent risk factor for the occurrence of SSI (odds ratio 2.82; 95 % confidence interval [CI] 1.05-7.52; P = 0.049). BMI also showed significant relationships with the volume of blood loss and the operation time (P = 0.001 and P < 0.001, respectively). Compared with patients of normal weight, overweight patients had a significantly higher risk of SSI after distal gastrectomy for cancer.

A retrospective analysis of the risk factors for surgical site infections and long-term follow-up after transpalpebral enucleation in horses.

PubMed

Huppes, Tsjester; Hermans, Hanneke; Ensink, Jos M

2017-06-02

Implants are often used to improve the cosmetic appearance of horses after enucleation of the eye. When surgical site infection (SSI) occurs, the implant will almost always be lost. The aim of this study is to collect data on the risk factors for SSIs and report long-term follow-up (cosmetic results and return to work) after transpalpebral enucleations. In this retrospective study, records of horses undergoing transpalpebral enucleation were reviewed (2007-2014) and telephone interviews were used to obtain long term follow-up. The potential risk factors for SSIs (indication for enucleation, use of an implant, standing procedures, duration of surgery, opening of the conjunctival sac and prolonged use of antimicrobials) were analysed for their association with the outcome measure 'SSI' vs 'no SSI' by multivariable binary logistic regression testing. Indications for enucleation were grouped as follows: Group 1 (clean) included equine recurrent uveitis, too small or too large globes, and intraocular tumours, Group 2 (non-clean) included corneal perforation/rupture and infected ulcers and Group 3 (tumour) included extraocular tumours. One hundred and seven cases of enucleation were evaluated. An implant was used in 49 horses. The overall number of SSIs was 8 (7.5%). Multivariable logistic regression testing showed implants (OR 7.5, P = 0.04) and standing procedures (OR 12.1; P = 0.03) were significantly associated with the percentage of SSIs and increased the risk of SSI. The eyes of horses in Groups 2 and 3 trended towards a larger risk for developing SSIs (OR 4.9; P = 0.09 and OR 5.9; P = 0.1, respectively). Prolonged use of antimicrobials, long surgery times and the opening of the conjunctival sac during dissection did not show significant associations with SSI risk. The risk of SSI after enucleation is low in clean eyes and when no implant is used. Placing an implant or performing a standing enucleation significantly increases the risk of SSIs. Although implants can be used for eyes that fall into Groups 2 and 3, 17% of the horses in these two groups developed an SSI leading to loss of the implant.

The Relationship between Social Support and Diet Quality in Middle-Aged and Older Adults in the United States.

PubMed

Pieroth, Renee; Rigassio Radler, Diane; Guenther, Patricia M; Brewster, Philip J; Marcus, Andrea

2017-08-01

Social support has been associated with physical and mental health; however, the relationship between social support and diet quality is not well understood. The purpose of this research was to assess the relationship between social support and overall diet quality among US adults. This study was a secondary analysis of data from adults aged 40 years and older who participated in the cross-sectional 2007-2008 National Health and Nutrition Examination Survey (N=3,243). Social support was determined by a modification of the Rees Social Support Index (SSI), which is the sum of five dichotomized variables addressing emotional support, financial support, marital status, close friends, and religious service attendance. Overall diet quality was measured by the Healthy Eating Index-2010 (HEI-2010) and calculated from the mean of two 24-hour dietary recalls. SAS survey procedures were used to incorporate the appropriate sample design weights. Unweighted frequencies are reported along with weighted means and standard errors (SE). Multivariable linear regression was used to compare the total HEI-2010 scores among the six SSI groups with additional models controlling for sex, age, race/ethnicity, income level, and education level, and stratifying by sex. In an unadjusted model, the mean total HEI-2010 score for those with an SSI score of 0 (n=37) was 50.0 (SE=2.83) compared to 57.1 (SE=0.89) for those with SSI score of 5 (n=676) (P<0.0001). The results were no longer statistically significant when adjusted for age, sex, race/ethnicity, income, and education level (P=0.14). However, when stratified by sex and adjusted for other demographics, higher SSI scores were associated with higher HEI-2010 scores compared to lower SSI scores in men (P=0.02), but there was no significant difference among SSI scores and HEI-2010 scores in women (P=0.43). This study suggests a positive relationship between social support and overall diet quality among middle-aged and older men, but not women, in the United States. Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Morbidity associated with 30-day surgical site infection following nonshunt pediatric neurosurgery

PubMed Central

Sherrod, Brandon A.; Rocque, Brandon G.

2017-01-01

Objective Morbidity associated with surgical site infection (SSI) following nonshunt pediatric neurosurgical procedures is poorly understood. The purpose of this study was to analyze acute morbidity and mortality associated with SSI after nonshunt pediatric neurosurgery using a nationwide cohort. Methods The authors reviewed data from the American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) 2012–2014 database, including all neurosurgical procedures performed on pediatric patients. Procedures were categorized by Current Procedural Terminology (CPT) codes. CSF shunts were excluded. Deep and superficial SSIs occurring within 30 days of an index procedure were identified. Deep SSIs included deep wound infections, intracranial abscesses, meningitis, osteomyelitis, and ventriculitis. The following outcomes occurring within 30 days of an index procedure were analyzed, along with postoperative time to complication development: sepsis, wound disruption, length of postoperative stay, readmission, reoperation, and death. Results A total of 251 procedures associated with a 30-day SSI were identified (2.7% of 9296 procedures). Superficial SSIs were more common than deep SSIs (57.4% versus 42.6%). Deep SSIs occurred more frequently after epilepsy or intracranial tumor procedures. Superficial SSIs occurred more frequently after skin lesion, spine, Chiari decompression, craniofacial, and myelomeningocele closure procedures. The mean (± SD) postoperative length of stay for patients with any SSI was 9.6 ± 14.8 days (median 4 days). Post-SSI outcomes significantly associated with previous SSI included wound disruption (12.4%), sepsis (15.5%), readmission (36.7%), and reoperation (43.4%) (p < 0.001 for each). Post-SSI sepsis rates (6.3% vs 28.0% for superficial versus deep SSI, respectively; p < 0.001), wound disruption rates (4.9% vs 22.4%, p < 0.001), and reoperation rates (23.6% vs 70.1%, p < 0.001) were significantly greater for patients with deep SSIs. Postoperative length of stay in patients discharged before SSI development was not significantly different for deep versus superficial SSI (4.2 ± 2.7 vs 3.6 ± 2.4 days, p = 0.094). No patient with SSI died within the first 30 days after surgery. Conclusions Thirty-day SSI is associated with significant 30-day morbidity in pediatric patients undergoing nonshunt neurosurgery. Rates of SSI-associated complications are significantly lower in patients with superficial infection than in those with deep infection. There were no cases of SSI-related mortality within 30 days of the index procedure. PMID:28186474

A profile of children with disabilities receiving SSI: highlights from the National Survey of SSI Children and Families.

PubMed

Rupp, Kalman; Davies, Paul S; Newcomb, Chad; Iams, Howard; Becker, Carrie; Mulpuru, Shanti; Ressler, Stephen; Romig, Kathleen; Miller, Baylor

This article provides a nationally representative profile of noninstitutionalized children 0 to 17 years of age who were receiving support from the Supplemental Security Income (SSI) program because of a disability. To assess the role of the SSI program in providing assistance to low-income children with disabilities and their families, it is important to obtain detailed information on demographic characteristics, income and assets, health and disabilities, and health care utilization. Yet administrative records of the Social Security Administration do not contain many of the relevant data items, and the records provide only an incomplete picture of the family relationships affecting the lives of children with disabilities. The National Survey of SSI Children and Families fills this gap. This summary article is based on survey interviews conducted between July 2001 and June 2002 and provides some highlights characterizing children with disabilities who were receiving SSI and their families. Most children receiving SSI (hereafter referred to as "SSI children") lived in a family headed by a single mother, and less than one in three lived with both parents. A very high proportion, about half, were living in a household with at least one other individual reported to have had a disability. About 70 percent of children received some kind of special education. SSI support was the most important source of family income, with earnings a close second. On average, SSI payments accounted for nearly half of the income for the children's families, and earnings accounted for almost 40 percent. When all sources of family income were considered, slightly more than half (54 percent) of SSI children lived in families above the poverty threshold, a notable fact given that the federal SSI program guarantees only a subpoverty level of income. However, beyond these averages there was substantial variation, with some children living in families with income well below the poverty threshold and others having income well over 200 percent of the poverty threshold. About one-third of SSI children lived in families owning a home, two-thirds lived with parents or guardians with at least one car, and about 40 percent lived with parents or guardians with zero liquid assets. Less than 4 percent lived with adults who owned stocks, mutual funds, notes, certificates of deposit, or savings bonds. The Social Security Administration's administrative records contain only a limited amount of information about disability diagnoses. The National Survey of SSI Children and Families supplements those records with data from an array of questions on functional limitations, self-reported health, and the perceived severity of disabilities. The data suggest that a great degree of variation in severity exists within the childhood caseload, as reflected in reports of the presence or absence of six functional limitations, perceived overall health status, and perceived impact of disability on the child's ability to do things. Overall, 36 percent of the children were reported to have had disabilities that affected their abilities to do things "a great deal," and for 21 percent their difficulties had very little or no impact. Physical disabilities were most common among children aged 0 to 5, and mental disabilities dominated the picture for the other two age groups: 6 to 12 and 13 to 17. Virtually all SSI children are covered by some form of health insurance, with Medicaid being by far the most common source of health insurance coverage. Just as in the case of the severity of disabilities, substantial variation was reported in health care utilization among SSI children. Almost 30 percent of children had two or fewer doctor visits during the 12 months preceding the interview, and close to 50 percent had five or more doctor visits. About four-fifths of the children had no reported hospitalizations or surgeries during the previous year. More than 40 percent of the children visited an emergency room during the previous year, most of them more than once. Importantly, no out-of-pocket costs associated with medical care were reported for more than two-thirds of the children, and only about 3 percent had annual expenses exceeding $1,000 for physical and mental health care. This finding suggests that SSI payments are not used to cover medical expenses for the overwhelming majority of children. The use of supportive therapies varied widely among SSI children: more than half reported having used physical, occupational, or speech therapy; only 8 percent used respite care for the parents or other family members. An analysis of the perception of the survey respondents shows that more than one-third of children had unmet needs for mental health counseling services, and about three-quarters of families had unmet needs for respite care. In several service categories, the proportion perceived to have had unmet service needs was around 10 percent or less. In the dominant service category of physical, occupational, and speech therapy, only 11 percent perceived to have had unmet service needs.

Cloning, characterisation and comparative analysis of a starch synthase IV gene in wheat: functional and evolutionary implications

PubMed Central

Leterrier, Marina; Holappa, Lynn D; Broglie, Karen E; Beckles, Diane M

2008-01-01

Background Starch is of great importance to humans as a food and biomaterial, and the amount and structure of starch made in plants is determined in part by starch synthase (SS) activity. Five SS isoforms, SSI, II, III, IV and Granule Bound SSI, have been identified, each with a unique catalytic role in starch synthesis. The basic mode of action of SSs is known; however our knowledge of several aspects of SS enzymology at the structural and mechanistic level is incomplete. To gain a better understanding of the differences in SS sequences that underscore their specificity, the previously uncharacterised SSIVb from wheat was cloned and extensive bioinformatics analyses of this and other SSs sequences were done. Results The wheat SSIV cDNA is most similar to rice SSIVb with which it shows synteny and shares a similar exon-intron arrangement. The wheat SSIVb gene was preferentially expressed in leaf and was not regulated by a circadian clock. Phylogenetic analysis showed that in plants, SSIV is closely related to SSIII, while SSI, SSII and Granule Bound SSI clustered together and distinctions between the two groups can be made at the genetic level and included chromosomal location and intron conservation. Further, identified differences at the amino acid level in their glycosyltransferase domains, predicted secondary structures, global conformations and conserved residues might be indicative of intragroup functional associations. Conclusion Based on bioinformatics analysis of the catalytic region of 36 SSs and 3 glycogen synthases (GSs), it is suggested that the valine residue in the highly conserved K-X-G-G-L motif in SSIII and SSIV may be a determining feature of primer specificity of these SSs as compared to GBSSI, SSI and SSII. In GBSSI, the Ile485 residue may partially explain that enzyme's unique catalytic features. The flexible 380s Loop in the starch catalytic domain may be important in defining the specificity of action for each different SS and the G-X-G in motif VI could define SSIV and SSIII action particularly. PMID:18826586

Performance of Shear Wave Elastography for Differentiation of Benign and Malignant Solid Breast Masses

PubMed Central

Song, Yi-Jiang; Deng, Zhu-Jun; Gao, Jian; Xie, Yan; Yin, Tian-Sheng; Ying, Li; Tang, Kai-Fu

2013-01-01

Objectives To perform a meta-analysis assessing the ability of shear wave elastography (SWE) to identify malignant breast masses. Methods PubMed, the Cochrane Library, and the ISI Web of Knowledge were searched for studies evaluating the accuracy of SWE for identifying malignant breast masses. The diagnostic accuracy of SWE was evaluated according to sensitivity, specificity, and hierarchical summary receiver operating characteristic (HSROC) curves. An analysis was also performed according to the SWE mode used: supersonic shear imaging (SSI) and the acoustic radiation force impulse (ARFI) technique. The clinical utility of SWE for identifying malignant breast masses was evaluated using analysis of Fagan plot. Results A total of 9 studies, including 1888 women and 2000 breast masses, were analyzed. Summary sensitivities and specificities were 0.91 (95% confidence interval [CI], 0.88–0.94) and 0.82 (95% CI, 0.75–0.87) by SSI and 0.89 (95% CI, 0.81–0.94) and 0.91 (95% CI, 0.84–0.95) by ARFI, respectively. The HSROCs for SSI and ARFI were 0.92 (95% CI, 0.90–0.94) and 0.96 (95% CI, 0.93–0.97), respectively. SSI and ARFI were both very informative, with probabilities of 83% and 91%, respectively, for correctly differentiating between benign and malignant breast masses following a “positive” measurement (over the threshold value) and probabilities of disease as low as 10% and 11%, respectively, following a “negative” measurement (below the threshold value) when the pre-test probability was 50%. Conclusions SWE could be used as a good identification tool for the classification of breast masses. PMID:24204613

Surgical site infections among high-risk patients in clean-contaminated head and neck reconstructive surgery: concordance with preoperative oral flora.

PubMed

Yang, Ching-Hsiang; Chew, Khong-Yik; Solomkin, Joseph S; Lin, Pao-Yuan; Chiang, Yuan-Cheng; Kuo, Yur-Ren

2013-12-01

Salivary contamination of surgical wounds in clean-contaminated head and neck surgery with free flap reconstruction remains a major cause of infection and leads to significant morbidity. This study investigates the correlation between intraoral flora and surgical site infections (SSIs) among high-risk head and neck cancer patients undergoing resection and free flap reconstruction. One hundred twenty-nine patients were identified as being at high risk for infective complications based on cancer stage, tumor size, comorbid factors, and extent of reconstruction. All patients had intraoral swab cultures before surgery. Patients with culture-confirmed SSI after surgery were chosen for analysis, using the κ index and its 95% confidence interval for concordance analysis. All patients received clindamycin and gentamicin for antibiotic prophylaxis for 5 days. Antibiotic susceptibility testing of all isolates was obtained and analyzed. Thirty-seven patients experienced SSI, or an infection rate of 28.3%, occurring at a mean of 9.3 postoperative days. The overall concordance between oral flora and SSI was fair to moderate (κ index of 0.25), but detailed analysis shows a higher concordance for known and opportunistic pathogens, such as Pseudomonas aeruginosa and Enterococcus faecalis, compared to typical oral commensals. Antibiotic susceptibility tests show rapid and significant increases in resistance to clindamycin, indicating a need for a more effective alternative. Predicting pathogens in SSI using preoperative oral swabs did not demonstrate a good concordance in general for patients undergoing clean-contaminated head and neck surgery, although concordance for certain pathogenic species seem to be higher than for typical intraoral commensals. The rapid development of resistance to clindamycin precludes its use as a prophylactic agent.

The Effect of Smoking on Thirty-Day Postoperative Complications After Total Joint Arthroplasty: A Propensity Score-Matched Analysis.

PubMed

Sahota, Shawn; Lovecchio, Francis; Harold, Ryan E; Beal, Matthew D; Manning, David W

2018-01-01

Total joint arthroplasty (TJA) is a highly successful treatment, but is burdensome to the national healthcare budget. National quality initiatives seek to reduce costly complications. Smoking's role in perioperative complication after TJA is less well known. This study aims to identify smoking's independent contribution to the risk of short-term complication after TJA. All patients undergoing primary TJA between 2011 and 2012 were selected from the American College of Surgeon's National Surgical Quality Improvement Program's database. Outcomes of interest included rates of readmission, reoperation, mortality, surgical complications, and medical complications. To eliminate confounders between smokers and nonsmokers, a propensity score was used to generate a 1:1 match between groups. A total of 1251 smokers undergoing TJA met inclusion criteria. Smokers in the combined total hip and knee arthroplasty cohort had higher 30-day readmission (4.8% vs 3.2%, P = .041), were more likely to have a surgical complication (odds ratio 1.84, 95% confidence interval 1.21-2.80), and had a higher rate of deep surgical site infection (SSI) (1.1% vs 0.2%, P = .007). Analysis of total hip arthroplasty only revealed that smokers had higher rates of deep SSI (1.3% vs 0.2%, P = .038) and higher readmission rate (4.3% vs 2.2%, P = .034). Analysis of total knee arthroplasty only revealed greater surgical complications (2.8% vs 1.2%, P = .048) and superficial SSI (1.8% vs 0.2%, P = .002) in smokers. Smoking in TJA is associated with higher rates of SSI, surgical complications, and readmission. Copyright © 2017 Elsevier Inc. All rights reserved.

20 CFR 416.1100 - Income and SSI eligibility.

Code of Federal Regulations, 2011 CFR

2011-04-01

..., BLIND, AND DISABLED Income General § 416.1100 Income and SSI eligibility. You are eligible for supplemental security income (SSI) benefits if you are an aged, blind, or disabled person who meets the...

Surgical site infections in an abdominal surgical ward at Kosovo Teaching Hospital.

PubMed

Raka, Lul; Krasniqi, Avdyl; Hoxha, Faton; Musa, Ruustem; Mulliqi, Gjyle; Krasniqi, Selvete; Kurti, Arsim; Dervishaj, Antigona; Nuhiu, Beqir; Kelmendi, Baton; Limani, Dalip; Tolaj, Ilir

2007-12-01

Abdominal surgical site infections (SSI) cause substantial morbidity and mortality for patients undergoing operative procedures. We determined the incidence of and risk factors for SSI after abdominal surgery in the Department of Abdominal Surgery at the University Clinical Centre of Kosovo (UCCK). Prospective surveillance of patients undergoing abdominal surgery was performed between December 2005 and June 2006. CDC definitions were followed to detect SSI and study forms were based on Europe Link for Infection Control through Surveillance (HELICS) protocol. A total of 253 surgical interventions in 225 patients were evaluated. The median age of patients was 42 years and 55.1% of them were male. The overall incidence rate of SSI was 12%. Follow-up was achieved for 84.1% of the procedures. For patients with an SSI, the median duration of hospitalization was 9 days compared with 4 days for those without an SSI (p2, use of antibiotic prophylaxis and NNIS class of >2 were all significant at p < .001. The SSI rates for the NNIS System risk classes 0, 1 and 2-3 were 4.2%, 46.7% and 100%, respectively. SSI caused considerable morbidity among surgical patients in UCCK. Appropriate active surveillance and infection control measures should be introduced during preoperative, intra-operative, and postoperative care to reduce infection rates.

Rates of Surgical Site Infection in Cholecystectomy: Comparison between a University Teaching Hospital, Madrid Region, Spain, and USA Rates.

PubMed

Rodríguez-Caravaca, Gil; Gil-Yonte, Pablo; Del-Moral-Luque, Juan Antonio; Lucas, Warren Covelé; Fernández-Cebrián, José María; Durán-Poveda, Manuel

2017-01-01

There are many factors that can influence surgical site infections (SSI) in cholecystectomies. Incidence of cholecystectomy SSI was studied and compared with the incidence in Madrid Region, Spain, and the United States. A prospective cohort study was conducted which included all patients who underwent gallbladder surgery for 5 consecutive years, at the Alcorcón Foundation University Teaching Hospital. SSI incidence rate was calculated. An association between risk factors and SSI incidence was assessed with the relative risk (RR). Infection rates were compared to those in the Madrid Region and to the overall Spanish and United States rates using the standardized infection ratio (SIR). The study included 1532 patients. Cumulative overall SSI was 1.96% (95% confidence interval [CI]: 1.3-2.7). The SIR was 0.89 with respect to the Madrid Region, 0.77 with respect to Spain's rate, and 1.77 with respect to the United States' rate. A laparoscopic route protected against infection (RR = 0.43; 95% CI: 0.2-0.9). Razor shaving in surgical preparation, duration of surgery, and neoplasm increased SSI incidence. SSI incidence rates among cholecystectomized patients at our hospital are higher than rates in the United States. A laparoscopic route protected against SSI. Copyright: © 2017 SecretarÍa de Salud

Recent variability of the solar spectral irradiance and its impact on climate modelling

NASA Astrophysics Data System (ADS)

Ermolli, I.; Matthes, K.; Dudok de Wit, T.; Krivova, N. A.; Tourpali, K.; Weber, M.; Unruh, Y. C.; Gray, L.; Langematz, U.; Pilewskie, P.; Rozanov, E.; Schmutz, W.; Shapiro, A.; Solanki, S. K.; Woods, T. N.

2013-04-01

The lack of long and reliable time series of solar spectral irradiance (SSI) measurements makes an accurate quantification of solar contributions to recent climate change difficult. Whereas earlier SSI observations and models provided a qualitatively consistent picture of the SSI variability, recent measurements by the SORCE (SOlar Radiation and Climate Experiment) satellite suggest a significantly stronger variability in the ultraviolet (UV) spectral range and changes in the visible and near-infrared (NIR) bands in anti-phase with the solar cycle. A number of recent chemistry-climate model (CCM) simulations have shown that this might have significant implications on the Earth's atmosphere. Motivated by these results, we summarize here our current knowledge of SSI variability and its impact on Earth's climate. We present a detailed overview of existing SSI measurements and provide thorough comparison of models available to date. SSI changes influence the Earth's atmosphere, both directly, through changes in shortwave (SW) heating and therefore, temperature and ozone distributions in the stratosphere, and indirectly, through dynamical feedbacks. We investigate these direct and indirect effects using several state-of-the art CCM simulations forced with measured and modelled SSI changes. A unique asset of this study is the use of a common comprehensive approach for an issue that is usually addressed separately by different communities. We show that the SORCE measurements are difficult to reconcile with earlier observations and with SSI models. Of the five SSI models discussed here, specifically NRLSSI (Naval Research Laboratory Solar Spectral Irradiance), SATIRE-S (Spectral And Total Irradiance REconstructions for the Satellite era), COSI (COde for Solar Irradiance), SRPM (Solar Radiation Physical Modelling), and OAR (Osservatorio Astronomico di Roma), only one shows a behaviour of the UV and visible irradiance qualitatively resembling that of the recent SORCE measurements. However, the integral of the SSI computed with this model over the entire spectral range does not reproduce the measured cyclical changes of the total solar irradiance, which is an essential requisite for realistic evaluations of solar effects on the Earth's climate in CCMs. We show that within the range provided by the recent SSI observations and semi-empirical models discussed here, the NRLSSI model and SORCE observations represent the lower and upper limits in the magnitude of the SSI solar cycle variation. The results of the CCM simulations, forced with the SSI solar cycle variations estimated from the NRLSSI model and from SORCE measurements, show that the direct solar response in the stratosphere is larger for the SORCE than for the NRLSSI data. Correspondingly, larger UV forcing also leads to a larger surface response. Finally, we discuss the reliability of the available data and we propose additional coordinated work, first to build composite SSI data sets out of scattered observations and to refine current SSI models, and second, to run coordinated CCM experiments.

Does the Type of Metal Instrumentation Affect the Risk of Surgical Site Infection in Pediatric Scoliosis Surgery?

PubMed

Wright, Margaret L; Skaggs, David L; Matsumoto, Hiroko; Woon, Regina P; Trocle, Ashley; Flynn, John M; Vitale, Michael G

2016-05-01

Retrospective cohort study. To determine the association of implant metal composition with the risk of surgical site infection (SSI) following pediatric spine surgery. SSI is a well-described complication following pediatric spine surgery. Many risk factors have been identified in the literature, but controversy remains regarding metal composition as a risk factor. This was a retrospective study of patients who underwent posterior spinal instrumentation procedures between January 1, 2006, and December 31, 2008, at three large children's hospitals for any etiology of scoliosis and had at least 1 year of postoperative follow-up. Procedures included posterior spinal fusion, growth-friendly instrumentation, and revision of spinal instrumentation. The Centers for Disease Control and Prevention definition of SSI was used. A chi-squared test was performed to determine the relationship between type of metal instrumentation and development of an SSI. The study included 874 patients who underwent 1,156 total procedures. Overall, 752 (65%) procedures used stainless steel instrumentation, 238 (21%) procedures used titanium instrumentation, and the remaining 166 (14%) procedures used cobalt chrome and titanium hybrid instrumentation. The overall risk of infection was 6.1% (70/1,156) per procedure, with 5.9% (44/752) for stainless steel, 6.7% (12/238) for titanium, and 6.0% (10/166) for cobalt chrome. The multiple regression analysis found no significant differences in the metal type used between patients with and without infection (p = .886) adjusting for etiology, instrumentation to pelvis, and type of procedures. When stratified based on etiology, the multiple regression analyses also found no significant difference in SSI between two metal type groups. This study found no difference in risk of infection with stainless steel, titanium, or cobalt chrome/titanium instrumentation and is adequately powered to detect a true difference in risk of SSI. Level II, prognostic. Copyright © 2016 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Phase II Randomized Trial of Negative-Pressure Wound Therapy to Decrease Surgical Site Infection in Patients Undergoing Laparotomy for Gastrointestinal, Pancreatic, and Peritoneal Surface Malignancies

PubMed Central

Shen, Perry; Blackham, Aaron U; Lewis, Stacey; Clark, Clancy J; Howerton, Russell; Mogal, Harveshp D; Dodson, Rebecca M; Russell, Gregory B; Levine, Edward A

2017-01-01

BACKGROUND Surgical site infections (SSIs) remain a major source of morbidity and cost after resection of intra-abdominal malignancies. Negative-pressure wound therapy (NPWT) has been reported to significantly reduce SSIs when applied to the closed laparotomy incision. This article reports the results of a randomized clinical trial examining the effect of NPWT on SSI rates in surgical oncology patients with increased risk for infectious complications. STUDY DESIGN From 2012 to 2016, two hundred and sixty-five patients who underwent open resection of intra-abdominal neoplasms were stratified into 3 groups: gastrointestinal (n = 57), pancreas (n = 73), or peritoneal surface (n = 135) malignancy. They were randomized to receive NPWT or standard surgical dressing (SSD) applied to the incision from postoperative days 1 through 4. Primary outcomes of combined incisional (superficial and deep) SSI rates were assessed up to 30 days after surgery. RESULTS There were no significant differences in superficial SSIs (12.8% vs 12.9%; p > 0.99) or deep SSI (3.0% vs 3.0%; p > 0.99) rates between the SSD and NPWT groups, respectively. When stratified by type of surgery, there were still no differences in combined incisional SSI rates for gastrointestinal (25% vs 24%; p > 0.99), pancreas (22% vs 22%; p > 0.99), and peritoneal surface malignancy (9% vs 9%; p > 0.99) patients. When performing univariate and multivariate logistic regression analysis of demographic and operative factors for the development of combined incisional SSI, the only independent predictors were preoperative albumin (p = 0.0031) and type of operation (p = 0.018). CONCLUSIONS Use of NPWT did not significantly reduce incisional SSI rates in patients having open resection of gastrointestinal, pancreatic, or peritoneal surface malignancies. Based on these results, at this time NPWT cannot be recommended as a therapeutic intervention to decrease infectious complications in these patient populations. PMID:28088597

Prevalence of surgical site infections before and after the implementation of a multimodal infection control programme.

PubMed

Barchitta, Martina; Matranga, Domenica; Quattrocchi, Annalisa; Bellocchi, Patrizia; Ruffino, Maria; Basile, Guido; Agodi, Antonella

2012-03-01

In order to assess the prevalence of surgical site infections (SSIs) before and after the implementation of a multimodal infection control programme including the realization of a campaign to increase compliance with guidelines for antimicrobial prophylaxis, we designed and conducted the present study involving all 20 of the surgical departments of a large teaching hospital in Catania, Italy. SSI definitions of the Hospital in Europe Link for Infection Control through Surveillance (HELICS) protocol were used in four 1 day point-prevalence surveys. After the first survey, an infection control programme was implemented involving the active commitment of surgeons and infection control staff. Overall, a total of 600 surgical patients were enrolled. A significant decreasing trend in the SSI rate (from 16.4 to 8.2 per 100 surgical patients, P=0.018) was shown. After multivariate analysis, significant risk factors for SSI were identified: age >31 years, kidney insufficiency and infection at admission. Taking into account the indication and the timing of administration of antibiotic prophylaxis, in the four surveys prophylaxis was administered inappropriately in 55.3% of surgical procedures. The approach used in this study remains a feasible method of evaluating the burden of SSIs using repeated prevalence surveys. The results provide evidence of a significant decreasing trend in the SSI rate following the infection control intervention. Furthermore, our study underlines the need to develop evidence-based guidelines in collaboration with surgeons, to achieve consensus before implementation in order to improve compliance with antimicrobial prophylaxis and, finally, decrease SSI rates.

Galileo SSI Observations of Volcanic Activity at Tvashtar Catena, Io

NASA Technical Reports Server (NTRS)

Milazzo, M. P.; Keszthely, L. P.; Radebaugh, J.; Davies, A. G.; Turtle, E. P.; Geissler, P.; Klaasen, K. P.; McEwen, A. S.

2005-01-01

Introduction: We report on the analysis of the Galileo SSI's observations of the volcanic activity at Tvashtar Catena, Io as discussed by Milazzo et al. Galileo's Solid State Imager (SSI) observed Tvashtar Catena (63 deg N, 120 deg W) four times between November 1999 and October 2001, providing a unique look at the distinctive high latitude volcanism on Io. The November 1999 observation spatially resolved, for the first time, an active extraterrestrial fissure eruption. The brightness temperature of the lavas at the November 1999 fissure eruption was 1300 K. The second observation (orbit I27, February 2000) showed a large (approx. 500 sq km) region with many, small spots of hot, active lava. The third observation was taken in conjunction with a Cassini observation in December 2000 and showed a Pele-like plume deposition ring, while the Cassini images revealed a 400 km high Pele-type plume above the Catena. The final Galileo SSI observation of Tvashtar was acquired in October 2001, and all obvious (to SSI) activity had ceased, although data from Galileo's Near Infrared Mapping Spectrometer (NIMS) indicated that there was still significant thermal emission from the Tvashtar region. We have concentrated on analyzing the style of eruption during orbit I27 (February 2000). Comparison with a lava flow cooling model indicates that the behavior of the Tvashtar eruption during I27 does not match that of "simple" advancing lava flows. Instead, it may be an active lava lake or a complex set of lava flows with episodic, overlapping (in time and space) eruptions.

Performance-based seismic assessment of skewed bridges with and without considering soil-foundation interaction effects for various site classes

NASA Astrophysics Data System (ADS)

Ghotbi, Abdoul R.

2014-09-01

The seismic behavior of skewed bridges has not been well studied compared to straight bridges. Skewed bridges have shown extensive damage, especially due to deck rotation, shear keys failure, abutment unseating and column-bent drift. This research, therefore, aims to study the behavior of skewed and straight highway overpass bridges both with and without taking into account the effects of Soil-Structure Interaction (SSI) due to near-fault ground motions. Due to several sources of uncertainty associated with the ground motions, soil and structure, a probabilistic approach is needed. Thus, a probabilistic methodology similar to the one developed by the Pacific Earthquake Engineering Research Center (PEER) has been utilized to assess the probability of damage due to various levels of shaking using appropriate intensity measures with minimum dispersions. The probabilistic analyses were performed for various bridge configurations and site conditions, including sand ranging from loose to dense and clay ranging from soft to stiff, in order to evaluate the effects. The results proved a considerable susceptibility of skewed bridges to deck rotation and shear keys displacement. It was also found that SSI had a decreasing effect on the damage probability for various demands compared to the fixed-base model without including SSI. However, deck rotation for all types of the soil and also abutment unseating for very loose sand and soft clay showed an increase in damage probability compared to the fixed-base model. The damage probability for various demands has also been found to decrease with an increase of soil strength for both sandy and clayey sites. With respect to the variations in the skew angle, an increase in skew angle has had an increasing effect on the amplitude of the seismic response for various demands. Deck rotation has been very sensitive to the increase in the skew angle; therefore, as the skew angle increased, the deck rotation responded accordingly. Furthermore, abutment unseating showed an increasing trend due to an increase in skew angle for both fixed-base and SSI models.

Surgical site infections in an abdominal surgical ward at Kosovo Teaching Hospital.

PubMed

Raka, Lul; Krasniqi, Avdyl; Hoxha, Faton; Musa, Ruustem; Mulliqi, Gjyle; Krasniqi, Selvete; Kurti, Arsim; Dervishaj, Antigona; Nuhiu, Beqir; Kelmendi, Baton; Limani, Dalip; Tolaj, Ilir

2008-01-01

Abdominal surgical site infections (SSI) cause substantial morbidity and mortality for patients undergoing operative procedures. We determined the incidence of and risk factors for SSI after abdominal surgery in the Department of Abdominal Surgery at the University Clinical Centre of Kosovo (UCCK). Prospective surveillance of patients undergoing abdominal surgery was performed between December 2005 and June 2006. CDC definitions were followed to detect SSI and study forms were based on Europe Link for Infection Control through Surveillance (HELICS) protocol. A total of 253 surgical interventions in 225 patients were evaluated. The median age of patients was 42 years and 55.1% of them were male. The overall incidence rate of SSI was 12%. Follow-up was achieved for 84.1% of the procedures. For patients with an SSI, the median duration of hospitalization was 9 days compared with 4 days for those without an SSI (p < 0.001). Surgical procedures were classified as emergent in 53.3% of cases. Superficial incisional SSI was most common (55%). Clinical infections were culture positive in 40.7% of cases. Duration of operation, duration of preoperative stay, wound class, ASA score > 2, use of antibiotic prophylaxis and NNIS class of > 2 were all significant at p < .001. The SSI rates for the NNIS System risk classes 0, 1 and 2-3 were 4.2%, 46.7% and 100%, respectively. SSI caused considerable morbidity among surgical patients in UCCK. Appropriate active surveillance and infection control measures should be introduced during preoperative, intra-operative, and postoperative care to reduce infection rates.

Surveillance, Auditing, and Feedback Can Reduce Surgical Site Infection Dramatically: Toward Zero Surgical Site Infection.

PubMed

Manivannan, Bhavani; Gowda, Deepak; Bulagonda, Pradeep; Rao, Abhishek; Raman, Sai Suguna; Natarajan, Shanmuga Vadivoo

2018-04-01

We evaluated the Surveillance of Surgical Site Infection (SSI), Auditing, and Feedback (SAF) effect on the rate of compliance with an SSI care bundle and measured its effectiveness in reducing the SSI rate. A prospective cohort study from January 2014 to December 2016 was classified into three phases: pre-SAF, early-SAF, and late-SAF. Pre-operative baseline characteristics of 24,677 patients who underwent orthopedic, cardiovascular thoracic surgery (CTVS) or urologic operations were recorded. Univariable analyses of the SSI rates in the pre-SAF and post-SAF phases were performed. Percentage compliance and non-compliance with each care component were calculated. Correlation between reduction in the SSI rate and increase in compliance with the pre-operative, peri-operative, and post-operative care-bundle components was performed using the Spearman test. There was a significant decrease in the SSI rate in orthopedic procedures that involved surgical implantation and in mitral valve/aortic valve (MVR/AVR) cardiac operations, with a relative risk (RR) ratio of 0.19 (95% confidence interval [CI] 0.12-0.31) and 0.08 (95% CI 0.03-0.22), respectively. The SSI rate was inversely correlated with the rate of compliance with pre-operative (r = -0.738; p = 0.037), peri-operative (r = - 0.802; p = 0.017), and post-operative (r = -0.762; p = 0.028) care bundles. Implementation of the Surveillance of SSI, Auditing, and Feedback bundle had a profound beneficial effect on the SSI rate, thereby reducing healthcare costs and improving patient quality of life.

First-in-human safety and immunogenicity investigations of three adjuvanted reduced dose inactivated poliovirus vaccines (IPV-Al SSI) compared to full dose IPV Vaccine SSI when given as a booster vaccination to adolescents with a history of IPV vaccination at 3, 5, 12months and 5years of age.

PubMed

Lindgren, Line M; Tingskov, Pernille N; Justesen, Annette H; Nedergaard, Bettina S; Olsen, Klaus J; Andreasen, Lars V; Kromann, Ingrid; Sørensen, Charlotte; Dietrich, Jes; Thierry-Carstensen, Birgit

2017-01-23

There is a demand of affordable IPV in the World. Statens Serum Institut (SSI) has developed three reduced dose IPV formulations adsorbed to aluminium hydroxide; 1/3 IPV-Al, 1/5 IPV-Al and 1/10 IPV-Al SSI, and now report the results of the first investigations in humans. 240 Danish adolescents, aged 10-15years, and childhood vaccinated with IPV were booster vaccinated with 1/3 IPV-Al, 1/5 IPV-Al, 1/10 IPV-Al or IPV Vaccine SSI. The booster effects (GMTRs) of the three IPV-Al SSI were compared to IPV Vaccine SSI, and evaluated for non-inferiority. The pre-vaccination GMTs were similar across the groups; 926 (type 1), 969 (type 2) and 846 (type 3) in the total trial population. The GMTRs by poliovirus type and IPV formulation were: Type 1: 17.0 (1/3 IPV-Al), 13.0 (1/5 IPV-Al), 7.1 (1/10 IPV-Al) and 42.2 (IPV Vaccine SSI). Type 2: 12.5 (1/3 IPV-Al), 13.1 (1/5 IPV-Al), 7.6 (1/10 IPV-Al) and 47.8 (IPV Vaccine SSI). Type 3: 14.5 (1/3 IPV-Al), 16.2 (1/5 IPV-Al), 8.9 (1/10 IPV-Al) and 62.4 (IPV Vaccine SSI) Thus, the three IPV-Al formulations were highly immunogenic, but inferior to IPV Vaccine SSI, in this booster vaccination trial. No SAE and no AE of severe intensity occurred. 59.2% of the subjects reported at least one AE. Injection site pain was the most frequent AE in all groups; from 24.6% to 43.3%. Injection site redness and swelling frequencies were<5% in most and<10% in all groups. The most frequent systemic AEs were fatigue (from 8.2% to 15.0%) and headache (from 15.0% to 28.3%). Most AEs were of mild intensity. In conclusion, the three IPV-Al SSI were safe in adolescents and the booster effects were satisfactory. ClinicalTrials.gov registration number: NCT02280447. Copyright © 2016. Published by Elsevier Ltd.

An examination of social interaction profiles based on the factors measured by the screen for social interaction.

PubMed

Mahoney, Emery B; Breitborde, Nicholas J K; Leone, Sarah L; Ghuman, Jaswinder Kaur

2014-10-01

Deficits in the capacity to engage in social interactions are a core deficit associated with Autistic Disorder (AD) and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). These deficits emerge at a young age, making screening for social interaction deficits and interventions targeted at improving capacity in this area important for early identification and intervention. Screening and early intervention efforts are particularly important given the poor short and long term outcomes for children with Autism Spectrum Disorders (ASDs) who experience social interaction deficits. The Screen for Social Interaction (SSI) is a well-validated screening measure that examines a child's capacity for social interaction using a developmental approach. The present study identified four underlying factors measured by the SSI, namely, Connection with Caregiver, Interaction/Imagination, Social Approach/Interest, and Agreeable Nature. The resulting factors were utilized to compare social interaction profiles across groups of children with AD, PDD-NOS, children with non-ASD developmental and/or psychiatric conditions and typically developing children. The results indicate that children with AD and those with PDD-NOS had similar social interaction profiles, but were able to be distinguished from typically developing children on every factor and were able to be distinguished from children with non-ASD psychiatric conditions on every factor except the Connection with Caregiver factor. In addition, children with non-ASD developmental and/or psychiatric conditions could be distinguished from typically developing children on the Connection with Caregiver factor and the Social Approach/Interest factor. These findings have implications for screening and intervention for children with ASDs and non-ASD psychiatric conditions. Copyright © 2014 Elsevier Ltd. All rights reserved.

A Multi-Disciplinary Review of the Potential Association between Closed-Suction Drains and Surgical Site Infection

PubMed Central

Reiffel, Alyssa J.; Barie, Philip S.

2013-01-01

Abstract Background Despite the putative advantages conferred by closed-suction drains (CSDs), the widespread utilization of post-operative drains has been questioned due to concerns regarding both efficacy and safety, particularly with respect to the risk of surgical site infection (SSI). Although discipline-specific reports exist delineating risk factors associated with SSI as they relate to the presence of CSDs, there are no broad summary studies to examine this issue in depth. Methods The pertinent medical literature exploring the relationship between CSDs and SSI across multiple surgical disciplines was reviewed. Results Across most surgical disciplines, studies to evaluate the risk of SSI associated with routine post-operative CSD have yielded conflicting results. A few studies do suggest an increased risk of SSI associated with drain placement, but are usually associated with open drainage and not the use of CSDs. No studies whatsoever attribute a decrease in the incidence of SSI (including organ/space SSI) to drain placement. Conclusions Until additional, rigorous randomized trials are available to address the issue definitively, we recommend judicious use and prompt, timely removal of CSDs. Given that the evidence is scant and weak to suggest that CSD use is associated with increased risk of SSI, there is no justification for the prolongation of antibiotic prophylaxis to “cover” an indwelling drain. PMID:23718273

Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review

PubMed Central

Chen, Brian Po-Han; Soleas, Ireena M.; Ferko, Nicole C.; Cameron, Chris G.; Hinoul, Piet

2017-01-01

Abstract Background: The incidence of surgical site infection (SSI) across surgical procedures, specialties, and conditions is reported to vary from 0.1% to 50%. Operative duration is often cited as an independent and potentially modifiable risk factor for SSI. The objective of this systematic review was to provide an in-depth understanding of the relation between operating time and SSI. Patients and Methods: This review included 81 prospective and retrospective studies. Along with study design, likelihood of SSI, mean operative times, time thresholds, effect measures, confidence intervals, and p values were extracted. Three meta-analyses were conducted, whereby odds ratios were pooled by hourly operative time thresholds, increments of increasing operative time, and surgical specialty. Results: Pooled analyses demonstrated that the association between extended operative time and SSI typically remained statistically significant, with close to twice the likelihood of SSI observed across various time thresholds. The likelihood of SSI increased with increasing time increments; for example, a 13%, 17%, and 37% increased likelihood for every 15 min, 30 min, and 60 min of surgery, respectively. On average, across various procedures, the mean operative time was approximately 30 min longer in patients with SSIs compared with those patients without. Conclusions: Prolonged operative time can increase the risk of SSI. Given the importance of SSIs on patient outcomes and health care economics, hospitals should focus efforts to reduce operative time. PMID:28832271

Pertinent spatio-temporal scale of observation to understand suspended sediment yield control factors in the Andean region: the case of the Santa River (Peru)

NASA Astrophysics Data System (ADS)

Morera, S. B.; Condom, T.; Vauchel, P.; Guyot, J.-L.; Galvez, C.; Crave, A.

2013-11-01

Hydro-sedimentology development is a great challenge in Peru due to limited data as well as sparse and confidential information. This study aimed to quantify and to understand the suspended sediment yield from the west-central Andes Mountains and to identify the main erosion-control factors and their relevance. The Tablachaca River (3132 km2) and the Santa River (6815 km2), located in two adjacent Andes catchments, showed similar statistical daily rainfall and discharge variability but large differences in specific suspended-sediment yield (SSY). In order to investigate the main erosion factors, daily water discharge and suspended sediment concentration (SSC) datasets of the Santa and Tablachaca rivers were analysed. Mining activity in specific lithologies was identified as the major factor that controls the high SSY of the Tablachaca (2204 t km2 yr-1), which is four times greater than the Santa's SSY. These results show that the analysis of control factors of regional SSY at the Andes scale should be done carefully. Indeed, spatial data at kilometric scale and also daily water discharge and SSC time series are needed to define the main erosion factors along the entire Andean range.

The Localized Scleroderma Skin Severity Index and Physician Global Assessment of Disease Activity: A Work in Progress Toward Development of Localized Scleroderma Outcome Measures

PubMed Central

ARKACHAISRI, THASCHAWEE; VILAIYUK, SOAMARAT; LI, SUZANNE; O’NEIL, KATHLEEN M.; POPE, ELENA; HIGGINS, GLORIA C.; PUNARO, MARILYNN; RABINOVICH, EGLA C.; ROSENKRANZ, MARGALIT; KIETZ, DANIEL A.; ROSEN, PAUL; SPALDING, STEVEN J.; HENNON, TERESA R.; TOROK, KATHRYN S.; CASSIDY, ELAINE; MEDSGER, THOMAS A.

2013-01-01

Objective To develop and evaluate a Localized Scleroderma (LS) Skin Severity Index (LoSSI) and global assessments’ clinimetric property and effect on quality of life (QOL). Methods A 3-phase study was conducted. The first phase involved 15 patients with LS and 14 examiners who assessed LoSSI [surface area (SA), erythema (ER), skin thickness (ST), and new lesion/extension (N/E)] twice for inter/intrarater reliability. Patient global assessment of disease severity (PtGA-S) and Children’s Dermatology Life Quality Index (CDLQI) were collected for intrarater reliability evaluation. The second phase was aimed to develop clinical determinants for physician global assessment of disease activity (PhysGA-A) and to assess its content validity. The third phase involved 2 examiners assessing LoSSI and PhysGA-A on 27 patients. Effect of training on improving reliability/validity and sensitivity to change of the LoSSI and PhysGA-A was determined. Results Interrater reliability was excellent for ER [intraclass correlation coefficient (ICC) 0.71], ST (ICC 0.70), LoSSI (ICC 0.80), and PhysGA-A (ICC 0.90) but poor for SA (ICC 0.35); thus, LoSSI was modified to mLoSSI. Examiners’ experience did not affect the scores, but training/practice improved reliability. Intrarater reliability was excellent for ER, ST, and LoSSI (Spearman’s rho = 0.71–0.89) and moderate for SA. PtGA-S and CDLQI showed good intrarater agreement (ICC 0.63 and 0.80). mLoSSI correlated moderately with PhysGA-A and PtGA-S. Both mLoSSI and PhysGA-A were sensitive to change following therapy. Conclusion mLoSSI and PhysGA-A are reliable and valid tools for assessing LS disease severity and show high sensitivity to detect change over time. These tools are feasible for use in routine clinical practice. They should be considered for inclusion in a core set of LS outcome measures for clinical trials. PMID:19833758

Evaluating the use of antibiotic prophylaxis during open reduction and internal fixation surgery in patients at low risk of surgical site infection.

PubMed

Xu, Sheng-Gen; Mao, Zhao-Guang; Liu, Bin-Sheng; Zhu, Hui-Hua; Pan, Hui-Lin

2015-02-01

Widespread overuse and inappropriate use of antibiotics contribute to increasingly antibiotic-resistant pathogens and higher health care costs. It is not clear whether routine antibiotic prophylaxis can reduce the rate of surgical site infection (SSI) in low-risk patients undergoing orthopaedic surgery. We designed a simple scorecard to grade SSI risk factors and determined whether routine antibiotic prophylaxis affects SSI occurrence during open reduction and internal fixation (ORIF) orthopaedic surgeries in trauma patients at low risk of developing SSI. The SSI risk scorecard (possible total points ranged from 5 to 25) was designed to take into account a patient's general health status, the primary cause of fractures, surgical site tissue condition or wound class, types of devices implanted, and surgical duration. Patients with a low SSI risk score (≤8 points) who were undergoing clean ORIF surgery were divided into control (routine antibiotic treatment, cefuroxime) and evaluation (no antibiotic treatment) groups and followed up for 13-17 months after surgery. The infection rate was much higher in patients with high SSI risk scores (≥9 points) than in patients with low risk scores assigned to the control group (10.7% vs. 2.2%, P<0.0001). SSI occurred in 11 of 499 patients in the control group and in 13 of 534 patients in the evaluation group during the follow-up period of 13-17 months. The SSI occurrence rate did not differ significantly (2.2% vs. 2.4%, P=0.97) between the control and evaluation groups. Routine antibiotic prophylaxis does not significantly decrease the rate of SSI in ORIF surgical patients with a low risk score. Implementation of this scoring system could guide the rational use of perioperative antibiotics and ultimately reduce antibiotic resistance, health care costs, and adverse reactions to antibiotics. Copyright © 2014 Elsevier Ltd. All rights reserved.

High humidity suppresses ssi4-mediated cell death and disease resistance upstream of MAP kinase activation, H2O2 production and defense gene expression.

PubMed

Zhou, Fasong; Menke, Frank L H; Yoshioka, Keiko; Moder, Wolfgang; Shirano, Yumiko; Klessig, Daniel F

2004-09-01

The Arabidopsis ssi4 mutant, which exhibits spontaneous lesion formation, constitutive expression of pathogenesis-related (PR) genes and enhanced resistance to virulent bacterial and oomycete pathogens, contains a gain-of-function mutation in a TIR-NBS-LRR type R gene. Epistatic analyses revealed that both PR gene expression and disease resistance are activated via a salicylic acid (SA)- and EDS1-dependent, but NPR1- and NDR1-independent signaling pathway. In this study, we demonstrate that in moderate relative humidity (RH; 60%), the ssi4 mutant accumulates H(2)O(2) and SA prior to lesion formation and displays constitutive activation of the MAP kinases AtMPK6 and AtMPK3. It also constitutively expresses a variety of defense-associated genes, including those encoding the WRKY transcription factors AtWRKY29 and AtWRKY6, the MAP kinases AtMPK6 and AtMPK3, the powdery mildew R proteins RPW8.1 and RPW8.2, EDS1 and PR proteins. All of these ssi4-induced responses, as well as the chlorotic, stunted morphology and enhanced disease resistance phenotype, are suppressed by high RH (95%) growth conditions. Thus, a humidity sensitive factor (HSF) appears to function at an early point in the ssi4 signaling pathway. All ssi4 phenotypes, except for MAP kinase activation, also were suppressed by the eds1-1 mutation. Thus, ssi4-induced MAP kinase activation occurs downstream of the HSF but either upstream of EDS1 or on a separate branch of the ssi4 signaling pathway. SA is a critical signaling component in ssi4-mediated defense responses. However, exogenously supplied SA failed to restore lesion formation in high RH-grown ssi4 plants, although it induced defense gene expression. Thus, additional signals also are involved.

Use of Medicare claims to rank hospitals by surgical site infection risk following coronary artery bypass graft surgery.

PubMed

Huang, Susan S; Placzek, Hilary; Livingston, James; Ma, Allen; Onufrak, Fallon; Lankiewicz, Julie; Kleinman, Ken; Bratzler, Dale; Olsen, Margaret A; Lyles, Rosie; Khan, Yosef; Wright, Paula; Yokoe, Deborah S; Fraser, Victoria J; Weinstein, Robert A; Stevenson, Kurt; Hooper, David; Vostok, Johanna; Datta, Rupak; Nsa, Wato; Platt, Richard

2011-08-01

To evaluate whether longitudinal insurer claims data allow reliable identification of elevated hospital surgical site infection (SSI) rates. We conducted a retrospective cohort study of Medicare beneficiaries who underwent coronary artery bypass grafting (CABG) in US hospitals performing at least 80 procedures in 2005. Hospitals were assigned to deciles by using case mix-adjusted probabilities of having an SSI-related inpatient or outpatient claim code within 60 days of surgery. We then reviewed medical records of randomly selected patients to assess whether chart-confirmed SSI risk was higher in hospitals in the worst deciles compared with the best deciles. Fee-for-service Medicare beneficiaries who underwent CABG in these hospitals in 2005. We evaluated 114,673 patients who underwent CABG in 671 hospitals. In the best decile, 7.8% (958/12,307) of patients had an SSI-related code, compared with 24.8% (2,747/11,068) in the worst decile ([Formula: see text]). Medical record review confirmed SSI in 40% (388/980) of those with SSI-related codes. In the best decile, the chart-confirmed annual SSI rate was 3.2%, compared with 9.4% in the worst decile, with an adjusted odds ratio of SSI of 2.7 (confidence interval, 2.2-3.3; [Formula: see text]) for CABG performed in a worst-decile hospital compared with a best-decile hospital. Claims data can identify groups of hospitals with unusually high or low post-CABG SSI rates. Assessment of claims is more reproducible and efficient than current surveillance methods. This example of secondary use of routinely recorded electronic health information to assess quality of care can identify hospitals that may benefit from prevention programs.

Improving Cardiac Surgical Site Infection Reporting and Prevention By Using Registry Data for Case Ascertainment.

PubMed

Nayar, Vaidehi; Kennedy, Andrea; Pappas, Janine; Atchley, Krista D; Field, Cynthia; Smathers, Sarah; Teszner, Eva E; Sammons, Julia S; Coffin, Susan E; Gerber, Jeffrey S; Spray, Thomas L; Steven, James M; Bell, Louis M; Forrer, Joan; Gonzalez, Fernando; Chi, Albert; Nieczpiel, William J; Martin, John N; Gaynor, J William

2016-01-01

The use of administrative data for surgical site infection (SSI) surveillance leads to inaccurate reporting of SSI rates [1]. A quality improvement (QI) initiative was conducted linking clinical registry and administrative databases to improve reporting and reduce the incidence of SSI [2]. At our institution, The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) and infection surveillance database (ISD) were linked to the enterprise data warehouse containing electronic health record (EHR) billing data. A data visualization tool was created to (1) use the STS-CHSD for case ascertainment, (2) resolve discrepancies between the databases, and (3) assess impact of QI initiatives, including wound alert reports, bedside reviews, prevention bundles, and billing coder education. Over the 24-month study period, 1,715 surgical cases were ascertained according to the STS-CHSD clinical criteria, with 23 SSIs identified through the STS-CHSD, 20 SSIs identified through the ISD, and 32 SSIs identified through the billing database. The rolling 12-month STS-CHSD SSI rate decreased from 2.73% (21 of 769 as of January 2013) to 1.11% (9 of 813 as of December 2014). Thirty reporting discrepancies were reviewed to ensure accuracy. Workflow changes facilitated communication and improved adjudication of suspected SSIs. Billing coder education increased coding accuracy and narrowed variation between the 3 SSI sources. The data visualization tool demonstrated temporal relationships between QI initiatives and SSI rate reductions. Linkage of registry and infection control surveillance data with the EHR improves SSI surveillance. The visualization tool and workflow changes facilitated communication, SSI adjudication, and assessment of the QI initiatives. Implementation of these initiatives was associated with decreased SSI rates. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Effects of hydrology, watershed size, and agricultural practices on sediment yields in two river basins in Iowa and Mississippi

USGS Publications Warehouse

Merten, Gustavo Henrique; Welch, Heather L.; Tomer, M.D.

2016-01-01

The specific sediment yield (SSY) from watersheds is the result of the balance between natural, scale-dependent erosion and deposition processes, but can be greatly altered by human activities. In general, the SSY decreases along the course of a river as sediments are trapped in alluvial plains and other sinks. However, this relation between SSY and basin area can actually be an increasing one when there is a predominance of channel erosion relative to hillslope erosion. The US Geological Survey (USGS) conducted a study of suspended sediment in the Iowa River basin (IRB), Iowa, and the Yazoo River basin (YRB), Mississippi, from 2006 through 2008. Within each river basin, the SSY from four largely agricultural watersheds of various sizes (2.3 to 35,000 km2 [0.9 to 13,513 mi2]) was investigated. In the smallest watersheds, YRB sites had greater SSY compared to IRB sites due to higher rain erosivity, more erodible soils, more overland flow, and fluvial geomorphological differences. Watersheds in the YRB showed a steady decrease in SSY with increasing drainage basin area, whereas in the IRB, the maximum SSY occurred at the 30 to 500 km2 (11.6 to 193 mi2) scale. Subsurface tile drainage and limits to channel downcutting restrict the upstream migration of sediment sources in the IRB. Nevertheless, by comparing the SSY-basin size scaling relationships with estimated rates of field erosion under conservation and conventional tillage treatments reported in previous literature, we show evidence that the SSY-basin size relationship in both the IRB and YRB remain impacted by historical erosion rates that occurred prior to conservation efforts.

Does Minimally Invasive Spine Surgery Minimize Surgical Site Infections?

PubMed

Kulkarni, Arvind Gopalrao; Patel, Ravish Shammi; Dutta, Shumayou

2016-12-01

Retrospective review of prospectively collected data. To evaluate the incidence of surgical site infections (SSIs) in minimally invasive spine surgery (MISS) in a cohort of patients and compare with available historical data on SSI in open spinal surgery cohorts, and to evaluate additional direct costs incurred due to SSI. SSI can lead to prolonged antibiotic therapy, extended hospitalization, repeated operations, and implant removal. Small incisions and minimal dissection intrinsic to MISS may minimize the risk of postoperative infections. However, there is a dearth of literature on infections after MISS and their additional direct financial implications. All patients from January 2007 to January 2015 undergoing posterior spinal surgery with tubular retractor system and microscope in our institution were included. The procedures performed included tubular discectomies, tubular decompressions for spinal stenosis and minimal invasive transforaminal lumbar interbody fusion (TLIF). The incidence of postoperative SSI was calculated and compared to the range of cited SSI rates from published studies. Direct costs were calculated from medical billing for index cases and for patients with SSI. A total of 1,043 patients underwent 763 noninstrumented surgeries (discectomies, decompressions) and 280 instrumented (TLIF) procedures. The mean age was 52.2 years with male:female ratio of 1.08:1. Three infections were encountered with fusion surgeries (mean detection time, 7 days). All three required wound wash and debridement with one patient requiring unilateral implant removal. Additional direct cost due to infection was $2,678 per 100 MISS-TLIF. SSI increased hospital expenditure per patient 1.5-fold after instrumented MISS. Overall infection rate after MISS was 0.29%, with SSI rate of 0% in non-instrumented MISS and 1.07% with instrumented MISS. MISS can markedly reduce the SSI rate and can be an effective tool to minimize hospital costs.

Derivation and Validation of the Surgical Site Infections Risk Model Using Health Administrative Data.

PubMed

van Walraven, Carl; Jackson, Timothy D; Daneman, Nick

2016-04-01

OBJECTIVE Surgical site infections (SSIs) are common hospital-acquired infections. Tracking SSIs is important to monitor their incidence, and this process requires primary data collection. In this study, we derived and validated a method using health administrative data to predict the probability that a person who had surgery would develop an SSI within 30 days. METHODS All patients enrolled in the National Surgical Quality Improvement Program (NSQIP) from 2 sites were linked to population-based administrative datasets in Ontario, Canada. We derived a multivariate model, stratified by surgical specialty, to determine the independent association of SSI status with patient and hospitalization covariates as well as physician claim codes. This SSI risk model was validated in 2 cohorts. RESULTS The derivation cohort included 5,359 patients with a 30-day SSI incidence of 6.0% (n=118). The SSI risk model predicted the probability that a person had an SSI based on 7 covariates: index hospitalization diagnostic score; physician claims score; emergency visit diagnostic score; operation duration; surgical service; and potential SSI codes. More than 90% of patients had predicted SSI risks lower than 10%. In the derivation group, model discrimination and calibration was excellent (C statistic, 0.912; Hosmer-Lemeshow [H-L] statistic, P=.47). In the 2 validation groups, performance decreased slightly (C statistics, 0.853 and 0.812; H-L statistics, 26.4 [P=.0009] and 8.0 [P=.42]), but low-risk patients were accurately identified. CONCLUSION Health administrative data can effectively identify postoperative patients with a very low risk of surgical site infection within 30 days of their procedure. Records of higher-risk patients can be reviewed to confirm SSI status.

Long-term housing subsidies and SSI/SSDI income: Creating health-promoting contexts for families experiencing housing instability with disabilities.

PubMed

Glendening, Zachary S; McCauley, Erin; Shinn, Marybeth; Brown, Scott R

2018-04-01

Though disability and housing instability are discussed separately in public health literature, few studies address families at their intersection. As a result, little is known about families who experience both homelessness and disability, how many receive disability benefits like SSI and SSDI, or the influence of those benefits on health-promoting outcomes like housing stability and self-sufficiency. Moreover, no previous research compares the ability of different housing and service interventions to increase disability benefit access. We examine relationships between disabilities and SSI/SSDI income reported when families enter emergency shelters and later health-promoting outcomes (housing stability and self-sufficiency) and how housing interventions affect SSI/SSDI receipt. Families in the (name removed) Study (N = 1857) were interviewed in emergency shelters, randomly offered of one of three housing interventions or usual care (i.e., no immediate referral to any intervention beyond shelter), and re-interviewed 20 months later. A third of families reported a disability at shelter entry. SSI/SSDI coverage of these families increased nearly 10% points over 20 months but never exceeded 40%. Disabilities predicted greater housing instability, food insecurity, and economic stress and less work and income. Among families reporting disabilities, SSI/SSDI receipt predicted fewer returns to emergency shelter, and more income despite less work. Offers of long-term housing subsidies increased SSI/SSDI receipt. Many families experiencing homelessness have disabilities; those receiving SSI/SSDI benefits have better housing and income outcomes. Providing families experiencing homelessness with long-term housing subsidies and SSI/SSDI could improve public health. Copyright © 2017 Elsevier Inc. All rights reserved.

Variable Case Detection and Many Unreported Cases of Surgical-Site Infection Following Colon Surgery and Abdominal Hysterectomy in a Statewide Validation.

PubMed

Calderwood, Michael S; Huang, Susan S; Keller, Vicki; Bruce, Christina B; Kazerouni, N Neely; Janssen, Lynn

2017-09-01

OBJECTIVE To assess hospital surgical-site infection (SSI) identification and reporting following colon surgery and abdominal hysterectomy via a statewide external validation METHODS Infection preventionists (IPs) from the California Department of Public Health (CDPH) performed on-site SSI validation for surgical procedures performed in hospitals that voluntarily participated. Validation involved chart review of SSI cases previously reported by hospitals plus review of patient records flagged for review by claims codes suggestive of SSI. We assessed the sensitivity of traditional surveillance and the added benefit of claims-based surveillance. We also evaluated the positive predictive value of claims-based surveillance (ie, workload efficiency). RESULTS Upon validation review, CDPH IPs identified 239 SSIs following colon surgery at 42 hospitals and 76 SSIs following abdominal hysterectomy at 34 hospitals. For colon surgery, traditional surveillance had a sensitivity of 50% (47% for deep incisional or organ/space [DI/OS] SSI), compared to 84% (88% for DI/OS SSI) for claims-based surveillance. For abdominal hysterectomy, traditional surveillance had a sensitivity of 68% (67% for DI/OS SSI) compared to 74% (78% for DI/OS SSI) for claims-based surveillance. Claims-based surveillance was also efficient, with 1 SSI identified for every 2 patients flagged for review who had undergone abdominal hysterectomy and for every 2.6 patients flagged for review who had undergone colon surgery. Overall, CDPH identified previously unreported SSIs in 74% of validation hospitals performing colon surgery and 35% of validation hospitals performing abdominal hysterectomy. CONCLUSIONS Claims-based surveillance is a standardized approach that hospitals can use to augment traditional surveillance methods and health departments can use for external validation. Infect Control Hosp Epidemiol 2017;38:1091-1097.

Exploring preservice elementary teachers' critique and adaptation of science curriculum materials in respect to socioscientific issues

NASA Astrophysics Data System (ADS)

Forbes, Cory T.; Davis, Elizabeth A.

2008-09-01

The work presented here represents a preliminary effort undertaken to address the role of teachers in supporting students’ learning and decision-making about socioscientific issues (SSI) by characterizing preservice elementary teachers’ critique and adaptation of SSI-based science curriculum materials and identifying factors that serve to mediate this process. Four undergraduate preservice elementary teachers were studied over the course of one semester. Results indicate that the teachers navigated multiple learning goals, as well as their own subject-matter knowledge, informal reasoning about SSI, and role identity, in their critique and adaptation of SSI-oriented science instructional materials. Implications for science teacher education and the design of curriculum materials in respect to SSI are discussed.

20 CFR 416.203 - Initial determinations of SSI eligibility.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Initial determinations of SSI eligibility. 416.203 Section 416.203 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility General § 416.203 Initial determinations of SSI...

20 CFR 416.203 - Initial determinations of SSI eligibility.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Initial determinations of SSI eligibility. 416.203 Section 416.203 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility General § 416.203 Initial determinations of SSI...

20 CFR 416.203 - Initial determinations of SSI eligibility.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Initial determinations of SSI eligibility. 416.203 Section 416.203 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility General § 416.203 Initial determinations of SSI...

20 CFR 416.203 - Initial determinations of SSI eligibility.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Initial determinations of SSI eligibility. 416.203 Section 416.203 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility General § 416.203 Initial determinations of SSI...

20 CFR 416.203 - Initial determinations of SSI eligibility.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Initial determinations of SSI eligibility. 416.203 Section 416.203 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility General § 416.203 Initial determinations of SSI...

Bringing the Excitement of Exploring Mars and the Giant Planets to Educators and the Public

NASA Astrophysics Data System (ADS)

Morrow, C. A.; Dusenbery, P. B.; Harold, J.

2003-05-01

We are living in a wonderful era of planetary exploration. In 2004 alone, two rovers will land on Mars and the Cassini-Huygens mission will arrive in the Saturn system for an extended 4-year tour. These events will bring much public attention and provide excellent reasons for substantive educational outreach to educators and the public. The Space Science Institute (SSI) of Boulder, CO and collaborators are responding with a comprehensive array of funded and proposed projects. These include the refurbishment and redeployment of the 5000 sq. ft MarsQuest national traveling exhibition, the launch of a 600 sq. ft. "mini-MarsQuest" called Destination Mars, the launch of an interactive website called "MarsQuest Online" (in partnership with TERC and JPL), a variety of workshops for teachers, museum educators, and planetarians (in partnership with "To Mars with MER", and JPL), and the development of a "Family Guide to Mars" for use by adults and children in informal learning settings. SSI is also proposing to develop another national traveling exhibition called "Giant Planets: Exploring the Outer Solar System". This exhibit (envisioned to be 3500 sq.ft.) and its educational program will take advantage of the excitement generated by the Cassini mission and origins-related research. Its education program will also benefit from SSI having led the development of the "Saturn Educator Guide" - a JPL-sponsored resource for teachers in grades 5 and up. This paper will provide an overview of our resources in planetary science education and communicate the valuable lessons we've learned about their design, development and dissemination. SSI's educational endeavors related to planetary science have been funded by several NASA and NSF grants and contracts.

Sporophytic self-incompatibility in Senecio squalidus L (Asteraceae)--the search for S.

PubMed

Hiscock, Simon J; McInnis, Stephanie M; Tabah, David A; Henderson, Catherine A; Brennan, Adrian C

2003-01-01

Senecio squalidus (Oxford Ragwort) is being used as a model species to study the genetics and molecular genetics of self-incompatibility (SI) in the Asteraceae. S. squalidus has a strong system of sporophytic SI (SSI) and populations within the UK contain very few S alleles probably due to a population bottleneck experienced on its introduction to the UK. The genetic control of SSI in S. squalidus is complex and may involve a second locus epistatic to S. Progress towards identifying the female determinant of SSI in S. squalidus is reviewed here. Research is focused on plants carrying two defined S alleles, S(1) and S(2). S(2) is dominant to S(1) in pollen and stigma. RT-PCR was used to amplify three SRK-like cDNAs from stigmas of S(1)S(2) heterozygotes, but the expression patterns of these cDNAs suggest that they are unlikely to be directly involved in SI or pollen-stigma interactions in contrast to SSI in the Brassicaceae. Stigma-specific proteins associated with the S(1) allele and the S(2) allele have been identified using isoelectric focusing and these proteins have been designated SSP1 (Stigma S-associated Protein 1) and SSP2. SSP1 and SSP2 cDNAs have been cloned by 3' and 5' RACE and shown to be allelic forms of the same gene, SSP. The expression of SSP and its linkage to the S locus are currently being investigated. Initial results show SSP to be expressed exclusively in stigmas and developmentally regulated, with maximal expression occurring at and just before anthesis when SI is fully functional, SSP expression being undetectable in immature buds. Together these data suggest that SSP is a strong candidate for a Senecio S-gene.

Supplemental Security Income Benefits for Mental Disorders.

PubMed

Perrin, James M; Houtrow, Amy; Kelleher, Kelly; Hoagwood, Kimberly; Stein, Ruth E K; Zima, Bonnie

2016-07-01

The Supplemental Security Income Program (SSI) provides financial support to low-income households with children and youth with severe disabilities. The program included children when it began in the early 1970s. The numbers of children receiving SSI benefits increased substantially in the early 1990s, in part through an expansion of the listings of mental health conditions with which children could become eligible. Over the past 20 years, larger numbers of children have received SSI benefits for mental disorders, and these increases have led to questions from the press and Congress regarding these numbers. Do they indicate more of an increase in mental disorders among SSI children than in the general population? The National Academy of Medicine (NAM; formerly the Institute of Medicine) convened a study panel to examine what is known about mental disorders among the child SSI population and how that compares with evidence about mental disorders in children in general. The NAM report provides detailed information about how SSI works, about the changing numbers of children receiving SSI for mental disorders, and some comparisons with other evidence about rising rates of mental disorders in the general population and especially among children living in poverty. The report indicates that increasing numbers of children with mental disorders in SSI mirror similar increases in the population in general. This article summarizes key evidence from the NAM report and suggests the implications for pediatricians. Copyright © 2016 by the American Academy of Pediatrics.

From the American Academy of Pediatrics: Policy statements--Supplemental Security Income (SSI) for children and youth with disabilities.

PubMed

2009-12-01

The Supplemental Security Income (SSI) program remains an important source of financial support for low-income families of children with special health care needs and disabling conditions. In most states, SSI eligibility also qualifies children for the state Medicaid program, providing access to health care services. The Social Security Administration (SSA), which administers the SSI program, considers a child disabled under SSI if there is a medically determinable physical or mental impairment or combination of impairments that results in marked and severe functional limitations. The impairment(s) must be expected to result in death or have lasted or be expected to last for a continuous period of at least 12 months. The income and assets of families of children with disabilities are also considered when determining financial eligibility. When an individual with a disability becomes an adult at 18 years of age, the SSA considers only the individual's income and assets. The SSA considers an adult to be disabled if there is a medically determinable impairment (or combination of impairments) that prevents substantial gainful activity for at least 12 continuous months. SSI benefits are important for youth with chronic conditions who are transitioning to adulthood. The purpose of this statement is to provide updated information about the SSI medical and financial eligibility criteria and the disability-determination process. This statement also discusses how pediatricians can help children and youth when they apply for SSI benefits.

7 CFR 273.20 - SSI cash-out.

Code of Federal Regulations, 2010 CFR

2010-01-01

... specifically increased to include the value of the food stamp allotment. (b) Receipt of SSI benefits. In... Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE FOOD STAMP AND FOOD DISTRIBUTION PROGRAM CERTIFICATION OF ELIGIBLE HOUSEHOLDS § 273.20 SSI cash-out. (a...

Culturally Equipped for Socio-Scientific Issues? A comparative study on how teachers and students in mono- and multiethnic schools handle work with complex issues

NASA Astrophysics Data System (ADS)

Ideland, Malin; Malmberg, Claes; Winberg, Mikael

2011-09-01

Socio-scientific issues (SSI) are not only said to increase students' interest in science, but they also strengthen the generic skills of teamwork, problem-solving, and media literacy. At the same time, these skills are prerequisites for successful work with SSI. The aim of the study is to analyze what happens when SSI are implemented in science classrooms with various degrees of ethnic diversity and socio-cultural status. We are also interested in knowing how teachers structure the SSI work from discourses on what suits different students. Quantitative and qualitative methods are combined, for example, questionnaires and ethnographic fieldwork, presented through partial least squares analysis and thick descriptions. We can notice discursive differences between 'Us' and 'The Other' and between mono- and multiethnic schools. In an earlier research, images of differences between the different student groups emerged, and we can find these in the results from the questionnaires. In an observation study, another pattern appeared that indicated similarities rather than differences between mono- and multiethnic classrooms. The students are first of all inside the discourse of 'the successful student.' Noteworthy is that the teachers' roles correspond better with the discourse than with how students actually act. The study also shows that SSI articulate a collision between different discourses on education: a discourse on differences between students in multi- and monoethnic classrooms; a discourse on how to become a successful student; and a discourse on the school's mission to educate participating citizens. It is suggested that schools should relate to, expose, and articulate discursive clashes that emerge when introducing new work forms.

Continuation of TNF blockade in patients with inflammatory rheumatic disease. An observational study on surgical site infections in 1,596 elective orthopedic and hand surgery procedures.

PubMed

Berthold, Elisabet; Geborek, Pierre; Gülfe, Anders

2013-10-01

Increased infection risk in inflammatory rheumatic diseases may be due to inflammation or immunosuppressive treatment. The influence of tumor necrosis factor (TNF) inhibitors on the risk of developing surgical site infections (SSIs) is not fully known. We compared the incidence of SSI after elective orthopedic surgery or hand surgery in patients with a rheumatic disease when TNF inhibitors were continued or discontinued perioperatively. We included 1,551 patients admitted for elective orthopedic surgery or hand surgery between January 1, 2003 and September 30, 2009. Patient demographic data, previous and current treatment, and factors related to disease severity were collected. Surgical procedures were grouped as hand surgery, foot surgery, implant-related surgery, and other surgery. Infections were recorded and defined according to the 1992 Centers for Disease Control definitions for SSI. In 2003-2005, TNF inhibitors were discontinued perioperatively (group A) but not during 2006-2009 (group B). In group A, there were 28 cases of infection in 870 procedures (3.2%) and in group B, there were 35 infections in 681 procedures (5.1%) (p = < 0.05). Only foot surgery had significantly more SSIs in group B, with very low rates in group A. In multivariable analysis with groups A and B merged, only age was predictive of SSI in a statistically significant manner. Overall, the SSI rates were higher after abolishing the discontinuation of anti-TNF perioperatively, possibly due to unusually low rates in the comparator group. None of the medical treatments analyzed, e.g. methotrexate or TNF inhibitors, were significant risk factors for SSI. Continuation of TNF blockade perioperatively remains a routine at our center.

The Localized Scleroderma Cutaneous Assessment Tool: responsiveness to change in a pediatric clinical population.

PubMed

Kelsey, Christina E; Torok, Kathryn S

2013-08-01

Lack of agreement on how to accurately capture disease outcomes in localized scleroderma (LS) has hindered the development of efficacious treatment protocols. The LS Cutaneous Assessment Tool (LoSCAT), consisting of the modified LS Skin Severity Index (mLoSSI) and the LS Damage Index, has potential for use in clinical trials. The goal of this article is to further evaluate the clinical responsiveness of the LoSCAT. Based on the modifiable nature of disease activity versus damage, we expected the mLoSSI to be responsive to change. At 2 study visits, a physician completed the LoSCAT and Physician Global Assessment (PGA) of Disease Activity and of Disease Damage for 29 patients with LS. Spearman correlations were used to examine the relationships between the change in the LoSCAT and the PGA scores. To evaluate contrasted group validity, patients were grouped according to disease activity classification and change scores of groups were compared. Minimal clinically important differences were calculated and compared with the standard error of measurement. Change in the mLoSSI score correlated strongly with change in the PGA of Disease Activity score, whereas change in the LS Damage Index score correlated weakly with change in the PGA of Disease Damage score. The mLoSSI and PGA of Disease Activity exhibited contrasted group validity. Minimal clinically important differences for the activity measures were greater than the respective standard errors of measurement. Only 2 study visits were included in analysis. This study gives further evidence that the LoSCAT, specifically the mLoSSI, is a responsive, valid measure of activity in LS and should be used in future treatment studies. Copyright © 2013 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

A Comparison of Inpatient Cost Per Day in General Surgery Patients with Type 2 Diabetes Treated with Basal-Bolus versus Sliding Scale Insulin Regimens.

PubMed

Phillips, Victoria L; Byrd, Anwar L; Adeel, Saira; Peng, Limin; Smiley, Dawn D; Umpierrez, Guillermo E

2017-01-01

The identification of cost-effective glycaemic management strategies is critical to hospitals. Treatment with a basal-bolus insulin (BBI) regimen has been shown to result in better glycaemic control and fewer complications than sliding scale regular insulin (SSI) in general surgery patients with type 2 diabetes mellitus (T2DM), but the effect on costs is unknown. We conducted a post hoc analysis of the RABBIT Surgery trial to examine whether total inpatient costs per day for general surgery patients with T2DM treated with BBI ( n  = 103) differed from those for patients with T2DM treated with SSI ( n  = 99) regimens. Data were collected from patient clinical and hospital billing records. Charges were adjusted to reflect hospital costs. General linearized models were used to estimate the risk-adjusted effects of BBI versus SSI treatment on average total inpatient costs per day. Risk-adjusted average total inpatient costs per day were $US5404. Treatment with BBI compared with SSI reduced average total inpatient costs per day by $US751 (14%; 95% confidence interval [CI] 20-4). Being treated in a university medical centre, being African American or having a bowel procedure or higher-volume pharmacy use significantly reduced costs per day. In general surgery patients with T2DM, a BBI regimen significantly reduced average total hospital costs per day compared with an SSI regimen. BBI has been shown to improve outcomes in a randomized controlled trial. Those results, combined with our findings regarding savings, suggest that hospitals should consider adopting BBI regimens in patients with T2DM undergoing surgery.

Full-text automated detection of surgical site infections secondary to neurosurgery in Rennes, France.

PubMed

Campillo-Gimenez, Boris; Garcelon, Nicolas; Jarno, Pascal; Chapplain, Jean Marc; Cuggia, Marc

2013-01-01

The surveillance of Surgical Site Infections (SSI) contributes to the management of risk in French hospitals. Manual identification of infections is costly, time-consuming and limits the promotion of preventive procedures by the dedicated teams. The introduction of alternative methods using automated detection strategies is promising to improve this surveillance. The present study describes an automated detection strategy for SSI in neurosurgery, based on textual analysis of medical reports stored in a clinical data warehouse. The method consists firstly, of enrichment and concept extraction from full-text reports using NOMINDEX, and secondly, text similarity measurement using a vector space model. The text detection was compared to the conventional strategy based on self-declaration and to the automated detection using the diagnosis-related group database. The text-mining approach showed the best detection accuracy, with recall and precision equal to 92% and 40% respectively, and confirmed the interest of reusing full-text medical reports to perform automated detection of SSI.

Psychometric properties of the "sport satisfaction instrument (SSI)" in female athletes: predictive model of sport commitment.

PubMed

Granero-Gallegos, A; Baena-Extremera, A; Gómez-López, M; Abraldes, J A

2014-08-01

The objective of this research was to assess the psychometric properties of the Sport Satisfaction Instrument (SSI) in a Spanish sample of female athletes in team sports federations, to decide whether it constitutes a valid and reliable instrument to be used in the context of female competitive sport in future research. The SSI was administered to a total of 615 athletes from 12 to 38 yr. of age. Confirmatory procedures and psychometric analysis supported the hypothesized theoretical model of two factors (Satisfaction/fun and Boredom). For female athletes, the 7-item model showed better goodness-of-fit indexes upon eliminating Item 2 from the Boredom subscale. Concurrent validity was explored through the correlations with the Perception of Success Questionnaire and Sport Commitment, obtaining positive correlations between Satisfaction/fun and Task Orientation and Sport Commitment, whereas Boredom correlated positively but less closely with Ego Orientation. The importance of Satisfaction/fun in the prediction of Sport Commitment, starting from task orientation, is emphasized.

Suppression of starch synthase I expression affects the granule morphology and granule size and fine structure of starch in wheat endosperm

PubMed Central

2014-01-01

Studies in Arabidopsis and rice suggest that manipulation of starch synthase I (SSI) expression in wheat may lead to the production of wheat grains with novel starch structure and properties. This work describes the suppression of SSI expression in wheat grains using RNAi technology, which leads to a low level of enzymatic activity for SSI in the developing endosperm, and a low abundance of SSI protein inside the starch granules of mature grains. The amylopectin fraction of starch from the SSI suppressed lines showed an increased frequency of very short chains (degree of polymerization, dp 6 and 7), a lower proportion of short chains (dp 8–12), and more intermediate chains (dp 13–20) than in the grain from their negative segregant lines. In the most severely affected line, amylose content was significantly increased, the morphology of starch granules was changed, and the proportion of B starch granules was significantly reduced. The change of the fine structure of the starch in the SSI-RNAi suppression lines alters the gelatinization temperature, swelling power, and viscosity of the starch. This work demonstrates that the roles of SSI in the determination of starch structure and properties are similar among different cereals and Arabidopsis. PMID:24634486

Administrative data measured surgical site infection probability within 30 days of surgery in elderly patients.

PubMed

van Walraven, Carl; Jackson, Timothy D; Daneman, Nick

2016-09-01

Elderly patients are inordinately affected by surgical site infections (SSIs). This study derived and internally validated a model that used routinely collected health administrative data to measure the probability of SSI in elderly patients within 30 days of surgery. All people exceeding 65 years undergoing surgery from two hospitals with known SSI status were linked to population-based administrative data sets in Ontario, Canada. We used bootstrap methods to create a multivariate model that used health administrative data to predict the probability of SSI. Of 3,436 patients, 177 (5.1%) had an SSI. The Elderly SSI Risk Model included six covariates: number of distinct physician fee codes within 30 days of surgery; presence or absence of a postdischarge prescription for an antibiotic; presence or absence of three diagnostic codes; and a previously derived score that gauged SSI risk based on procedure codes. The model was highly explanatory (Nagelkerke's R 2 , 0.458), strongly discriminative (C statistic, 0.918), and well calibrated (calibration slope, 1). Health administrative data can effectively determine 30-day risk of SSI risk in elderly patients undergoing a broad assortment of surgeries. External validation is necessary before this can be routinely used to monitor SSIs in the elderly. Copyright © 2016 Elsevier Inc. All rights reserved.

An Overview of Plume Tracker: Mapping Volcanic Emissions with Interactive Radiative Transfer Modeling

NASA Astrophysics Data System (ADS)

Realmuto, V. J.; Berk, A.; Guiang, C.

2014-12-01

Infrared remote sensing is a vital tool for the study of volcanic plumes, and radiative transfer (RT) modeling is required to derive quantitative estimation of the sulfur dioxide (SO2), sulfate aerosol (SO4), and silicate ash (pulverized rock) content of these plumes. In the thermal infrared, we must account for the temperature, emissivity, and elevation of the surface beneath the plume, plume altitude and thickness, and local atmospheric temperature and humidity. Our knowledge of these parameters is never perfect, and interactive mapping allows us to evaluate the impact of these uncertainties on our estimates of plume composition. To enable interactive mapping, the Jet Propulsion Laboratory is collaborating with Spectral Sciences, Inc., (SSI) to develop the Plume Tracker toolkit. This project is funded by a NASA AIST Program Grant (AIST-11-0053) to SSI. Plume Tracker integrates (1) retrieval procedures for surface temperature and emissivity, SO2, NH3, or CH4 column abundance, and scaling factors for H2O vapor and O3 profiles, (2) a RT modeling engine based on MODTRAN, and (3) interactive visualization and analysis utilities under a single graphics user interface. The principal obstacle to interactive mapping is the computational overhead of the RT modeling engine. Under AIST-11-0053 we have achieved a 300-fold increase in the performance of the retrieval procedures through the use of indexed caches of model spectra, optimization of the minimization procedures, and scaling of the effects of surface temperature and emissivity on model radiance spectra. In the final year of AIST-11-0053 we will implement parallel processing to exploit multi-core CPUs and cluster computing, and optimize the RT engine to eliminate redundant calculations when iterating over a range of gas concentrations. These enhancements will result in an additional 8 - 12X increase in performance. In addition to the improvements in performance, we have improved the accuracy of the Plume Tracker retrievals through refinements in the description of surface emissivity and use of vector projection to define the misfit between model and observed spectra. Portions of this research were conducted at the Jet Propulsion Laboratory, California Institute of Technology, under contract to the National Aeronautics and Space Administration.

[Prospective multi-institutional analysis according to the "Japanese guidelines for prevention of perioperative infections in urological field"].

PubMed

Wada, Koichiro; Uehara, Shinya; Kira, Shinichiro; Matsumoto, Masahiro; Sho, Takehiko; Kurimura, Yuichiro; Hashimoto, Jiro; Uehara, Teruhisa; Yamane, Takashi; Kanamaru, Sojun; Togo, Yoshikazu; Taoka, Rikiya; Takahashi, Akira; Yamada, Yusuke; Yokomizo, Akira; Yasuda, Mitsuru; Tanaka, Kazushi; Hamasuna, Ryoichi; Takahashi, Satoshi; Hayami, Hiroshi; Watanabe, Toyohiko; Monden, Koichi; Kiyota, Hiroshi; Deguchi, Takashi; Naito, Seiji; Tsukamoto, Taiji; Arakawa, Soichi; Fujisawa, Masato; Yamamoto, Shingo; Kumon, Hiromi; Matsumoto, Tetsuro

2013-05-01

The "Japanese guidelines for prevention of perioperative infections in urological field" was edited by the Japanese Urological Association in 2007. They are the first Japanese guidelines for antimicrobial prophylaxis specifically to prevent perioperative infections in the urological field. We report here the results of a multicenter prospective study conducted to examine the validity and usefulness of these guidelines. The subjects were 513 patients who had undergone urological surgeries between July and September 2008 at 10 nationwide university institutions in the Japanese Society of UTI Cooperative Study Group. These surgeries were transurethral resection of bladder (TURBT), transurethral resection of prostate (TURP), adrenalectomy, nephrectomy, nephroureterectomy, radical prostatectomy and total cystectomy. Analysis was performed on patient information, surgical procedures, types and durations of administration of prophylactic antibiotic agents, and the presence of surgical site infections (SSI) and remote infections (RI). Of 513 patients, 387 (75.4%) were administered prophylactic antibiotic agents according to the guidelines. In these patients, the incidences of SSI and RI were 5.9% and 4.1%, respectively. Multivariate analysis showed that significant factors for SSI were the surgical risk (according to the ASA physical status classification system), diabetes, and operation time, and that the only significant factor for RI was the operation time. More large-scale study and evidences are necessary in order to demonstrate the validity and usefulness of these guidelines.

In vivo quantification of the shear modulus of the human Achilles tendon during passive loading using shear wave dispersion analysis.

PubMed

Helfenstein-Didier, C; Andrade, R J; Brum, J; Hug, F; Tanter, M; Nordez, A; Gennisson, J-L

2016-03-21

The shear wave velocity dispersion was analyzed in the Achilles tendon (AT) during passive dorsiflexion using a phase velocity method in order to obtain the tendon shear modulus (C 55). Based on this analysis, the aims of the present study were (i) to assess the reproducibility of the shear modulus for different ankle angles, (ii) to assess the effect of the probe locations, and (iii) to compare results with elasticity values obtained with the supersonic shear imaging (SSI) technique. The AT shear modulus (C 55) consistently increased with the ankle dorsiflexion (N = 10, p < 0.05). Furthermore, the technique showed a very good reproducibility (all standard error of the mean values <10.7 kPa and all coefficient of variation (CV) values ⩽ 0.05%). In addition, independently from the ankle dorsiflexion, the shear modulus was significantly higher in the proximal location compared to the more distal one. The shear modulus provided by SSI was always lower than C55 and the difference increased with the ankle dorsiflexion. However, shear modulus values provided by both methods were highly correlated (R = 0.84), indicating that the conventional shear wave elastography technique (SSI technique) can be used to compare tendon mechanical properties across populations. Future studies should determine the clinical relevance of the shear wave dispersion analysis, for instance in the case of tendinopathy or tendon tear.

Postoperative Outcomes in Vedolizumab-Treated Patients Undergoing Abdominal Operations for Inflammatory Bowel Disease.

PubMed

Lightner, Amy L; Raffals, Laura E; Mathis, Kellie L; Cima, Robert R; Tse, Chung Sang; Pemberton, John H; Dozois, Eric J; Loftus, Edward V

2017-02-01

Vedolizumab was recently approved by the Food and Drug Administration for the treatment of moderate to severe ulcerative colitis [UC] and Crohn's disease [CD]. No study to date has examined the rate of postoperative infectious complications among patients who received vedolizumab in the perioperative period. We sought to determine the 30-day postoperative infectious complication rate among inflammatory bowel disease [IBD] patients who received vedolizumab within 12 weeks of an abdominal operation as compared to patients who received tumour necrosis factor α [TNFα] inhibitors or no biological therapy. A retrospective chart review between May 1, 2014 and December 31, 2015 of adult IBD patients who underwent an abdominal operation was performed. The study cohort comprised patients who received vedolizumab within 12 weeks of their abdominal operation and the control cohorts were patients who received TNFα inhibitors or no biological therapy. In total, 94 patients received vedolizumab within 12 weeks of an abdominal operation. Fifty experienced postoperative complications [53%], 35 of which were surgical site infections [SSIs] [36%]. The vedolizumab group experienced significantly higher rates of any postoperative infection [53% vs 33% anti-TNF and 28% non-biologics; p<0.001] and SSI [37% vs 10% and 13%; p<0.001]. On univariate and multivariate analysis, exposure to vedolizumab remained a significant predictor of postoperative SSI [p<0.001]. Thirty-seven per cent of IBD patients who received vedolizumab within 30 days of a major abdominal operation experienced a 30-day postoperative SSI, significantly higher than patients receiving TNFα inhibitors or no biological therapy. Vedolizumab within 12 weeks of surgery remained the only predictor of 30-day postoperative SSI on multivariate analysis. Copyright © 2016 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Staphylococcus Aureus Prevention Strategies in Cardiac Surgery: A Cost-Effectiveness Analysis.

PubMed

Hong, Jonathan C; Saraswat, Manoj K; Ellison, Trevor A; Magruder, J Trent; Crawford, Todd; Gardner, Julia M; Padula, William V; Whitman, Glenn J

2018-01-01

Cardiac surgery patients colonized with Staphylococcus aureus have a greater risk of surgical site infection (SSI). The purpose of this study was to evaluate the cost-effectiveness of decolonization strategies to prevent SSIs. We compared three decolonization strategies: universal decolonization (UD), all subjects treated; targeted decolonization (TD), only S aureus carriers treated; and no decolonization (ND). Decolonization included mupirocin, chlorhexidine, and vancomycin. We implemented a decision tree comparing the costs and quality-adjusted life-years (QALYs) of these strategies on SSI over a 1-year period for subjects undergoing coronary artery bypass graft surgery from a US health sector perspective. Deterministic and probabilistic sensitivity analyses were conducted to address the uncertainty in the variables. Universal decolonization was the dominant strategy because it resulted in reduced costs at near-equal QALYs compared with TD and ND. Compared with ND, UD decreased costs by $462 and increased QALYs by 0.002 per subject, whereas TD decreased costs by $205 and increased QALYs by 0.001 per subject. For 1,000 subjects, UD prevented 19 SSI and TD prevented 10 SSI compared with ND. Sensitivity analysis showed UD to be the most cost-effective strategy in more than 91% of simulations. For the 220,000 coronary artery bypass graft procedures performed yearly in the United States, UD would save $102 million whereas TD would save $45 million compared with ND. Universal decolonization outperforms other strategies. However, the potential costs savings of $57 million per 220,000 coronary artery bypass graft procedures comparing UD versus TD must be weighed against the potential risk of developing resistance associated with universal decolonization. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

The SATIRE-S model and why getting solar cycle spectral irradiance trends correct is so important

NASA Astrophysics Data System (ADS)

Ball, William; Haigh, Joanna; Krivova, Natalie; Unruh, Yvonne; Solanki, Sami

2014-05-01

There is currently a wide range of potential spectral solar irradiance (SSI) solar cycle (SC) amplitudes suggested by observations and models. Therefore, SSI SC changes are still not fully understood. The magnitude of the SC flux changes has a direct impact upon the temperature and chemistry of the Earth's atmosphere. To contribute to an understanding of the solar-climate connection, it is critical that we, as the solar community, communicate effectively with the climate community, providing uncertainties in SSI data and assessments of possible SSI options. We present the SATIRE-S reconstruction in the context of these SSI datasets. SATIRE-S is a physically based, consistent SSI reconstruction over the last three solar cycles. It shows different SC spectral variability at all wavelengths compared to the NRLSSI model, widely used in climate research. Most-importantly, SC changes in the ultra-violet (UV) can be twice as large in SATIRE-S as NRLSSI. Typically NRLSSI provides a lower limit of SC SSI UV variability. SORCE satellite observations provide SC magnitudes at the upper limit of variability, exceeding that of SATIRE-S by a factor of three at some UV wavelengths. There is currently no way to be certain if any of these three SSI datasets, or others, is correct. We also present the SSI datasets in terms of their impact on stratospheric ozone, within a 2D atmospheric model, as an example of why it is important to get SC changes correct. Using NRLSSI results in the 2D atmospheric model, we see a decrease in ozone concentration at all altitudes from solar maximum to minimum. SATIRE-S and SORCE/SOLSTICE observations instead show an increase in ozone concentration in the mesosphere. The magnitude of the increase in the mesosphere when using SOLSTICE also depends greatly upon the version of the data, which means that studies using different data versions of SOLSTICE may lead to different conclusions. These results highlight why an accurate understanding of SC SSI changes, and their uncertainties, are essential for the climate community that uses our work.

Randomized clinical trial of negative pressure wound therapy for high-risk groin wounds in lower extremity revascularization.

PubMed

Lee, Kevin; Murphy, Patrick B; Ingves, Matthew V; Duncan, Audra; DeRose, Guy; Dubois, Luc; Forbes, Thomas L; Power, Adam

2017-12-01

The surgical site infection (SSI) rate in vascular surgery after groin incision for lower extremity revascularization can lead to significant morbidity and mortality. This trial was designed to study the effect of negative pressure wound therapy (NPWT) on SSI in closed groin wounds after lower extremity revascularization in patients at high risk for SSI. A single-center, randomized, controlled trial was performed at an academic tertiary medical center. Patients with previous femoral artery surgical exposure, body mass index of >30 kg/m 2 or the presence of ischemic tissue loss were classified as a high-risk patient for SSI. All wounds were closed primarily and patients were randomized to either NPWT or standard dressing. The primary outcome of the trial was postoperative 30-day SSI in the groin wound. The secondary outcomes included 90-day SSI, hospital duration of stay, readmissions or reoperations for SSI, and mortality. A total of 102 patients were randomized between August 2014 and December 2015. Patients were classified as at high risk owing to the presence of previous femoral artery cut down (29%), body mass index of >30 kg/m 2 (39%) or presence of ischemic tissue loss (32%). Revascularization procedures performed included femoral to distal artery bypass (57%), femoral endarterectomy (18%), femoral to femoral artery crossover (17%), and other procedures (8%). The primary outcome of 30-day SSI was 11% in NPWT group versus 19% in standard dressing group (P = .24). There was a statistically significant shorter mean duration of hospital stay in the NPWT group (6.4 days) compared with the standard group (8.9 days; P = .01). There was no difference in readmission or reoperation for SSI or mortality between the two groups. This study demonstrated a nonsignificant lower rate of groin SSI in high-risk revascularization patients with NPWT compared with standard dressing. Owing to a lower than expected infection rate, the study was underpowered to detect a difference at the prespecified level. The NPWT group did show significantly shorter mean hospital duration of stay compared with the standard dressing group. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

An economic model: value of antimicrobial-coated sutures to society, hospitals, and third-party payers in preventing abdominal surgical site infections.

PubMed

Singh, Ashima; Bartsch, Sarah M; Muder, Robert R; Lee, Bruce Y

2014-08-01

While the persistence of high surgical site infection (SSI) rates has prompted the advent of more expensive sutures that are coated with antimicrobial agents to prevent SSIs, the economic value of such sutures has yet to be determined. Using TreeAge Pro, we developed a decision analytic model to determine the cost-effectiveness of using antimicrobial sutures in abdominal incisions from the hospital, third-party payer, and societal perspectives. Sensitivity analyses systematically varied the risk of developing an SSI (range, 5%-20%), the cost of triclosan-coated sutures (range, $5-$25/inch), and triclosan-coated suture efficacy in preventing infection (range, 5%-50%) to highlight the range of costs associated with using such sutures. Triclosan-coated sutures saved $4,109-$13,975 (hospital perspective), $4,133-$14,297 (third-party payer perspective), and $40,127-$53,244 (societal perspective) per SSI prevented, when a surgery had a 15% SSI risk, depending on their efficacy. If the SSI risk was no more than 5% and the efficacy in preventing SSIs was no more than 10%, triclosan-coated sutures resulted in extra expenditure for hospitals and third-party payers (resulting in extra costs of $1,626 and $1,071 per SSI prevented for hospitals and third-party payers, respectively; SSI risk, 5%; efficacy, 10%). Our results suggest that switching to triclosan-coated sutures from the uncoated sutures can both prevent SSIs and save substantial costs for hospitals, third-party payers, and society, as long as efficacy in preventing SSIs is at least 10% and SSI risk is at least 10%.

Scaled signal intensity of uterine fibroids based on T2-weighted MR images: a potential objective method to determine the suitability for magnetic resonance-guided focused ultrasound surgery of uterine fibroids.

PubMed

Park, Hyun; Yoon, Sang-Wook; Sokolov, Amit

2015-12-01

Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) is a non-invasive method to treat uterine fibroids. To help determine the patient suitability for MRgFUS, we propose a new objective measure: the scaled signal intensity (SSI) of uterine fibroids in T2 weighted MR images (T2WI). Forty three uterine fibroids in 40 premenopausal women were included in this retrospective study. SSI of each fibroid was measured from the screening T2WI by standardizing its mean signal intensity to a 0-100 scale, using reference intensities of rectus abdominis muscle (0) and subcutaneous fat (100). Correlation between the SSI and the non-perfused volume (NPV) ratio (a measure for treatment success) was calculated. Pre-treatment SSI showed a significant inverse-correlation with post treatment NPV ratio (p < 0.05). When dichotomizing NPV ratio at 45 %, the optimal cut off value of the SSI was found to be 16.0. A fibroid with SSI value 16.0 or less can be expected to have optimal responses. The SSI of uterine fibroids in T2WI can be suggested as an objective parameter to help in patient selection for MRgFUS. • Signal intensity of fibroid in MR images predicts treatment response to MRgFUS. • Signal intensity is standardized into scaled form using adjacent tissues as references. • Fibroids with SSI less than 16.0 are expected to have optimal responses.

Reduction of Surgical Site Infections after Implementation of a Bundle of Care

PubMed Central

Crolla, Rogier M. P. H.; van der Laan, Lijckle; Veen, Eelco J.; Hendriks, Yvonne; van Schendel, Caroline; Kluytmans, Jan

2012-01-01

Background Surgical Site Infections (SSI) are relatively frequent complications after colorectal surgery and are associated with substantial morbidity and mortality. Objective Implementing a bundle of care and measuring the effects on the SSI rate. Design Prospective quasi experimental cohort study. Methods A prospective surveillance for SSI after colorectal surgery was performed in the Amphia Hospital, Breda, from January 1, 2008 until January 1, 2012. As part of a National patient safety initiative, a bundle of care consisting of 4 elements covering the surgical process was introduced in 2009. The elements of the bundle were perioperative antibiotic prophylaxis, hair removal before surgery, perioperative normothermia and discipline in the operating room. Bundle compliance was measured every 3 months in a random sample of surgical procedures. Results Bundle compliance improved significantly from an average of 10% in 2009 to 60% in 2011. 1537 colorectal procedures were performed during the study period and 300 SSI (19.5%) occurred. SSI were associated with a prolonged length of stay (mean additional length of stay 18 days) and a significantly higher 6 months mortality (Adjusted OR: 2.71, 95% confidence interval 1.76–4.18). Logistic regression showed a significant decrease of the SSI rate that paralleled the introduction of the bundle. The adjusted Odds ratio of the SSI rate was 36% lower in 2011 compared to 2008. Conclusion The implementation of the bundle was associated with improved compliance over time and a 36% reduction of the SSI rate after adjustment for confounders. This makes the bundle an important tool to improve patient safety. PMID:22962619

Preventable Complications Driving Rising Costs in Management of Patients with Critical Limb Ischemia.

PubMed

Dua, Anahita; Desai, Sapan S; Patel, Bhavin; Seabrook, Gary R; Brown, Kellie R; Lewis, Brian; Rossi, Peter J; Malinowski, Michael; Lee, Cheong J

2016-05-01

This study aimed to identify factors that drive increasing health-care costs associated with the management of critical limb ischemia in elective inpatients. Patients with a primary diagnosis code of critical limb ischemia (CLI) were identified from the 2001-2011 Nationwide Inpatient Sample. Demographics, CLI management, comorbidities, complications (bleeding, surgical site infection [SSI]), length of stay, and median in-hospital costs were reviewed. Statistical analysis was completed using Students' t-test and Mann-Kendall trend analysis. Costs are reported in 2011 US dollars corrected using the consumer price index. From 2001 to 2011, there were a total of 451,823 patients who underwent open elective revascularization as inpatients for CLI. Costs to treat CLI increased by 63% ($12,560 in 2001 to $20,517 in 2011, P < 0.001 in trend analysis). Endovascular interventions were 20% more expensive compared with open surgery ($19,566 vs. $16,337, P < 0.001). Age, gender, and insurance status did not affect the cost of care. From 2001 to 2011, the number of patient comorbidities (7.56-12.40) and percentage of endovascular cases (13.4% to 27.4%) increased, accounting for a 6% annual increase in total cost despite decreased median length of stay (6 to 5 days). Patients who developed SSI had total costs 83% greater than patients without SSIs ($30,949 vs. $16,939; P < 0.001). Patients who developed bleeding complications had total costs 41% greater than nonbleeding patients ($23,779 vs. $16,821, P < 0.001). Overall, there was a 32% reduction in SSI rates but unchanged rates of bleeding complications during this period. The cost of CLI treatment is increasing and driven by rising endovascular use, SSI, and bleeding in the in-patient population. Further efforts to reduce complications in this patient population may contribute to a reduction in health care-associated costs of treating CLI. Copyright © 2016 Elsevier Inc. All rights reserved.

Have Recent Modifications of Operating Room Attire Policies Decreased Surgical Site Infections? An American College of Surgeons NSQIP Review of 6,517 Patients.

PubMed

Farach, Sandra M; Kelly, Kristin N; Farkas, Rachel L; Ruan, Daniel T; Matroniano, Amy; Linehan, David C; Moalem, Jacob

2018-05-01

After a Department of Health site visit, 2 teaching hospitals imposed strict regulations on operating room attire, including full coverage of ears and facial hair. We hypothesized that this intervention would reduce superficial surgical site infections (SSIs). We compared NSQIP data from all patients undergoing operations in the 9 months before implementation (n = 3,077) to time-matched data 9 months post-implementation (n = 3,440). Univariate and multivariable analyses were used to examine patient, clinical, and operative factors associated with SSIs. Power analysis was performed using pre-intervention SSI rates. Despite a shift toward more clean cases, there were more SSIs post-implementation (33 vs 30 [1%]; p = 0.95). There were no differences in length of stay, complications, or mortality between the 2 time periods. Overall, SSI increased with wound class: 0.6%, 0.9%, 2.3%, and 3.8% in clean, clean-contaminated, contaminated, and infected cases, respectively. Limiting the review to clean or clean-contaminated cases, incisional SSIs increased from 0.7% (20 of 2,754) to 0.8% (24 of 3,115) (p = 0.85). A multivariable analysis showed that implementation of these policies was not associated with decreased SSIs (odds ratio 1.2; 95% CI 0.70 to 1.96; p = 0.56). The largest predictors of SSIs were preoperative infection, operative time >75th percentile, open wounds, and dirty/contaminated wounds. A hypothetical analysis revealed that a sample size of 485,154 patients would be required to demonstrate a 10% SSI reduction among patients with clean or clean-contaminated wounds. Implementation of stringent operating room attire policies do not reduce SSI rates. A study to prove this principle further would be impractical to conduct. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

40 CFR 60.5130 - What are the operator training and qualification requirements?

Code of Federal Regulations, 2013 CFR

2013-07-01

... (CONTINUED) AIR PROGRAMS (CONTINUED) STANDARDS OF PERFORMANCE FOR NEW STATIONARY SOURCES Emission Guidelines... operated unless a fully trained and qualified SSI unit operator is accessible, either at the facility or can be at the facility within 1 hour. The trained and qualified SSI unit operator may operate the SSI...

40 CFR 60.4810 - What are the operator training and qualification requirements?

Code of Federal Regulations, 2013 CFR

2013-07-01

... (CONTINUED) AIR PROGRAMS (CONTINUED) STANDARDS OF PERFORMANCE FOR NEW STATIONARY SOURCES Standards of... the operator training and qualification requirements? (a) A SSI unit cannot be operated unless a fully... within 1 hour. The trained and qualified SSI unit operator may operate the SSI unit directly or be the...

40 CFR 60.4810 - What are the operator training and qualification requirements?

Code of Federal Regulations, 2014 CFR

2014-07-01

... (CONTINUED) AIR PROGRAMS (CONTINUED) STANDARDS OF PERFORMANCE FOR NEW STATIONARY SOURCES Standards of... the operator training and qualification requirements? (a) A SSI unit cannot be operated unless a fully... within 1 hour. The trained and qualified SSI unit operator may operate the SSI unit directly or be the...

40 CFR 60.5130 - What are the operator training and qualification requirements?

Code of Federal Regulations, 2014 CFR

2014-07-01

... (CONTINUED) AIR PROGRAMS (CONTINUED) STANDARDS OF PERFORMANCE FOR NEW STATIONARY SOURCES Emission Guidelines... operated unless a fully trained and qualified SSI unit operator is accessible, either at the facility or can be at the facility within 1 hour. The trained and qualified SSI unit operator may operate the SSI...

40 CFR 60.4810 - What are the operator training and qualification requirements?

Code of Federal Regulations, 2012 CFR

2012-07-01

... (CONTINUED) AIR PROGRAMS (CONTINUED) STANDARDS OF PERFORMANCE FOR NEW STATIONARY SOURCES Standards of... the operator training and qualification requirements? (a) A SSI unit cannot be operated unless a fully... within 1 hour. The trained and qualified SSI unit operator may operate the SSI unit directly or be the...

20 CFR 408.425 - How do we establish your eligibility for SSI?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false How do we establish your eligibility for SSI? 408.425 Section 408.425 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS Evidence Requirements Ssi Eligibility § 408.425 How do we establish your...

20 CFR 408.425 - How do we establish your eligibility for SSI?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false How do we establish your eligibility for SSI? 408.425 Section 408.425 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS Evidence Requirements Ssi Eligibility § 408.425 How do we establish your...

20 CFR 408.425 - How do we establish your eligibility for SSI?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false How do we establish your eligibility for SSI? 408.425 Section 408.425 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS Evidence Requirements Ssi Eligibility § 408.425 How do we establish your...

20 CFR 408.425 - How do we establish your eligibility for SSI?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false How do we establish your eligibility for SSI? 408.425 Section 408.425 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS Evidence Requirements Ssi Eligibility § 408.425 How do we establish your...

20 CFR 408.425 - How do we establish your eligibility for SSI?

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false How do we establish your eligibility for SSI? 408.425 Section 408.425 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS Evidence Requirements Ssi Eligibility § 408.425 How do we establish your...

SSI Variations in the visible as observed with SOLAR/SOLSPEC during cycle 24 - Comparison with SORCE/SIM.

NASA Astrophysics Data System (ADS)

Irbah, A.; Damé, L.; Meftah, M.; Bekki, S.; Bolsée, D.

2017-12-01

The solar spectral irradiance (SSI) and its temporal variations are of prime importance to apprehend the physics of the Sun and to understand its effects on Earth climate through changes of atmospheric properties. Ground based measurements of SSI are indeed affected by the Earth atmosphere and space observations are therefore required to perform adequate observations. Only a few long series of SSI space measurements were obtained these last decades. The SOLSPEC instrument of the SOLAR payload on the International Space Station (ISS) has recorded one of them from April 2008 to February 2017 covering almost the whole solar cycle 24. The instrument is a spectro-radiometer recording data of the Sun from 166 to 3088 nm. Operated from the ISS in a harsh environment it needed appropriate processing methods to extract significant scientific results from noise and instrumental effects. We present the methods used to process the data to evidence visible SSI variations during cycle 24. We discuss the results obtained showing SSI variations in phase with solar activity. We compare them with SORCE/SIM measurements.

Association between Pre-Operative Cefazolin Dose and Surgical Site Infection in Obese Patients.

PubMed

Peppard, William J; Eberle, David G; Kugler, Nathan W; Mabrey, Danielle M; Weigelt, John A

A fixed dose of cefazolin results in serum concentrations that decrease as body mass increases. Current national guidelines suggest a pre-operative cefazolin dose of two grams may be insufficient for patients ≥120 kg; thus a three gram dose is recommended. These recommendations, however, are based on pharmacokinetic rather than outcome data. We evaluate the efficacy of pre-operative cefazolin two gram and three gram doses as measured by the rate of surgical site infection (SSI). We conducted a retrospective review of adult patients ≥100 kg who were prescribed cefazolin as surgical prophylaxis between September 1, 2012 and May 31, 2013 at an academic medical center. Patients were excluded if cefazolin was prescribed but not administered, had a known infection at the site of surgery, or inappropriately received cefazolin prophylaxis based on surgical indication. The SSIs were identified by documentation of SSI in the medical record or findings consistent with the standard Centers for Disease Control and Prevention definition. Inpatient and outpatient records up to 90 days post-operative were reviewed for delayed SSI. Four hundred eighty-three surgical cases were identified in which pre-operative cefazolin was prescribed. Forty-seven patients were excluded leaving a total of 436 patients for final analysis: 152 in the cefazolin two gram group and 284 in the three gram group. Baseline demographics were similar between groups with a mean follow-up duration of 77 days for both groups. Unadjusted SSI rates were 7.2% and 7.4% (odds ratio [OR] 0.98, p = 0.95), for the two gram and three gram groups, respectively. When differences in follow-up between groups were considered and logistic regression was adjusted with propensity score, there remained no difference in SSI rates (OR 0.87, 95% confidence interval 0.36-2.06, p = 0.77). In otherwise similar obese surgical patients weighing ≥100 kg, the administration of a pre-operative cefazolin two gram dose is associated with a similar rate of SSI compared with patients who received a three gram dose.

Lithospheric structure of an incipient rift basin: Results from receiver function analysis of Bransfield Strait, NW Antarctic Peninsula

NASA Astrophysics Data System (ADS)

Biryol, C. Berk; Lee, Stephen J.; Lees, Jonathan M.; Shore, Michael J.

2018-06-01

Bransfield Basin (BB), located northwest of the Antarctic Peninsula (AP) and southeast of the South Shetland Islands (SSI), is the most active section of the Antarctic continental margin. The region has long been (50 Ma) a convergent plate boundary where the Phoenix plate was subducting beneath the Antarctic Plate and is characterized by long-lived arc magmatism and accretion. However, the collision of the Antarctic-Phoenix spreading center with the subduction front near SSI (ca. 4 Ma) gave way to the opening of slab windows and dramatic decrease in the subduction rate of the Phoenix plate beneath AP and SSI. Consequently, the Phoenix slab began to rollback slowly along the South Shetland Trench (SST), giving way to slow extension in the back-arc region and rifting along the BB. Although there is consensus on the factors that control the current deformation and extension of the BB, the origin of the BB and the tectonic configuration of the basin are still unclear. Most of the controversy stems from uncertainties regarding the crustal thickness of the BB. Hence, we computed teleseismic receiver functions for 10 broadband stations in the region that belong to existing permanent and temporary deployments in order obtain robust constraints on the lithospheric structure and crustal thickness of the BB, as well as the AP and SSI. Our results indicate that the crust is thinning from 30 km to 26 km from the AP towards the South Shetland trench and Central BB showing the asymmetrical character of the rift basin. The crustal thickness and Vp/Vs variations are less pronounced along the AP but very significant across the SSB indicating the lithospheric scale segmentation of the South Shetland Block (SSB) and the incipient rift basin under the control of the opening of slab window and the roll-back of stalled Phoenix slab. High Vp/Vs ratios (∼1.9) beneath BB and SSI, agree well with the nascent rift character of BB, the presence of a steep Phoenix slab and consequently a wider mantle wedge characterized by the presence of underplating partial melts beneath SSI and BB.

Medical comorbidities and perioperative allogeneic red blood cell transfusion are risk factors for surgical site infection after shoulder arthroplasty.

PubMed

Everhart, Joshua S; Bishop, Julie Y; Barlow, Jonathan D

2017-11-01

Multiple perioperative factors have been implicated in infection risk after shoulder arthroplasty. The purpose of this study was to determine surgical site infection (SSI) risk due to medical comorbidities or blood transfusion after primary or revision shoulder arthroplasty. Comprehensive data on medical comorbidities, surgical indication, perioperative transfusion, and SSI were obtained for 707 patients who underwent primary or revision hemiarthroplasty or total shoulder arthroplasty in a single hospital system. Multivariate Poisson regression was used to determine the independent association between allogeneic red blood cell transfusion, medical comorbidities, and SSI after controlling for procedure. The SSI rate was 1.9% for primary hemiarthroplasties and 1.3% for primary total shoulder arthroplasties. Among patients without prior shoulder infection, revision arthroplasty or prior open reduction and internal fixation had higher SSI risk than primary arthroplasties (incidence risk ratio [IRR], 11.4; 95% confidence interval [CI], 3.84-34.0; P < .001); among primary arthroplasties, SSI risk factors included male gender (IRR, 60.0; CI, 4.39-819; P = .002), rheumatoid arthritis (IRR, 8.63; CI, 1.84-40.4; P = .006), and long-term corticosteroid use (IRR, 37.4; CI, 5.79-242; P < .001). Perioperative allogeneic red blood cell transfusion significantly increased SSI risk and was dose dependent (IRR, 1.68 per unit packed red blood cell; CI, 1.21-2.35; P = .002). Gender, rheumatoid arthritis, and long-term (>1 year) corticosteroid use affect SSI risk after shoulder arthroplasty. Revision surgery, particularly in the setting of prior infection, increased risk of future infection. Finally, allogeneic red blood cell transfusion increases SSI risk after shoulder arthroplasty in a dose-dependent manner. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

A positive association between nutritional risk and the incidence of surgical site infections: A hospital-based register study.

PubMed

Skeie, Eli; Koch, Anne Mette; Harthug, Stig; Fosse, Unni; Sygnestveit, Kari; Nilsen, Roy Miodini; Tangvik, Randi J

2018-01-01

Surgical site infections (SSI) are amongst the most common health care-associated infections and have adverse effects for patient health and for hospital resources. Although surgery guidelines recognize poor nutritional status to be a risk factor for SSI, they do not tell how to identify this condition. The screening tool Nutritional Risk Screening 2002 is commonly used at hospitals to identify patients at nutritional risk. We investigated the association between nutritional risk and the incidence of SSI among 1194 surgical patients at Haukeland University Hospital (Bergen, Norway). This current study combines data from two mandatory hospital-based registers: a) the incidence of SSI within 30 days after surgery, and b) the point-prevalence of patients at nutritional risk. Patients with more than 30 days between surgery and nutritional risk screening were excluded. Associations were assessed using logistic regression, and the adjusted odds ratio included age (continuous), gender (male/female), type of surgery (acute/elective) and score from The American Society of Anesthesiologists Physical Status Classification System. There was a significant higher incidence of SSI among patients at nutritional risk (11.8%), as compared to those who were not (7.0%) (p = 0.047). Moreover, the incidence of SSI was positively associated with the prevalence of nutritional risk in both simple (OR 1.76 (95% CI: 1.04, 2.98)) and adjusted (OR 1.81 (95% CI: 1.04, 3.16)) models. Answering "yes" to the screening questions regarding reduced dietary intake and weight loss was significantly associated with the incidence of SSI (respectively OR 2.66 (95% CI: 1.59, 4.45) and OR 2.15 (95% CI: 1.23, 3.76)). In conclusion, we demonstrate SSI to occur more often among patients at nutritional risk as compared to those who are not at nutritional risk. Future studies should investigate interventions to prevent both SSI and nutritional risk among surgical patients.

Case Studies of Secondary School Teachers Designing Socioscientific Issues-Based Instruction and Their Students' Socioscientific Reasoning

NASA Astrophysics Data System (ADS)

Karahan, Engin

Addressing socioscientific issues (SSI) has been one of the main focuses in science education since the Science, Technology, and Society (STS) movement in the 1970s (Levinson, 2006); however, teaching controversial socioscientific issues has always been challenging for teachers (Dillon, 1994; Osborne, Duschl, & Fairbrother, 2002). Although teachers exhibit positive attitudes for using controversial socioscientific issues in their science classrooms, only a small percentage of them actually incorporate SSI content into their science curricula on a regular basis (Sadler, Amirshokoohi, Kazempour, & Allspaw, 2006; Lee & Witz, 2009). The literature in science education has highlighted the signi?cant relationships among teacher beliefs, teaching practices, and student learning (Bryan & Atwater, 2002; King, Shumow, & Lietz, 2001; Lederman, 1992). Despite the fact that the case studies present a relatively detailed picture of teachers' values and motivations for teaching SSI (e.g. Lee, 2006; Lee & Witz, 2009; Reis & Galvao, 2004), these studies still miss the practices of these teachers and potential outcomes for their students. Therefore, there is a great need for in-depth case studies that would focus on teachers' practices of designing and teaching SSI-based learning environments, their deeper beliefs and motivations for teaching SSI, and their students' response to these practices (Lee, 2006). This dissertation is structured as three separate, but related, studies about secondary school teachers' experiences of designing and teaching SSI-based classes and their students' understanding of science and SSI reasoning. The case studies in this dissertation seek answers for (1) teachers' practices of designing and teaching SSI-based instruction, as well as its relation to their deeper personal beliefs and motivations to teach SSI, and (2) how their students respond to their approaches of teaching SSI in terms of their science understanding and SSI reasoning. The first paper presents case studies of three secondary science teachers within three high schools located along the Minnesota River Basin. The findings of this study documented the experiences of the participant teachers, as well as the contextual influences on those experiences. The second paper presents a case study of a science teacher and a social studies teacher which describes how these two teachers collaboratively designed and taught an environmental ethics class. The results of this study documented teachers' ways of sharing responsibilities, bringing their content and pedagogical expertise, and promoting the agency of their students in the environmental ethics class. The final paper in this dissertation presents case studies of secondary school students who were the participants in the SSI-based science classes described in the first two studies. The results of this study provided evidence for participant students' understanding of science and their socioscientific reasoning, as well as how they were influenced by the instructional decisions their teachers made.

The different mechanisms of sporophytic self-incompatibility.

PubMed

Hiscock, Simon J; Tabah, David A

2003-06-29

Flowering plants have evolved a multitude of mechanisms to avoid self-fertilization and promote outbreeding. Self-incompatibility (SI) is by far the most common of these, and is found in ca. 60% of flowering plants. SI is a genetically controlled pollen-pistil recognition system that provides a barrier to fertilization by self and self-related pollen in hermaphrodite (usually co-sexual) flowering plants. Two genetically distinct forms of SI can be recognized: gametophytic SI (GSI) and sporophytic SI (SSI), distinguished by how the incompatibility phenotype of the pollen is determined. GSI appears to be the most common mode of SI and can operate through at least three different mechanisms, two of which have been characterized extensively at a molecular level in the Solanaceae and Papaveraceae. Because molecular studies of SSI have been largely confined to species from the Brassicaceae, predominantly Brassica species, it is not yet known whether SSI, like GSI, can operate through different molecular mechanisms. Molecular studies of SSI are now being carried out on Ipomoea trifida (Convolvulaceae) and Senecio squalidus (Asteraceae) and are providing important preliminary data suggesting that SSI in these two families does not share the same molecular mechanism as that of the Brassicaceae. Here, what is currently known about the molecular regulation of SSI in the Brassicaceae is briefly reviewed, and the emerging data on SSI in I. trifida, and more especially in S. squalidus, are discussed.

Designing and Implementing Web-Based Scaffolding Tools for Technology-Enhanced Socioscientific Inquiry

ERIC Educational Resources Information Center

Shin, Suhkyung; Brush, Thomas A.; Glazewski, Krista D.

2017-01-01

This study explores how web-based scaffolding tools provide instructional support while implementing a socio-scientific inquiry (SSI) unit in a science classroom. This case study focused on how students used web-based scaffolding tools during SSI activities, and how students perceived the SSI unit and the scaffolding tools embedded in the SSI…

Complete Soil-Structure Interaction (SSI) Analyses of I-walls Embedded in Level Ground During Flood Loading

DTIC Science & Technology

2012-09-01

at the ground surface el 0 ft versus water elevation...sheet pile at the ground surface . ................ 62  Figure 3.24. Total displacements for a water elevation of 16.5 ft and a gap tip elevation of -11...103  Figure 4.19. Relative horizontal displacements of the sheet pile at the ground surface

Demonstrating success in reducing adult cardiac surgical site infections and the economic impact of using multidisciplinary collaboration.

PubMed

Chiwera, Lilian; Wigglesworth, Neil; McCoskery, Carol; Lucchese, Gianluca; Newsholme, William

2018-03-28

Cardiac surgical site infections (SSIs) have devastating consequences and present several challenges for patients and healthcare providers. Adult cardiac SSI surveillance commenced in 2009 at our hospitals, Guy's & St Thomas' NHS Foundation Trust, London, as a patient safety initiative amid reported increased incidence of SSIs. Before this time, infection incidence was unclear because data collection was not standardised. Our aim was to standardise SSI data collection and establish baseline SSI rates to facilitate deployment of evidence based targeted interventions within clinical governance structures to improve quality, safety and efficiency in line with our organisational targets. We standardised local data collection protocols in line with Public Health England recommendations and identified local champions. We undertook prospective SSI surveillance collaboratively to enable us to identify potential practice concerns and address them more effectively through a series of initiatives. Clinical staff completed dedicated surveillance forms intraoperatively and post operatively. Overall adult cardiac SSI rates fell from 5.4% in 2009 to 1.2% in 2016 and Coronary Artery Bypass Graft (CABG) rates from 6.5% in 2009 to 1.7% in 2016, p<0.001. Gram negative bacteria were recognised as important SSI causative organisms and were better controlled after introducing stringent infection control measures. We successfully implemented comprehensive, evidence-based infection control practices through a multidisciplinary collaborative approach; an approach we consider to have great potential to reduce Gram negative, Staphylococcus aureus, polymicrobial and overall SSI burden and/or associated costs. We now investigate all SSIs using an established SSI detailed investigation protocol to promote continual quality improvement that aligns us perfectly with global efforts to fight antimicrobial resistance. Copyright © 2018. Published by Elsevier Ltd.

Effect of scan quality on diagnostic accuracy of spectral-domain optical coherence tomography in glaucoma.

PubMed

Rao, Harsha L; Addepalli, Uday K; Yadav, Ravi K; Senthil, Sirisha; Choudhari, Nikhil S; Garudadri, Chandra S

2014-03-01

To evaluate the effect of scan quality on the diagnostic accuracies of optic nerve head (ONH), retinal nerve fiber layer (RNFL), and ganglion cell complex (GCC) parameters of spectral-domain optical coherence tomography (SD OCT) in glaucoma. Cross-sectional study. Two hundred fifty-two eyes of 183 control subjects (mean deviation [MD]: -1.84 dB) and 207 eyes of 159 glaucoma patients (MD: -7.31 dB) underwent ONH, RNFL, and GCC scanning with SD OCT. Scan quality of SD OCT images was based on signal strength index (SSI) values. Influence of SSI on diagnostic accuracy of SD OCT was evaluated by receiver operating characteristic (ROC) regression. Diagnostic accuracies of all SD OCT parameters were better when the SSI values were higher. This effect was statistically significant (P < .05) for ONH and RNFL but not for GCC parameters. In mild glaucoma (MD of -5 dB), area under ROC curve (AUC) for rim area, average RNFL thickness, and average GCC thickness parameters improved from 0.651, 0.678, and 0.726, respectively, at an SSI value of 30 to 0.873, 0.962, and 0.886, respectively, at an SSI of 70. AUCs of the same parameters in advanced glaucoma (MD of -15 dB) improved from 0.747, 0.890, and 0.873, respectively, at an SSI value of 30 to 0.922, 0.994, and 0.959, respectively, at an SSI of 70. Diagnostic accuracies of SD OCT parameters in glaucoma were significantly influenced by the scan quality even when the SSI values were within the manufacturer-recommended limits. These results should be considered while interpreting the SD OCT scans for glaucoma. Copyright © 2014 Elsevier Inc. All rights reserved.

Sternocleidomastoid muscle flap used for repairing the dead space after supraomohyoid neck dissection

PubMed Central

Li, Jinzhong; Han, Zhengxue

2015-01-01

Surgical site infection (SSI) is a common complication followed neck dissection and dead space is a common reason of SSI. The present study is aimed to explore whether the sternocleidomastoid muscle (SCM) flap transposition to repair the dead space in level II of neck could decrease the postoperative SSI in patients with oral squamous cell carcinoma (OSCC) underwent supraomohyoid neck dissection (SOND). Ninety-six patients with cT2-3N0 OSCC who underwent extended resection of primary cancer combined SOND and reconstructed with free flap from March 2011 to October 2014 in our department were included. Forty-eight cases underwent SCM transposition to repair the potential dead space in level II of the neck, the other 48 cases did not. The two groups were matched at age, gender, concomitant diseases, and perioperative treatments. All the patients underwent exhaustive hemostasis and careful placement of negative pressure drainage. The wound healing was observed on 7 days postoperatively. The SSI rates of neck between the two groups were compared using Fisher’s exact test. The dead space in level II was observed in all the neck wounds after SOND. The neck wounds healed by primary intention in 46 cases underwent SCM flap transposition, and in 39 cases underwent routine SOND only. Two cases with SCM flap transposition and 9 cases in the group without SCM flap transposition presented SSI in neck. There was significant difference in the SSI rate between the two groups (P = 0.0248). The dead space in level II could be an important cause of SSI in neck followed SOND. Repairing of the dead space in level II using SCM flap transposition reduce the SSI rate of neck followed SOND. PMID:25785129

Sternocleidomastoid muscle flap used for repairing the dead space after supraomohyoid neck dissection.

PubMed

Li, Jinzhong; Han, Zhengxue

2015-01-01

Surgical site infection (SSI) is a common complication followed neck dissection and dead space is a common reason of SSI. The present study is aimed to explore whether the sternocleidomastoid muscle (SCM) flap transposition to repair the dead space in level II of neck could decrease the postoperative SSI in patients with oral squamous cell carcinoma (OSCC) underwent supraomohyoid neck dissection (SOND). Ninety-six patients with cT2-3N0 OSCC who underwent extended resection of primary cancer combined SOND and reconstructed with free flap from March 2011 to October 2014 in our department were included. Forty-eight cases underwent SCM transposition to repair the potential dead space in level II of the neck, the other 48 cases did not. The two groups were matched at age, gender, concomitant diseases, and perioperative treatments. All the patients underwent exhaustive hemostasis and careful placement of negative pressure drainage. The wound healing was observed on 7 days postoperatively. The SSI rates of neck between the two groups were compared using Fisher's exact test. The dead space in level II was observed in all the neck wounds after SOND. The neck wounds healed by primary intention in 46 cases underwent SCM flap transposition, and in 39 cases underwent routine SOND only. Two cases with SCM flap transposition and 9 cases in the group without SCM flap transposition presented SSI in neck. There was significant difference in the SSI rate between the two groups (P = 0.0248). The dead space in level II could be an important cause of SSI in neck followed SOND. Repairing of the dead space in level II using SCM flap transposition reduce the SSI rate of neck followed SOND.

Youth transitioning out of foster care: an evaluation of a Supplemental Security Income policy change.

PubMed

King, Laura; Rukh-Kamaa, Aneer

2013-01-01

Youths with disabilities face numerous challenges when they transition to adulthood. Those who are aging out of foster care face the additional challenge of losing their foster care benefits, although some will be eligible for Supplemental Security Income (SSI) payments after foster care ceases. However, the time needed to process SSI applications exposes those youths to a potential gap in the receipt of benefits as they move between foster care and SSI. We evaluate the effects of a 2010 Social Security Administration policy change that allows such youths to apply for SSI payments 60 days earlier than the previous policy allowed. The change provides additional time for processing claims before the applicant ages out of the foster care system. We examine administrative records on SSI applications from before and after the policy change to determine if the change has decreased the gap between benefits for the target population.

[Patient readmission for surgical site infection: integrative review].

PubMed

Machado, Lilian; Turrini, Ruth N T; Siqueira, Ana L

2013-02-01

Surgical site infections (SSI) represent an inherent risk after surgical procedures associated both to the surgical procedure and to the patient clinical conditions. To analyze in an integrative review the studies related to patient readmission due to SSI. The review was carried out by LILACS, CINHAL, MEDLINE and COCHRANE databases and articles published from 1966 to 2010 were selected. It was analyzed 13 studies classified as transversal (7), cohort (4) and longitudinal (2). Few studies analyzed only the readmissions related to the SSI. Time to define the readmission ranged from 28 to 90 days after surgery and studies related to orthopedic procedures were more frequent. The ISS readmission rates were lower than 5%. The main aetiological agents isolated from ISS were Staphylococcus aureus and coagulase-negative staphylococci. Monitoring readmissions due to SSI could contribute to dimension the occurrence of ISS post-discharge, once about half of the SSI post-discharge was diagnosed at the readmission moment.

Discover Space: an IYA program for libraries

NASA Astrophysics Data System (ADS)

Dusenbery, P.

2009-12-01

Across the country, there is a growing concern regarding the number of students entering science and technology careers. While the focus for education reform is on school improvement, there is considerable research that supports the role that out-of-school experiences can play in student achievement. This is particularly true when family interactions are factored in. Libraries provide an untapped resource for engaging underserved youth and their families in fostering an appreciation and deeper understanding of science and technology topics. The nation’s more than 17,000 public libraries attract diverse audiences in almost every community. Science exhibits in libraries could potentially reach many adults and upper elementary and middle school students with STEM content. The Space Science Institute (SSI) is partnering with the American Library Association (ALA) to develop a pilot exhibit called Discover Space. The exhibit includes two areas: Space Storms and Star Quest and is currently on tour in Colorado. It is a featured IYA outreach project from SSI. This presentation will focus on the results of a national survey of libraries that SSI and ALA conducted in 2008 about interest in STEM exhibits as well as the development process that was used to design and fabricate the exhibit. Preliminary evaluation results will also be shared. The presentation will conclude with an examination of how this program could benefit underserved communities around the country.

Using Social Media to Promote Pre-Service Science Teachers' Practices of Socio-Scientific Issue (SSI) - Based Teaching

ERIC Educational Resources Information Center

Pitiporntapin, Sasithep; Lankford, Deanna Marie

2015-01-01

This paper addresses using social media to promote pre-service science teachers' practices of Socio-Scientific Issue (SSI) based teaching in a science classroom setting. We designed our research in two phases. The first phase examined pre-service science teachers' perceptions about using social media to promote their SSI-based teaching. The…

Turkish Preservice Science Teachers' Socioscientific Issues-Based Teaching Practices in Middle School Science Classrooms

ERIC Educational Resources Information Center

Genel, Abdulkadir; Topçu, Mustafa Sami

2016-01-01

Background: Despite a growing body of research and curriculum reforms including socioscientific issues (SSI) across the world, how preservice science teachers (PST) or in-service science teachers can teach SSI in science classrooms needs further inquiry. Purpose: The purpose of this study is to describe the abilities of PSTs to teach SSI in middle…

20 CFR 416.1816 - Information we need concerning marriage when you apply for SSI.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Information we need concerning marriage when....1816 Information we need concerning marriage when you apply for SSI. When you apply for SSI benefits... are living in the same household with anyone of the opposite sex who is not related to you. If you are...

20 CFR 416.1816 - Information we need concerning marriage when you apply for SSI.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Information we need concerning marriage when....1816 Information we need concerning marriage when you apply for SSI. When you apply for SSI benefits... are living in the same household with anyone of the opposite sex who is not related to you. If you are...

20 CFR 416.1816 - Information we need concerning marriage when you apply for SSI.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Information we need concerning marriage when....1816 Information we need concerning marriage when you apply for SSI. When you apply for SSI benefits... are living in the same household with anyone of the opposite sex who is not related to you. If you are...

20 CFR 416.1816 - Information we need concerning marriage when you apply for SSI.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Information we need concerning marriage when....1816 Information we need concerning marriage when you apply for SSI. When you apply for SSI benefits... are living in the same household with anyone of the opposite sex who is not related to you. If you are...

20 CFR 416.1816 - Information we need concerning marriage when you apply for SSI.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Information we need concerning marriage when....1816 Information we need concerning marriage when you apply for SSI. When you apply for SSI benefits... are living in the same household with anyone of the opposite sex who is not related to you. If you are...

Moral Sensitivity in the Context of Socioscientific Issues in High School Science Students

ERIC Educational Resources Information Center

Fowler, Samantha R.; Zeidler, Dana L.; Sadler, Troy D.

2009-01-01

This study is a part of a larger study that examined using socioscientific issues (SSI) as a form of effective science teaching. The purpose was to investigate how teaching a year-long curriculum using SSI affects science learning outcomes. In this report, we examine the effects of a SSI-driven curriculum on the development of students' moral…

A Framework for Teachers' Assessment of Socio-Scientific Argumentation: An Example Using the GMO Issue

ERIC Educational Resources Information Center

Christenson, Nina; Chang Rundgren, Shu-Nu

2015-01-01

Socio-scientific issues (SSI) have proven to be suitable contexts for students to actively reflect on and argue about complex social issues related to science. Research has indicated that explicitly teaching SSI argumentation is a good way to help students develop their argumentation skills and make them aware of the complexity of SSI. However,…

Resistance to Dialogic Discourse in SSI Teaching: The Effects of an Argumentation-Based Workshop, Teaching Practicum, and Induction on a Preservice Science Teacher

ERIC Educational Resources Information Center

Kilinc, Ahmet; Demiral, Umit; Kartal, Tezcan

2017-01-01

Teaching socioscientific issues (SSI) necessitates dialogic discourse activities. However, a majority of science teachers prefer monologic discourse in SSI contexts. In addition, some of these teachers are resistant to change (from monologic to dialogic discourse) despite certain professional development attempts. The purpose of the present…

DoSSiER: Database of scientific simulation and experimental results

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wenzel, Hans; Yarba, Julia; Genser, Krzystof

The Geant4, GeantV and GENIE collaborations regularly perform validation and regression tests for simulation results. DoSSiER (Database of Scientific Simulation and Experimental Results) is being developed as a central repository to store the simulation results as well as the experimental data used for validation. DoSSiER can be easily accessed via a web application. In addition, a web service allows for programmatic access to the repository to extract records in json or xml exchange formats. In this paper, we describe the functionality and the current status of various components of DoSSiER as well as the technology choices we made.

DoSSiER: Database of scientific simulation and experimental results

DOE PAGES

Wenzel, Hans; Yarba, Julia; Genser, Krzystof; ...

2016-08-01

The Geant4, GeantV and GENIE collaborations regularly perform validation and regression tests for simulation results. DoSSiER (Database of Scientific Simulation and Experimental Results) is being developed as a central repository to store the simulation results as well as the experimental data used for validation. DoSSiER can be easily accessed via a web application. In addition, a web service allows for programmatic access to the repository to extract records in json or xml exchange formats. In this paper, we describe the functionality and the current status of various components of DoSSiER as well as the technology choices we made.

Risk factors and outcomes of organ-space surgical site infections after elective colon and rectal surgery.

PubMed

Gomila, Aina; Carratalà, Jordi; Camprubí, Daniel; Shaw, Evelyn; Badia, Josep Mª; Cruz, Antoni; Aguilar, Francesc; Nicolás, Carmen; Marrón, Anna; Mora, Laura; Perez, Rafel; Martin, Lydia; Vázquez, Rosa; Lopez, Ana Felisa; Limón, Enric; Gudiol, Francesc; Pujol, Miquel

2017-01-01

Organ-space surgical site infections (SSI) are the most serious and costly infections after colorectal surgery. Most previous studies of risk factors for SSI have analysed colon and rectal procedures together. The aim of the study was to determine whether colon and rectal procedures have different risk factors and outcomes for organ-space SSI. A multicentre observational prospective cohort study of adults undergoing elective colon and rectal procedures at 10 Spanish hospitals from 2011 to 2014. Patients were followed up until 30 days post-surgery. Surgical site infection was defined according to the Centers for Disease Control and Prevention criteria. Oral antibiotic prophylaxis (OAP) was considered as the administration of oral antibiotics the day before surgery combined with systemic intravenous antibiotic prophylaxis. Of 3,701 patients, 2,518 (68%) underwent colon surgery and 1,183 (32%) rectal surgery. In colon surgery, the overall SSI rate was 16.4% and the organ-space SSI rate was 7.9%, while in rectal surgery the rates were 21.6% and 11.5% respectively ( p  < 0.001). Independent risk factors for organ-space SSI in colon surgery were male sex (Odds ratio -OR-: 1.57, 95% CI: 1.14-2.15) and ostomy creation (OR: 2.65, 95% CI: 1.8-3.92) while laparoscopy (OR: 0.5, 95% CI: 0.38-0.69) and OAP combined with intravenous antibiotic prophylaxis (OR: 0.7, 95% CI: 0.51-0.97) were protective factors. In rectal surgery, independent risk factors for organ-space SSI were male sex (OR: 2.11, 95% CI: 1.34-3.31) and longer surgery (OR: 1.49, 95% CI: 1.03-2.15), whereas OAP with intravenous antibiotic prophylaxis (OR: 0.49, 95% CI: 0.32-0.73) was a protective factor. Among patients with organ-space SSI, we found a significant difference in the overall 30-day mortality, being higher in colon surgery than in rectal surgery (11.5% vs 5.1%, p  = 0.04). Organ-space SSI in colon and rectal surgery has some differences in terms of incidence, risk factors and outcomes. These differences could be considered for surveillance purposes and for the implementation of preventive strategies. Administration of OAP would be an important measure to reduce the OS-SSI rate in both colon and rectal surgeries.

Array magnetics modal analysis for the DIII-D tokamak based on localized time-series modelling

DOE PAGES

Olofsson, K. Erik J.; Hanson, Jeremy M.; Shiraki, Daisuke; ...

2014-07-14

Here, time-series analysis of magnetics data in tokamaks is typically done using block-based fast Fourier transform methods. This work presents the development and deployment of a new set of algorithms for magnetic probe array analysis. The method is based on an estimation technique known as stochastic subspace identification (SSI). Compared with the standard coherence approach or the direct singular value decomposition approach, the new technique exhibits several beneficial properties. For example, the SSI method does not require that frequencies are orthogonal with respect to the timeframe used in the analysis. Frequencies are obtained directly as parameters of localized time-series models.more » The parameters are extracted by solving small-scale eigenvalue problems. Applications include maximum-likelihood regularized eigenmode pattern estimation, detection of neoclassical tearing modes, including locked mode precursors, and automatic clustering of modes, and magnetics-pattern characterization of sawtooth pre- and postcursors, edge harmonic oscillations and fishbones.« less

Development of Standard Station Interface for Comprehensive Nuclear Test Ban Treaty Organistation Monitoring Networks

NASA Astrophysics Data System (ADS)

Dricker, I. G.; Friberg, P.; Hellman, S.

2001-12-01

Under the contract with the CTBTO, Instrumental Software Technologies Inc., (ISTI) has designed and developed a Standard Station Interface (SSI) - a set of executable programs and application programming interface libraries for acquisition, authentication, archiving and telemetry of seismic and infrasound data for stations of the CTBTO nuclear monitoring network. SSI (written in C) is fully supported under both the Solaris and Linux operating systems and will be shipped with fully documented source code. SSI consists of several interconnected modules. The Digitizer Interface Module maintains a near-real-time data flow between multiple digitizers and the SSI. The Disk Buffer Module is responsible for local data archival. The Station Key Management Module is a low-level tool for data authentication and verification of incoming signatures. The Data Transmission Module supports packetized near-real-time data transmission from the primary CTBTO stations to the designated Data Center. The AutoDRM module allows transport of seismic and infrasound signed data via electronic mail (auxiliary station mode). The Command Interface Module is used to pass the remote commands to the digitizers and other modules of SSI. A station operator has access to the state-of-health information and waveforms via an the Operator Interface Module. Modular design of SSI will allow painless extension of the software system within and outside the boundaries of CTBTO station requirements. Currently an alpha version of SSI undergoes extensive tests in the lab and onsite.

The Soy Isoflavones for Reducing Bone Loss (SIRBL) Study: Three year effects on pQCT bone mineral density and strength measures in postmenopausal women

PubMed Central

SHEDD-WISE, KRISTINE M.; ALEKEL, D. LEE; HOFMANN, HEIKE; HANSON, KATHY B.; SCHIFERL, DAN J.; HANSON, LAURA N.; VAN LOAN, MARTA D.

2011-01-01

Soy isoflavones exert inconsistent bone density-preserving effects, but the bone strength-preserving effects in humans are unknown. Our double-blind randomized controlled trial examined two soy isoflavone doses (80 or 120 mg/d) vs placebo tablets on volumetric bone mineral density (vBMD) and strength (via peripheral quantitative computed tomography) in healthy postmenopausal women (46–63 y). We measured 3 y change in cortical (Ct) BMD, cortical thickness (CtThk), periosteal circumference (PC), endosteal circumference (EC), and strength-strain index (SSI) at 1/3 midshaft femur (N=171) and trabecular (Tb) BMD, PC, and SSI at 4% distal tibia (N=162). We found no treatment effect on femur CtThk, PC, or EC, or tibia TbBMD or PC. Strongest predictors (negative) of tibia TbBMD and SSI and femur CtBMD were timepoint and bone resorption; whole body fat mass was protective of SSI. As time since last menstrual period (TLMP) increased (p=0.012), 120 mg/d was protective of CtBMD. Strongest predictors of femur SSI were timepoint, bone resorption, and TLMP (protective). Isoflavone tablets were negative predictors of SSI, but 80 mg/d became protective as bone turnover increased (p=0.011). Soy isoflavone treatment for 3 y was modestly beneficial for midshaft femur vBMD as TLMP increased, and for midshaft femur SSI as bone turnover increased. PMID:21295742

Potential Risk Factors for Surgical Site Infection after Isolated Coronary Artery Bypass Grafting in a Bahrain Cardiac Centre: A Retrospective, Case-Controlled Study

PubMed Central

Abuzaid, Ahmed Abdulaziz; Zaki, Mahmood; Al Tarief, Habib

2015-01-01

Objective: The purposes of this study were to determine the incidence of surgical site infections (SSI) and associated risk factors in patients undergoing isolated coronary artery bypass grafting (CABG) in our cardiac center during a 2-year period. Materials and Methods: Retrospective case-control analysis for 80 patients who underwent isolated cardiac surgery CABG. These patients were divided into the SSI study group (n = 40) and the noninfected control group (n = 40). Eight potential perioperative risk variables were compared between the two groups using univariate logistic regression analysis. Results: Univariate analysis was carried out for eight potential risk factors. The risk factors found to be significant were: Impaired estimated glomerular filtration rate (P = 0.011) and impaired left ventricular ejection fraction (P = 0.015). However, Factors found to have no significant influence on the incidence of SSIs were: Perioperative length of hospital stay (days), urgency of surgery, use of bilateral internal mammary artery (BIMA) grafting, prolonged cardiopulmonary bypass duration, elevated body mass index. Conclusions: Patients with comorbidities of impaired renal function and/or impaired left ventricular systolic function are at high risk of developing SSI. There appears to be a relationship between SSIs in CABG patients and impaired renal or LV function (low ejection fraction). CABG with BIMA grafting could be performed safely even in diabetics. Future studies should consider further scrutiny of these and other factors in relation to SSIs in a larger surgical population. PMID:27326347

Analysis of preoperative antibiotic prophylaxis in stented, distal hypospadias repair.

PubMed

Smith, Jacob; Patel, Ashay; Zamilpa, Ismael; Bai, Shasha; Alliston, Jeffrey; Canon, Stephen

2017-04-01

Surgical site infection [SSI] is a risk for any surgical procedure, including hypospadias repair. Prophylactic antibiotic therapy for patients having surgery is often effective in preventing SSIs, but with increasing rates of antibiotic resistance, this practice has been questioned. The objectives of this study are 1) to assess the incidence of SSIs in patients following stented, distal hypospadias repair and 2) to observe for any potential difference in the incidence of SSIs for patients with and without preoperative antibiotic utilization in this setting. We retrospectively reviewed consecutive patients treated with stented, distal hypospadias repair from 2011 to 2014 by three surgeons and compared two groups: patients who received preoperative antibiotics and patients who did not. Patients with a history of previous hypospadias repair were excluded from the study. Two hundred twenty-four subjects were identified. Group 1 (135) received preoperative antibiotic and Group 2 (89) did not receive preoperative antibiotics. There was no statistically significant difference in SSI prevalence with 0 patients in Group 1 and 1 patient in Group 2 having a SSI. Although prophylactic antibiotics prior to hypospadias repair are most often used by pediatric urologists, this study demonstrates further evidence that antibiotics prior to this procedure do not appear to lower the rate of SSI. This study is limited by its retrospective nature and disparate mean follow up in the two cohorts. Surgical site infection does not appear to be decreased by prophylactic antibiotic therapy before distal hypospadias repair.

Analysis of 178 penetrating stomach and small bowel injuries.

PubMed

Salim, Ali; Teixeira, Pedro G R; Inaba, Kenji; Brown, Carlos; Browder, Timothy; Demetriades, Demetrios

2008-03-01

Surgical site infections (SSIs), such as wound infection, fascial dehiscence, and intraabdominal abscess, commonly occur following penetrating abdominal trauma. However, most of the literature involves penetrating colon injuries. There are few reports describing complications following penetrating stomach and small bowel injuries. Based on the hypothesis that SSIs are commonly found following penetrating stomach and small bowel trauma, a prospective observational study was performed at an academic Level I trauma center from March 1, 2004 until August 31, 2006. The subjects were patients who had sustained a penetrating injury to the stomach or small bowel. Patients were followed for the development of an SSI, defined as wound infection, fascial dehiscence, or intraabdominal abscess. A total of 178 patients were admitted with penetrating stomach or small bowel injuries over the 29-month period. There were 121 (68%) gunshot injuries and 57 (32%) stab wounds. Associated intraabdominal injuries occurred in 74% of patients. Overall, SSIs occurred in 20% of cases. Risk factors for SSI included associated duodenal or colon injury, whereas time to operating room, blood loss, and type and duration of antibiotic use were not. When associated colon injuries were excluded, SSIs occurred in 16% of patients with gastric injuries and 13% of those with small bowel injuries. SSIs commonly follow penetrating stomach and small bowel trauma. Risk factors for SSI include associated duodenal or colon injury. Delay to operating room, blood loss, and type and length of antibiotic prophylaxis were not associated with an increased risk of SSI.

View of Socioscientific Issues among Educators: The Willingness of Teachers to Accept SSI into the Classroom and the Reasoning Underyling Those Beliefs

ERIC Educational Resources Information Center

Parr, John Carlos

2013-01-01

Socioscientific issues (SSI) are potentially controversial topics, which can be examined using a social and a scientific perspective. The inclusion of these topics in elementary and secondary classrooms has caused a number of conflicts over the past century. In the present study, I explore the willingness of teachers to include three SSI:…

FoSSI: the family of simplified solver interfaces for the rapid development of parallel numerical atmosphere and ocean models

NASA Astrophysics Data System (ADS)

Frickenhaus, Stephan; Hiller, Wolfgang; Best, Meike

The portable software FoSSI is introduced that—in combination with additional free solver software packages—allows for an efficient and scalable parallel solution of large sparse linear equations systems arising in finite element model codes. FoSSI is intended to support rapid model code development, completely hiding the complexity of the underlying solver packages. In particular, the model developer need not be an expert in parallelization and is yet free to switch between different solver packages by simple modifications of the interface call. FoSSI offers an efficient and easy, yet flexible interface to several parallel solvers, most of them available on the web, such as PETSC, AZTEC, MUMPS, PILUT and HYPRE. FoSSI makes use of the concept of handles for vectors, matrices, preconditioners and solvers, that is frequently used in solver libraries. Hence, FoSSI allows for a flexible treatment of several linear equations systems and associated preconditioners at the same time, even in parallel on separate MPI-communicators. The second special feature in FoSSI is the task specifier, being a combination of keywords, each configuring a certain phase in the solver setup. This enables the user to control a solver over one unique subroutine. Furthermore, FoSSI has rather similar features for all solvers, making a fast solver intercomparison or exchange an easy task. FoSSI is a community software, proven in an adaptive 2D-atmosphere model and a 3D-primitive equation ocean model, both formulated in finite elements. The present paper discusses perspectives of an OpenMP-implementation of parallel iterative solvers based on domain decomposition methods. This approach to OpenMP solvers is rather attractive, as the code for domain-local operations of factorization, preconditioning and matrix-vector product can be readily taken from a sequential implementation that is also suitable to be used in an MPI-variant. Code development in this direction is in an advanced state under the name ScOPES: the Scalable Open Parallel sparse linear Equations Solver.

Lessons Learned from Unfavorable Microsurgical Head and Neck Reconstruction: Japan National Cancer Center Hospital and Okayama University Hospital.

PubMed

Kimata, Yoshihiro; Matsumoto, Hiroshi; Sugiyama, Narusi; Onoda, Satoshi; Sakuraba, Minoru

2016-10-01

The risk of surgical site infection (SSI) remains high after major reconstructive surgery of the head and neck. Clinical data regarding SSI in microsurgical tongue reconstruction are described at National Cancer Hospital in Japan, including discussions of unfavorable representative cases, the relationship between SSI and preoperative irradiation at Okayama University Hospital in Japan, and strategies for SSI control in head and neck reconstruction. Local complications are inevitable in patients undergoing reconstruction in the head and neck areas. The frequency of major complications can be decreased, and late postoperative complications can be prevented with the help of appropriate methods. Copyright © 2016 Elsevier Inc. All rights reserved.

Compliance With a Comprehensive Antibiotic Protocol Improves Infection Incidence in Pediatric Spine Surgery.

PubMed

Vandenberg, Curt; Niswander, Cameron; Carry, Patrick; Bloch, Nikki; Pan, Zhaoxing; Erickson, Mark; Garg, Sumeet

A multidisciplinary task force, designated Target Zero, has developed protocols for prevention of surgical site infection (SSI) for spine surgery at our institution. The purpose of this study was to evaluate how compliance with an antibiotic bundle impacts infection incidences in pediatric spine surgery. After institutional review board approval, a consecutive series of 511 patients (517 procedures) who underwent primary spine procedures from 2008 to 2012 were retrospectively reviewed to identify patients who developed SSI. Patients were followed for a minimum of 90 days postoperatively. Compliance data were collected prospectively in 511 consecutive patients and a total of 517 procedures. Three criteria were required for antibiotic bundle compliance: appropriate antibiotics completely administered within 1 hour before incision, antibiotics appropriately redosed intraoperatively for blood loss and time, and antibiotics discontinued within 24 hours postoperatively. A multivariable logistic regression analysis was used to test the association between compliance and the development of an infection. Overall antibiotic bundle compliance rate was 85%. After adjusting for risk category, estimated blood loss, and study year, the likelihood of an infection was increased in the noncompliant group compared with the compliant group (adjusted odds ratio: 3.0, 95% CI, 0.96-9.47, P=0.0587). When expressed as the number needed to treat, strict adherence to antibiotic bundle compliance prevented 1 SSI within 90 days of surgery for every 26 patients treated with the antibiotic bundle. Reasons for noncompliance included failure to infuse preoperative antibiotics 1 hour before incision (10.3%), failure to redose antibiotics intraoperatively based on time or blood loss (5.5%), and failure to discontinue antibiotics within 24 hours postoperatively (1.9%). Compliance with a comprehensive antibiotic protocol can lead to meaningful reductions in SSI incidences in pediatric spine surgery. Institutions should focus on improving compliance with prophylactic antibiotic protocols to decrease SSI in pediatric spine surgery. Level III-retrospective cohort study.

Evidence-based care bundles for preventing surgical site infections in spinal instrumentation surgery.

PubMed

Yamada, Koji; Abe, Hiroaki; Higashikawa, Akiro; Tonosu, Juichi; Kuniya, Takashi; Nakajima, Koji; Fujii, Haruko; Niwa, Kazuki; Shinozaki, Tomohiro; Watanabe, Kenichi; Sakae, Tanaka; Okazaki, Hiroshi

2018-05-22

Retrospective study, using prospectively collected data. To evaluate the impact of evidence-based care bundles for preventing surgical site infections (SSI) in spinal instrumentation surgery. About half of all SSIs are preventable via evidence-based methods. For successful SSI prevention, the bacterial load must be minimized, and methicillin-resistant Staphylococcus aureus (MRSA) protection must be maximized. However, it is difficult to cover all of these requirements by single preventative method. We screened consecutive patients scheduled for spinal instrumentation surgeries at a single tertiary referral hospital for high surgical, SSI, and MRSA colonization risks. Evidence-based care bundles were implemented for high risk patients and included: 1) additional vancomycin prophylaxis, 2) diluted povidone-iodine irrigation, and 3) nasal and body decontamination. Patient demographics, comorbidities, operative features, and SSIs reported to the Japanese Nosocomial Infections Surveillance system were prospectively obtained in the same method by the same assessor and were used for the analyses. The results were compared before and after the application of the bundle. There were 1,042 spinal instrumentation surgeries (741 before and 301 after care bundles) performed from November 2010 to December 2015. Of 301 surgeries, 57 cases (18.9%) received care bundles. There were no significant differences in patient backgrounds before and after the intervention. The SSI rate decreased significantly from 3.8% to 0.7% (P < 0.01) after the intervention, with an overall 82% relative risk reduction. A significant protective effect was observed in the multivariate analysis (adjusted odds ratio 0.18, 95% confidence interval: 0.04-0.77, P = 0.02). There were no MRSA-related SSIs among those that received care bundles, even though MRSA was the predominant pathogen in the study population. Evidence-based care bundles, applied in selected high-risk spinal instrumentation cases, minimized bacterial load, maximized MRSA protection, and significantly reduced SSI rates without topical vancomycin powder. 4.

Efficacy and safety profile of antibiotic prophylaxis usage in clean and clean-contaminated plastic and reconstructive surgery: a meta-analysis of randomized controlled trials.

PubMed

Zhang, Yi; Dong, Jiasheng; Qiao, Yufei; He, Jinguang; Wang, Tao; Ma, Sunxiang

2014-01-01

There is no consensus with regard to antibiotic prophylaxis usage in clean and clean-contaminated plastic and reconstructive surgery. This meta-analysis sought to assess the efficacy and safety of antibiotic prophylaxis and to determine appropriate duration of prophylaxis. An English language literature search was conducted using PubMed and the Cochrane Collaboration for randomized controlled trials (RCTs) that evaluate the use of antibiotic prophylaxis to prevent postoperative surgical site infection (SSI) in patients undergoing clean and clean-contaminated plastic and reconstructive surgery. Data from intention-to-treat analyses were used where available. For the dichotomous data, results for each study were odds ratio (OR) with 95% confidence interval (CI) and combined for meta-analysis using the Mantel-Haenszel method or the DerSimonian and Laird method. Study quality was critically appraised by 2 reviewers using established criteria. STATA version 12 was used for meta-analyses. Twelve RCTs involving 2395 patients were included, of which 8 trials were considered to be of high methodological quality. Effect of antibiotic prophylaxis in plastic and reconstructive surgery was found favorable over placebo in SSI prevention (13 studies; 2449 participants; OR, 0.53; 95% CI, 0.4-0.7; P < 0.01) and the other wound complication (OWC) prevention (9 studies; 1843 participants; OR, 0.36; 95% CI, 0.15-0.84; P < 0.02). Subgroup analysis performed according to surgical wound type or the duration of prophylaxis did not modify the results except for the OWC with short-term antibiotic treatment. Compared with short-term antibiotic prophylaxis, long-term administration showed no evidence of a difference in risk of SSI (7 studies; 1012 participants; OR, 0.99; 95% CI, 0.63-1.55; P < 0.95), OWC (5 studies; 824 participants; OR, 0.92; 95% CI, 0.46-1.86; P < 0.82), and adverse event relative to antibiotic administration (3 studies; 653 participants; OR, 0.23; 95% CI, 0.01-4.92; P < 0.35). This meta-analysis of RCTs provides evidence supporting that antibiotic prophylaxis reduced postoperative SSI in clean plastic surgeries with high-risk factors and clean-contaminated plastic surgeries. Besides, a short-course administration regimen seemed to be of adequate efficacy and safety. High-quality prospective trials on larger scale are needed to further confirm these findings.

Modelling Solar and Stellar Brightness Variabilities

NASA Astrophysics Data System (ADS)

Yeo, K. L.; Shapiro, A. I.; Krivova, N. A.; Solanki, S. K.

2016-04-01

Total and spectral solar irradiance, TSI and SSI, have been measured from space since 1978. This is accompanied by the development of models aimed at replicating the observed variability by relating it to solar surface magnetism. Despite significant progress, there remains persisting controversy over the secular change and the wavelength-dependence of the variation with impact on our understanding of the Sun's influence on the Earth's climate. We highlight the recent progress in TSI and SSI modelling with SATIRE. Brightness variations have also been observed for Sun-like stars. Their analysis can profit from knowledge of the solar case and provide additional constraints for solar modelling. We discuss the recent effort to extend SATIRE to Sun-like stars.

Fractography used with lifetime prediction tests on commercial grades of alumina and silicon carbide

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kuebler, J.; Woodtli, J.; Berroth, K.

1996-12-31

Fractographic investigations were conducted on alumina and {alpha}-SSiC bend bars from a round robin test comparing a static and a dynamic lifetime test method. The investigations revealed that not all fracture origins found on {alpha}-SSiC specimens had contact with the ambient medium and therefore the dynamic lifetime tests did not measure the materials` behaviour under stress in water. In addition to the conventional SEM fractography an alternate technique, using an auto focus scanning laser profilometer was applied for characterizing the fractures. This tool is very promising for fractography because of the ability to handle topographic data by imaging procedures andmore » fractal analysis.« less

PrimeSupplier Cross-Program Impact Analysis and Supplier Stability Indicator Simulation Model

NASA Technical Reports Server (NTRS)

Calluzzi, Michael

2009-01-01

PrimeSupplier, a supplier cross-program and element-impact simulation model, with supplier solvency indicator (SSI), has been developed so that the shuttle program can see early indicators of supplier and product line stability, while identifying the various elements and/or programs that have a particular supplier or product designed into the system. The model calculates two categories of benchmarks to determine the SSI, with one category focusing on agency programmatic data and the other focusing on a supplier's financial liquidity. PrimeSupplier was developed to help NASA smoothly transition design, manufacturing, and repair operations from the Shuttle program to the Constellation program, without disruption in the industrial supply base.

Overview of the production of sintered SiC optics and optical sub-assemblies

NASA Astrophysics Data System (ADS)

Williams, S.; Deny, P.

2005-08-01

The following is an overview on sintered silicon carbide (SSiC) material properties and processing requirements for the manufacturing of components for advanced technology optical systems. The overview will compare SSiC material properties to typical materials used for optics and optical structures. In addition, it will review manufacturing processes required to produce optical components in detail by process step. The process overview will illustrate current manufacturing process and concepts to expand the process size capability. The overview will include information on the substantial capital equipment employed in the manufacturing of SSIC. This paper will also review common in-process inspection methodology and design rules. The design rules are used to improve production yield, minimize cost, and maximize the inherent benefits of SSiC for optical systems. Optimizing optical system designs for a SSiC manufacturing process will allow systems designers to utilize SSiC as a low risk, cost competitive, and fast cycle time technology for next generation optical systems.

Validation of COLA score for predicting wound infection in patients undergoing surgery for rectal cancer.

PubMed

Saylam, Baris; Tez, Mesut; Comcali, Bulent; Vural, Veli; Duzgun, Arife Polat; Ozer, Mehmet Vasfi; Coskun, Faruk

2017-01-01

The purpose of our study was to estimate the incidence of SSI (Surgical site infection) and the effect of COLA (contamination, obesity, laparotomy and ASA grade) score on SSI in patients undergoing rectal surgical procedures for rectal cancer. A total of 92 patients who underwent operation for rectum cancer were enrolled in this study. Wound surveillance was performed in all patients by a staff surgeon identified infected wounds during the hospital stay, and collected information for up to 30 days after operation. The overall rate of incisional SSI and organ/space SSI was 22.8% and 7.6% respectively. Surgical site infection rates were 14.2%, 20.58%, 40.7%, 57.1% for COLA 1,2,3 and 4 scores respectively. The area under the receiver/ operator characteristic curve for the score was 0,660. COLA scoring systems predict, with reasonable accuracy, the risk of SSI in rectal cancer patients undergoing elective rectal surgery. COLA score Rectal surgery, Surgical site infection, Risk prediction, Wound infection.

PTSD and key somatic complaints and cultural syndromes among rural Cambodians: the results of a needs assessment survey.

PubMed

Hinton, Devon E; Hinton, Alexander L; Eng, Kok-Thay; Choung, Sophearith

2012-09-01

This article describes a culturally sensitive assessment tool for traumatized Cambodians, the Cambodian "Somatic Symptom and Syndrome Inventory" (SSI), and reports the outcome of a needs assessment conducted in rural Cambodia using the instrument. Villagers locally identified (N = 139) as still suffering the effects of the Pol Pot genocide were evaluated. All 139 had post-traumatic stress disorder (PTSD) as assessed by the PTSD Checklist (PCL), and they had elevated SSI scores. The severity of the SSI items varied by level of PTSD severity, and several items--for example, dizziness, dizziness on standing, khyâl (a windlike substance) attacks, and "thinking a lot"--were extremely elevated in those participants with higher levels of PTSD. The SSI was more highly correlated to self-perceived health (Short Form Health Survey-3) and past trauma events (Harvard Trauma Questionnaire) than was the PCL. The study shows the SSI items to be a core aspect of the Cambodian trauma ontology.

Use of surveillance data to identify target populations for Staphylococcus aureus vaccines and prevent surgical site infections: A pilot study

PubMed Central

Gustin, Marie-Paule; Giard, Marine; Bénet, Thomas; Vanhems, Philippe

2015-01-01

The development of anti-staphylococcal vaccines is nowadays a priority to prevent surgical site infections (SSI). The objective of the present study was to identify a potential target population by assessing surveillance data on surgery patients for possible anti-staphylococcal vaccine administration. Individuals at high risk of SSI by Staphylococcus aureus (SA) were targeted by the French SSI Surveillance Network in south-eastern France between 2008 and 2011. Among 238,470 patients, those undergoing primary total hip replacement appeared to be an interesting and healthy enough population for anti-staphylococcal vaccine testing. These male patients, subjected to multiple procedures and with American Society of Anesthesiologists score >2, had a probability of SA SSI about 21 times higher than females with no severe systemic disease and no multiple procedures. Our study indicates that surveillance data on SSI might be an interesting epidemiological source for planning vaccine trials to prevent nosocomial infections. PMID:25668663

Quantifying the Extremity of Windstorms for Regions Featuring Infrequent Events

NASA Astrophysics Data System (ADS)

Walz, M. A.; Leckebusch, G. C.; Kruschke, T.; Rust, H.; Ulbrich, U.

2017-12-01

This paper introduces the Distribution-Independent Storm Severity Index (DI-SSI). The DI-SSI represents an approach to quantify the severity of exceptional surface wind speeds of large scale windstorms that is complementary to the Storm Severity Index (SSI) introduced by Leckebusch et al. (2008). While the SSI approaches the extremeness of a storm from a meteorological and potential loss (impact) perspective, the DI-SSI defines the severity in a more climatological perspective. The idea is to assign equal index values to wind speeds of the same singularity (e.g. the 99th percentile) under consideration of the shape of the tail of the local wind speed climatology. Especially in regions at the edge of the classical storm track the DI-SSI shows more equitable severity estimates, e.g. for the extra-tropical cyclone Klaus. Here were compare the integral severity indices for several prominent windstorm in the European domain and discuss the advantages and disadvantages of the respective index. In order to compare the indices, their relation with the North Atlantic Oscillation (NAO) is studied, which is one of the main large scale drivers for the intensity of European windstorms. Additionally we can identify a significant relationship between the frequency and intensity of windstorms for large parts of the European domain.

Efficacy of Negative Pressure Wound Treatment in Preventing Surgical Site Infections after Whipple Procedures.

PubMed

Gupta, Ryan; Darby, Geoffrey C; Imagawa, David K

2017-10-01

Surgical site infections (SSIs) occur at an average rate of 21.1 per cent after Whipple procedures per NSQIP data. In the setting of adherence to standard National Surgery Quality Improvement Program (NSQIP) Hepatopancreatobiliary recommendations including wound protector use and glove change before closing, this study seeks to evaluate the efficacy of using negative pressure wound treatment (NPWT) over closed incision sites after a Whipple procedure to prevent SSI formation. We retrospectively examined consecutive patients from January 2014 to July 2016 who met criteria of completing Whipple procedures with full primary incision closure performed by a single surgeon at a single institution. Sixty-one patients were included in the study between two cohorts: traditional dressing (TD) (n = 36) and NPWT dressing (n = 25). There was a statistically significant difference (P = 0.01) in SSI formation between the TD cohort (n = 15, SSI rate = 0.41) and the NPWT cohort (n = 3, SSI rate = 0.12). The adjusted odds ratio (OR) of SSI formation was significant for NPWT use [OR = 0.15, P = 0.036] and for hospital length of stay [OR = 1.21, P = 0.024]. Operative length, operative blood loss, units of perioperative blood transfusion, intraoperative gastrojejunal tube placement, preoperative stent placement, and postoperative antibiotic duration did not significantly impact SSI formation (P > 0.05).

Intrajudge and Interjudge Reliability of the Stuttering Severity Instrument-Fourth Edition.

PubMed

Davidow, Jason H; Scott, Kathleen A

2017-11-08

The Stuttering Severity Instrument (SSI) is a tool used to measure the severity of stuttering. Previous versions of the instrument have known limitations (e.g., Lewis, 1995). The present study examined the intra- and interjudge reliability of the newest version, the Stuttering Severity Instrument-Fourth Edition (SSI-4) (Riley, 2009). Twelve judges who were trained on the SSI-4 protocol participated. Judges collected SSI-4 data while viewing 4 videos of adults who stutter at Time 1 and 4 weeks later at Time 2. Data were analyzed for intra- and interjudge reliability of the SSI-4 subscores (for Frequency, Duration, and Physical Concomitants), total score, and final severity rating. Intra- and interjudge reliability across the subscores and total score concurred with the manual's reported reliability when reliability was calculated using the methods described in the manual. New calculations of judge agreement produced different values from those in the manual-for the 3 subscores, total score, and final severity rating-and provided data absent from the manual. Clinicians and researchers who use the SSI-4 should carefully consider the limitations of the instrument. Investigation into the multitasking demands of the instrument may provide information on whether separating the collection of data for specific variables will improve intra- and interjudge reliability of those variables.

Leading causes of certifiable visual loss in England and Wales during the year ending 31 March 2013.

PubMed

Quartilho, A; Simkiss, P; Zekite, A; Xing, W; Wormald, R; Bunce, C

2016-04-01

The last article on causes of sight impairment (SI) in England and Wales was for April 2007-March 2008. This report updates these figures for April 2012-March 2013. In England and Wales, registration for SI is initiated by completion of a certificate of vision impairment (CVI). The main cause of visual impairment was ascertained for certificates completed April 2012-March 2013. A proportional comparison against April 2007-March 2008 was made. We received 24 009 CVIs of which 10 410 were for severe sight impairment (SSI) and 13 129 were for SI. These numbers were slightly higher than those observed in April 2007-March 2008 (9823 SSI; 12 607 SI). The ratio SI:SSI has remained static with 55% of all certifications being SI. The proportion of certificates without a single main cause has fallen slightly (16.6 to 14%). The proportion of certificates with a main cause of degeneration of the macula and posterior pole (mostly age-related macular degeneration (AMD)) decreased from 58.6 to 50% SSI and from 57.2 to 52.5% SI. Glaucoma remains the second most common cause (11% SSI; 7.6% SI) but hereditary retinal disorders overtook diabetes as third leading cause of SSI. AMD is still by far the leading cause of certifications for sight impairment in England and Wales (both SI and SSI). Proportionate changes have been observed since 2008, but it is important to note that a proportionate increase in one condition will impact on others.

Analyzing the risk factors influencing surgical site infections: the site of environmental factors.

PubMed

Alfonso-Sanchez, Jose L; Martinez, Isabel M; Martín-Moreno, Jose M; González, Ricardo S; Botía, Francisco

2017-06-01

Addressing surgical site infection (SSI) is accomplished, in part, through studies that attempt to clarify the nature of many essential factors in the control of SSI. We sought to examine the link between multiple risk factors, including environmental factors, and SSI for prevention management. We conducted a longitudinal prospective study to identify SSIs in all patients who underwent interventions in 2014 in 8 selected hospitals on the Mediterranean coast of Spain. Risk factors related to the operating theatre included level of fungi and bacterial contamination, temperature and humidity, air renewal and differential air pressure. Patient-related variables included age, sex, comorbidity, nutrition level and transfusion. Other factors were antibiotic prophylaxis, electric versus manual shaving, American Society of Anaesthesiologists physical status classification, type of intervention, duration of the intervention and preoperative stay. Superficial SSI was most often associated with environmental factors, such as environmental contamination by fungi (from 2 colony-forming units) and bacteria as well as surface contamination. When there was no contamination in the operating room, no SSI was detected. Factors that determined deep and organ/space SSI were more often associated with patient characteristics (age, sex, transfusion, nasogastric feeding and nutrition, as measured by the level of albumin in the blood), type of intervention and preoperative stay. Antibiotic prophylaxis and shaving with electric razor were protective factors for both types of infection, whereas the duration of the intervention and the classification of the intervention as "dirty" were shared risk factors. Our results suggest the importance of environmental and surface contamination control to prevent SSI.

Evaluating impacts of different longitudinal driver assistance systems on reducing multi-vehicle rear-end crashes during small-scale inclement weather.

PubMed

Li, Ye; Xing, Lu; Wang, Wei; Wang, Hao; Dong, Changyin; Liu, Shanwen

2017-10-01

Multi-vehicle rear-end (MVRE) crashes during small-scale inclement (SSI) weather cause high fatality rates on freeways, which cannot be solved by traditional speed limit strategies. This study aimed to reduce MVRE crash risks during SSI weather using different longitudinal driver assistance systems (LDAS). The impact factors on MVRE crashes during SSI weather were firstly analyzed. Then, four LDAS, including Forward collision warning (FCW), Autonomous emergency braking (AEB), Adaptive cruise control (ACC) and Cooperative ACC (CACC), were modeled based on a unified platform, the Intelligent Driver Model (IDM). Simulation experiments were designed and a large number of simulations were then conducted to evaluate safety effects of different LDAS. Results indicate that the FCW and ACC system have poor performance on reducing MVRE crashes during SSI weather. The slight improvement of sight distance of FCW and the limitation of perception-reaction time of ACC lead the failure of avoiding MVRE crashes in most scenarios. The AEB system has the better effect due to automatic perception and reaction, as well as performing the full brake when encountering SSI weather. The CACC system has the best performance because wireless communication provides a larger sight distance and a shorter time delay at the sub-second level. Sensitivity analyses also indicated that the larger number of vehicles and speed changes after encountering SSI weather have negative impacts on safety performances. Results of this study provide useful information for accident prevention during SSI weather. Copyright © 2017 Elsevier Ltd. All rights reserved.

The soy isoflavones for reducing bone loss study: 3-yr effects on pQCT bone mineral density and strength measures in postmenopausal women.

PubMed

Shedd-Wise, Kristine M; Alekel, D Lee; Hofmann, Heike; Hanson, Kathy B; Schiferl, Dan J; Hanson, Laura N; Van Loan, Marta D

2011-01-01

Soy isoflavones exert inconsistent bone density-preserving effects, but the bone strength-preserving effects in humans are unknown. Our double-blind randomized controlled trial examined 2 soy isoflavone doses (80 or 120mg/d) vs placebo tablets on volumetric bone mineral density (vBMD) and strength (by means of peripheral quantitative computed tomography) in healthy postmenopausal women (46-63yr). We measured 3-yr changes in cortical BMD (CtBMD), cortical thickness (CtThk), periosteal circumference (PC), endosteal circumference (EC), and strength-strain index (SSI) at 1/3 midshaft femur (N=171), and trabecular BMD (TbBMD), PC, and SSI at 4% distal tibia (N=162). We found no treatment effect on femur CtThk, PC, or EC, or tibia TbBMD or PC. The strongest predictors (negative) of tibia TbBMD and SSI and femur CtBMD were timepoint and bone resorption; whole-body fat mass was protective of SSI. As time since last menstrual period (TLMP) increased (p=0.012), 120-mg/d dose was protective of CtBMD. The strongest predictors of femur SSI were timepoint, bone resorption, and TLMP (protective). Isoflavone tablets were negative predictors of SSI, but 80-mg/d dose became protective as bone turnover increased (p=0.011). Soy isoflavone treatment for 3yr was modestly beneficial for midshaft femur vBMD as TLMP increased and for midshaft femur SSI as bone turnover increased. Copyright © 2011 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

Impact of case-relevant and case-irrelevant communication within the surgical team on surgical-site infection.

PubMed

Tschan, F; Seelandt, J C; Keller, S; Semmer, N K; Kurmann, A; Candinas, D; Beldi, G

2015-12-01

Surgical-site infections (SSIs) are the most common complications after surgery. An influence from talking and distractions during surgery on patient outcomes has been suggested, but there is limited evidence. The aim of this prospective observational study was to assess the relationship between intraoperative communication within the surgical team and SSI, and between intraoperative distractions and SSI. This prospective observational study included patients undergoing elective, open abdominal procedures. For each procedure, intraoperative case-relevant and case-irrelevant communication, and intraoperative distractions were observed continuously on site. The influence of communication and distractions on SSI after surgery was assessed using logistic regressions, adjusting for risk factors. A total of 167 observed procedures were analysed; their mean(s.d.) duration was 4·6(2·1) h. A total of 24 SSIs (14·4 per cent) were diagnosed. Case-relevant communication during the procedure was independently associated with a reduced incidence of organ/space SSI (propensity score-adjusted odds ratio 0·86, 95 per cent c.i. 0·77 to 0·97; P = 0·014). Case-irrelevant communication during the closing phase of the procedure was independently associated with increased incidence of incisional SSI (propensity score-adjusted odds ratio 1·29, 1·08 to 1·55; P = 0·006). Distractions had no association with SSI. More case-relevant communication was associated with fewer organ/space SSIs, and more case-irrelevant communication during wound closure was associated with incisional SSI. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

Effect of a single prophylactic preoperative oral antibiotic dose on surgical site infection following complex dermatological procedures on the nose and ear: a prospective, randomised, controlled, double-blinded trial.

PubMed

Rosengren, Helena; Heal, Clare F; Buttner, Petra G

2018-04-19

There is limited published research studying the effect of antibiotic prophylaxis on surgical site infection (SSI) in dermatological surgery, and there is no consensus for its use in higher-risk cases. The objective of this study was to determine the effectiveness of a single oral preoperative 2 g dose of cephalexin in preventing SSI following flap and graft dermatological closures on the nose and ear. Prospective double-blinded, randomised, placebo-controlled trial testing for difference in infection rates. Primary care skin cancer clinics in North Queensland, Australia, were randomised to 2 g oral cephalexin or placebo 40-60 min prior to skin incision. 154 consecutive eligible patients booked for flap or graft closure following skin cancer excision on the ear and nose. 2 g dose of cephalexin administered 40-60 min prior to surgery. Overall 8/69 (11.6%) controls and 1/73 (1.4%) in the intervention group developed SSI (p=0.015; absolute SSI reduction 10.2%; number needed to treat (NNT) for benefit 9.8, 95% CI 5.5 to 45.5). In males, 7/44 controls and 0/33 in the intervention group developed SSI (p=0.018; absolute SSI reduction 15.9%; NNT for benefit 6.3, 95% CI 3.8 to 19.2). SSI was much lower in female controls (1/25) and antibiotic prophylaxis did not further reduce this (p=1.0). There was no difference between the study groups in adverse symptoms attributable to high-dose antibiotic administration (p=0.871). A single oral 2 g dose of cephalexin given before complex skin closure on the nose and ear reduced SSI. ANZCTR 365115; Post-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Choice of intravenous antibiotic prophylaxis for colorectal surgery does matter.

PubMed

Deierhoi, Rhiannon J; Dawes, Lillian G; Vick, Catherine; Itani, Kamal M F; Hawn, Mary T

2013-11-01

The Surgical Care Improvement Program endorses mandatory compliance with approved intravenous prophylactic antibiotics; however, oral antibiotics are optional. We hypothesized that surgical site infection (SSI) rates may vary depending on the choice of antibiotic prophylaxis. A retrospective cohort study of elective colorectal procedures using Veterans Affairs Surgical Quality Improvement Program (VASQIP) and SSI outcomes data was linked to the Office of Informatics and Analytics (OIA) and Pharmacy Benefits Management (PBM) antibiotic data from 2005 to 2009. Surgical site infection rates by type of IV antibiotic agent alone (IV) or in combination with oral antibiotic (IV + OA) were determined. Generalized estimating equations were used to examine the association between type of antibiotic prophylaxis and SSI for the entire cohort and stratified by use of oral antibiotics. After 5,750 elective colorectal procedures, 709 SSIs (12.3%) developed within 30 days. Oral antibiotic + IV (n = 2,426) had a lower SSI rate than IV alone (n = 3,324) (6.3% vs 16.7%, p < 0.0001). There was a significant difference in the SSI rate based on type of preoperative IV antibiotic given (p ≤ 0.0001). Generalized estimating equations adjusting for significant covariates of age, body mass index, procedure work relative value units, and operation duration demonstrated an independent protective effect of oral antibiotics (odds ratio [OR] 0.37, 95% CI 0.29 to 0.46), as well as increased rates of SSI associated with ampicillin/sulbactam (OR 2.21, 95% CI 1.37 to 3.56) and second generation cephalosporins (cefoxitin, OR 2.50, 95% CI 1.83 to 3.42; cefotetan, OR 2.70, 95% CI 1.72 to 4.22) when compared with first generation cephalosporin/metronidazole. The choice of IV antibiotic was related to the SSI rate; however, oral antibiotics were associated with reduced SSI rate for every antibiotic class. Published by Elsevier Inc.

Operating Room Traffic as a Modifiable Risk Factor for Surgical Site Infection.

PubMed

Wanta, Brendan T; Glasgow, Amy E; Habermann, Elizabeth B; Kor, Daryl J; Cima, Robert R; Berbari, Elie F; Curry, Timothy B; Brown, Michael J; Hyder, Joseph A

2016-12-01

Surgical site infections (SSI) contribute to surgical patients' morbidity and costs. Operating room traffic may be a modifiable risk factor for SSI. We investigated the impact of additional operating room personnel on the risk of superficial SSI (sSSI). In this matched case-control study, cases included patients in whom sSSI developed in clean surgical incisions after elective, daytime operations. Control subjects were matched by age, gender, and procedure. Operating room personnel were classified as (1) surgical scrubbed, (2) surgical non-scrubbed, or (3) anesthesia. We used conditional logistic regression to test the extent to which additional personnel overall and from each work group were associated with infection. In total, 474 patients and 803 control subjects were identified. Each additional person among total personnel and personnel from each work group was significantly associated with greater odds of infection (all personnel, odds ratio [OR] = 1.082, 95% confidence interval [CI] 1.031-1.134, p = 0.0013; surgical scrubbed OR = 1.132, 95% CI 1.029-1.245, p = 0.0105; surgical non-scrubbed OR = 1.123, 95% CI 1.008-1.251, p = 0.0357; anesthesia OR = 1.153, 95% CI 1.031-1.290, p = 0.0127). After adjusting for operative duration, body mass index, diabetes mellitus, and vascular disease, additional personnel and sSSI were no longer associated overall or for any work groups (total personnel OR = 1.033, 95% CI 0.974-1.095, p = 0.2746; surgical scrubbed OR = 1.060, 95% CI 0.952-1.179, p = 0.2893; surgical non-scrubbed OR = 1.023 95% CI 0.907-1.154, p = 0.7129; anesthesia OR = 1.051, 95% CI 0.926-1.193, p = 0.4442). The presence of additional operating room personnel was not independently associated with increased odds of sSSI. Efforts dedicated to sSSI reduction should focus on other modifiable risk factors.

State Share of Instruction Funding to Ohio Public Community Colleges: A Policy Analysis

ERIC Educational Resources Information Center

Johnson, Betsy

2012-01-01

This study investigated various state policies to determine their impact on the state share of instruction (SSI) funding to community colleges in the state of Ohio. To complete the policy analysis, the researcher utilized three policy analysis tools, defined by Gill and Saunders (2010) as iterative processes, intuition and judgment, and advice and…

Meta-analysis of randomized and quasi-randomized clinical trials of topical antibiotics after primary closure for the prevention of surgical-site infection.

PubMed

Heal, C F; Banks, J L; Lepper, P; Kontopantelis, E; van Driel, M L

2017-08-01

Surgical-site infections (SSIs) increase patient morbidity and costs. The aim was to identify and synthesize all RCTs evaluating the effect of topical antibiotics on SSI in wounds healing by primary intention. The search included Ovid MEDLINE, Ovid Embase, the Cochrane Wounds Specialized Register, Central Register of Controlled Trials and EBSCO CINAHL from inception to May 2016. There was no restriction of language, date or setting. Two authors independently selected studies, extracted data and assessed risk of bias. When sufficient numbers of comparable trials were available, data were pooled in meta-analysis. Fourteen RCTs with 6466 participants met the inclusion criteria. Pooling of eight trials (5427 participants) showed that topical antibiotics probably reduced the risk of SSI compared with no topical antibiotic (risk ratio (RR) 0·61, 95 per cent c.i. 0·42 to 0·87; moderate-quality evidence), equating to 20 fewer SSIs per 1000 patients treated. Pooling of three trials (3012 participants) for risk of allergic contact dermatitis found no clear difference between antibiotics and no antibiotic (RR 3·94, 0·46 to 34·00; very low-quality evidence). Pooling of five trials (1299 participants) indicated that topical antibiotics probably reduce the risk of SSI compared with topical antiseptics (RR 0·49, 0·30 to 0·80; moderate-quality evidence); 43 fewer SSIs per 1000 patients treated. Pooling of two trials (541 participants) showed no clear difference in the risk of allergic contact dermatitis with antibiotics or antiseptic agents (RR 0·97, 0·52 to 1·82; very low-quality evidence). Topical antibiotics probably prevent SSI compared with no topical antibiotic or antiseptic. No conclusion can be drawn regarding whether they cause allergic contact dermatitis. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

The population genetics of sporophytic self-incompatibility in Senecio squalidus L. (Asteraceae): avoidance of mating constraints imposed by low S-allele number.

PubMed

Brennan, Adrian C; Harris, Stephen A; Hiscock, Simon J

2003-06-29

Senecio squalidus L. (Asteraceae) has been the subject of several ecological and population genetic studies due to its well-documented history of introduction, establishment and spread throughout Britain in the past 300 years. Our recent studies have focused on identifying and quantifying factors associated with the sporophytic self-incompatibility (SSI) system of S. squalidus that may have contributed to its success as a colonist. These findings are of general biological interest because they provide important insights into the short-term evolutionary dynamics of a plant mating system. The number of S-alleles in populations and their dominance interactions were investigated in eight wild British populations using cross-diallel studies. The numbers of S-alleles in British S. squalidus populations are typically low (average of 5.3 S-alleles) and the entire British population is estimated to possess no more than 7-11 S-alleles. Such low numbers of S-alleles are most probably a consequence of population bottlenecks associated with introduction and colonization. Potential evolutionary impacts on SSI caused by a paucity of S-alleles, such as restricted mate availability, are discussed, and we suggest that increased dominance interactions between S-alleles may be an important short-term means of increasing mate availability when S-allele numbers are low.

Protein-protein interactions among enzymes of starch biosynthesis in high-amylose barley genotypes reveal differential roles of heteromeric enzyme complexes in the synthesis of A and B granules.

PubMed

Ahmed, Zaheer; Tetlow, Ian J; Ahmed, Regina; Morell, Matthew K; Emes, Michael J

2015-04-01

The present study investigated the role of protein phosphorylation, and protein complex formation between key enzymes of amylopectin synthesis, in barley genotypes exhibiting "high amylose" phenotypes. Starch branching enzyme (SBE) down-regulated lines (ΔSBEIIa and ΔSBEIIb), starch synthase (SS)IIa (ssiia(-), sex6) and SSIII (ssiii(-), amo1) mutants were compared to a reference genotype, OAC Baxter. Down-regulation of either SBEIIa or IIb caused pleiotropic effects on SSI and starch phosphorylase (SP) and resulted in formation of novel protein complexes in which the missing SBEII isoform was substituted by SBEI and SP. In the ΔSBEIIb down-regulated line, soluble SP activity was undetectable. Nonetheless, SP was incorporated into a heteromeric protein complex with SBEI and SBEIIa and was readily detected in starch granules. In amo1, unlike other mutants, the data suggest that both SBEIIa and SBEIIb are in a protein complex with SSI and SSIIa. In the sex6 mutant no protein complexes involving SBEIIa or SBEIIb were detected in amyloplasts. Studies with Pro-Q Diamond revealed that GBSS, SSI, SSIIa, SBEIIb and SP are phosphorylated in their granule bound state. Alteration in the granule proteome in ΔSBEIIa and ΔSBEIIb lines, suggests that different protein complexes are involved in the synthesis of A and B granules. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Which somatic symptoms are associated with an unfavorable course in Chinese patients with major depressive disorder?

PubMed

Novick, Diego; Montgomery, William S; Aguado, Jaume; Peng, Xiaomei; Brugnoli, Roberto; Haro, Josep Maria

2015-12-01

This was an analysis of the impact of somatic symptoms on the severity and course of depression in Chinese patients treated for an acute episode of major depressive disorder (MDD). Data were extracted from a 3-month prospective observational study which enrolled 909 patients with MDD in psychiatric care settings; this analysis focused on the Chinese patients (n=300). Depression severity was assessed using the Clinical Global Impression of Severity (CGI-S) and 17-item Hamilton Depression Rating Scale (HAMD-17); somatic symptoms were assessed using the patient-rated 28-item Somatic Symptom Inventory (SSI). Cluster analysis using baseline SSI scores grouped patients into three clusters with no/mild, moderate, or severe somatic symptoms. Four SSI factors (pain, autonomic symptoms, energy, and central nervous system) were defined, and regression analyses identified which factors were associated with remission at 3 months. More than 70% of the patients had moderate or severe somatic symptoms. Baseline depression severity (HAMD-17 and CGI-S scores) was associated with more severe somatic symptoms. Remission rates differed between clusters of patients: 84.1%, 72.0%, and 55.3% for no/mild, moderate, and severe somatic symptoms, respectively (P=0.0034). Pain symptoms were the somatic symptoms more strongly associated with lower remission rates at 3 months. Somatic symptoms are associated with greater clinical severity and lower remission rates. Among somatic symptoms, pain symptoms have the greatest prognostic value and should be taken into account when treating patients with depression. © 2015 Wiley Publishing Asia Pty Ltd.

Solar Spectral Irradiance Changes During Cycle 24

NASA Technical Reports Server (NTRS)

Marchenko, Sergey; Deland, Matthew

2014-01-01

We use solar spectra obtained by the Ozone Monitoring Instrument (OMI) on board the Aura satellite to detect and follow long-term (years) and short-term (weeks) changes in the solar spectral irradiance (SSI) in the 265-500 nm spectral range. During solar Cycle 24, in the relatively line-free regions the SSI changed by approximately 0.6% +/- 0.2% around 265 nm. These changes gradually diminish to 0.15% +/- 0.20% at 500 nm. All strong spectral lines and blends, with the notable exception of the upper Balmer lines, vary in unison with the solar "continuum." Besides the lines with strong chromospheric components, the most involved species include Fe I blends and all prominent CH, NH, and CN spectral bands. Following the general trend seen in the solar "continuum," the variability of spectral lines also decreases toward longer wavelengths. The long-term solar cycle SSI changes are closely, to within the quoted 0.1%-0.2% uncertainties, matched by the appropriately adjusted short-term SSI variations derived from the 27 day rotational modulation cycles. This further strengthens and broadens the prevailing notion about the general scalability of the UV SSI variability to the emissivity changes in the Mg II 280 nm doublet on timescales from weeks to years. We also detect subtle deviations from this general rule: the prominent spectral lines and blends at lambda approximately or greater than 350 nm show slightly more pronounced 27 day SSI changes when compared to the long-term (years) trends. We merge the solar data from Cycle 21 with the current Cycle 24 OMI and GOME-2 observations and provide normalized SSI variations for the 170-795 nm spectral region.

Ketamine versus midazolam in bipolar depression with suicidal thoughts: A pilot midazolam-controlled randomized clinical trial.

PubMed

Grunebaum, Michael F; Ellis, Steven P; Keilp, John G; Moitra, Vivek K; Cooper, Thomas B; Marver, Julia E; Burke, Ainsley K; Milak, Matthew S; Sublette, M Elizabeth; Oquendo, Maria A; Mann, J John

2017-05-01

To evaluate feasibility and effects of a sub-anesthetic infusion dose of ketamine versus midazolam on suicidal ideation in bipolar depression. Neurocognitive, blood and saliva biomarkers were explored. Sixteen participants with bipolar depression and a Scale for Suicidal Ideation (SSI) score of ≥4 were randomized to ketamine (0.5 mg/kg) or midazolam (0.02 mg/kg). Current pharmacotherapy was maintained excluding benzodiazepines within 24 hours. The primary clinical outcome was SSI score on day 1 post-infusion. Results supported feasibility. Mean reduction of SSI after ketamine infusion was almost 6 points greater than after midazolam, although this was not statistically significant (estimate=5.84, SE=3.01, t=1.94, P=.074, 95% confidence interval ([CI)]=-0.65 to 12.31). The number needed to treat for response (SSI <4 and at least 50% below baseline) was 2.2, and for remission (SSI=0) was 3.2. The strongest neurocognitive correlation was between memory improvement on the Selective Reminding Test (SRT) and reduction in SSI score on day 1 after ketamine (ρ=-.89, P=.007). Pre- to post-infusion decrease in serum brain derived neurotrophic factor (BDNF) correlated with reduction in SSI from baseline to day 1 after ketamine (n=5, ρ=0.90, P=.037) but not midazolam (P=.087). The study demonstrated feasibility. Suicidal thoughts were lower after ketamine than after midazolam at a trend level of significance, likely due to the small pilot sample. Memory improvement and BDNF are promising biomarkers. Replication is needed in an adequately powered full-scale trial. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Past history of skin infection and risk of surgical site infection after elective surgery.

PubMed

Faraday, Nauder; Rock, Peter; Lin, Elaina E; Perl, Trish M; Carroll, Karen; Stierer, Tracey; Robarts, Polly; McFillin, Angela; Ross, Tracy; Shah, Ashish S; Riley, Lee H; Tamargo, Rafael J; Black, James H; Blasco-Colmenares, Elena; Guallar, Eliseo

2013-01-01

To identify baseline patient characteristics associated with increased susceptibility to surgical site infection (SSI) after elective surgery. The Center for Medicare and Medicaid Services considers SSI to be preventable through adherence to current infection control practices; however, the etiology of wound infection is incompletely understood. Prospective cohort study involving patients undergoing cardiac, vascular, craniotomy, and spinal surgery at 2 academic medical centers in Baltimore, MD. A comprehensive medical history was obtained at baseline, and participants were followed for 6 months using active inpatient and outpatient surveillance for deep SSI and infectious death. Infection control best practices were monitored perioperatively. The relative risk of SSI/infectious death was determined comparing those with versus those without a past medical history of skin infection using Cox proportional hazards models. Of 613 patients (mean [SD] = 62.3 [11.5] years; 42.1% women), 22.0% reported a history of skin infection. The cumulative incidence of deep SSI/infectious death was 6.7% versus 3.1% for those with and without a history of skin infection, respectively (unadjusted hazard ratio (HR) = 2.25; 95% confidence interval (95% CI), 0.98-5.14; P = 0.055). Risk estimates increased after adjustments for demographic and socioeconomic variables (HR = 2.82; 95% CI, 1.18-6.74; P = 0.019) and after propensity score adjustment for all potential confounders (HR = 3.41; 95% CI, 1.36-8.59; P = 0.009). Adjustments for intraoperative infection risk factors and adherence to infection control best practice metrics had no impact on risk estimates. A history of skin infection identified a state of enhanced susceptibility to SSI at baseline that is independent of traditional SSI risk factors and adherence to current infection control practices.

A longitudinal evaluation of the effect of Medi-Cal managed care on supplemental security income and aid to families with dependent children enrollees in two California counties.

PubMed

Lo Sasso, A T; Freund, D A

2000-09-01

We examined the differential effect of Medicaid managed care (MMC) among Aid to Families With Dependent Children (AFDC) and Supplemental Security Income (SSI) enrollees over time by comparing the experiences of adult nonelderly enrollees in the Health Plan of San Mateo in California versus Ventura County's fee-for-service (FFS) enrollees. Four years of administrative claims data were used to construct a longitudinal data set and estimate panel data models to decompose the effect of managed care over time. AFDC MMC enrollees exhibited generally fewer ambulatory visits, lower expenditures, and higher monthly probabilities of a preventable hospitalization relative to comparably enrolled FFS patients. SSI MMC enrollees had more emergency department visits and higher monthly probabilities of hospitalization. However, SSI MMC enrollees had more ambulatory visits and more medications during the first year of enrollment relative to SSI FFS enrollees, although levels were similar in subsequent years. SSI MMC enrollees did not exhibit a significantly higher level of expenditures in the first year of enrollment, although in subsequent years, expenditure levels were significantly lower. The results for emergency department visits and preventable hospitalizations presented a decidedly downbeat picture of access to care for AFDC and SSI enrollees in MMC. However, some aspects of utilization under managed care exhibited results consistent with long-term- oriented treatment for enrollees with a greater likelihood of remaining in the system for a longer period of time (SSI enrollees). By contrast, enrollees more likely to be enrolled for shorter periods (AFDC enrollees) tended to exhibit care patterns under MMC consistent with lower levels of care relative to FFS.

University Students' Knowledge Structures and Informal Reasoning on the Use of Genetically Modified Foods: Multidimensional Analyses

NASA Astrophysics Data System (ADS)

Wu, Ying-Tien

2013-10-01

This study aims to provide insights into the role of learners' knowledge structures about a socio-scientific issue (SSI) in their informal reasoning on the issue. A total of 42 non-science major university students' knowledge structures and informal reasoning were assessed with multidimensional analyses. With both qualitative and quantitative analyses, this study revealed that those students with more extended and better-organized knowledge structures, as well as those who more frequently used higher-order information processing modes, were more oriented towards achieving a higher-level informal reasoning quality. The regression analyses further showed that the "richness" of the students' knowledge structures explained 25 % of the variation in their rebuttal construction, an important indicator of reasoning quality, indicating the significance of the role of students' sophisticated knowledge structure in SSI reasoning. Besides, this study also provides some initial evidence for the significant role of the "core" concept within one's knowledge structure in one's SSI reasoning. The findings in this study suggest that, in SSI-based instruction, science instructors should try to identify students' core concepts within their prior knowledge regarding the SSI, and then they should try to guide students to construct and structure relevant concepts or ideas regarding the SSI based on their core concepts. Thus, students could obtain extended and well-organized knowledge structures, which would then help them achieve better learning transfer in dealing with SSIs.

A Soil Service Index: Potential Soil Services to Society under Scenarios of Human Land Use and Population Growth

NASA Astrophysics Data System (ADS)

Hugelius, G.; Ahlström, A.; Loisel, J.; Harden, J. W.

2017-12-01

Soils provide numerous and indispensable services to ecological systems and human societies. As human populations and human land use changes, the capacity of soils to maintain these services may also change. To investigate this we provide the first global scale study based on the soil service index (SSI; see presentations by Harden et al. and Loisel et al. in this session for more details). In this index multiple soil services are numerically or quantitatively assessed, normalized to a unit-less scale for purposes of intercomparability. Soil services assessed under the SSI include organic matter and/or organic carbon storage; plant productivity; CO2 or GHG exchange with the atmosphere; water storage capacity; and nutrient storage and/or availability. The SSI may be applied at any scale. Here we present a first global application of the SSI and provide broad-scale analyses of soil service spatial distributions. We assess how the SSI will change under projected changes in human societies populations and human land use (following representative concentration pathway scenarios). Present and future potential utilization and vulnerability of soil resources are analyzed in the context of human population distributions and its projected changes. The SSI is designed to be broadly useful across scientific, governance and resource management organizations. To exemplify this, the parameterization of this is global soil service estimate is based on only open source input data.

PubMed Central

SPAGNOLO, A.M.; OTTRIA, G.; AMICIZIA, D.; PERDELLI, F.

2013-01-01

Summary Surgical site infections (SSI) account for 14% to 17% of all hospital-acquired infections and 38% of nosocomial infections in surgical patients. SSI remain a substantial cause of morbidity and death, possibly because of the larger numbers of elderly surgical patients or those with a variety of chronic and immunocompromising conditions, and emergence of antibiotic-resistant microorganisms. Factors causing surgical site infection are multifarious. Several studies have identified the main patient-related (endogenous risk factors) and procedure-related (external risk factors) factors that influence the risk of SSI. The rate of surgical wound infections is strongly influenced by operating theatre quality, too. A safe and salubrious operating theatre is an environment in which all sources of pollution and any micro-environmental alterations are kept strictly under control. This can be achieved only through careful planning, maintenance and periodic checks, as well as proper ongoing training for staff. Many international scientific societies have produced guidelines regarding the environmental features of operating theatres (positive pressure, exchanges of filtered air per hour, air-conditioning systems with HEPA filters, etc.) and issued recommendations on healthcare-associated infection, including SSI, concerning surveillance methods, intervention to actively prevent SSI and approaches to monitoring the implementation of such strategies. Therefore, the prevention of SSI requires a multidisciplinary approach and the commitment of all concerned, including that of those who are responsible for the design, layout and functioning of operating theatres. PMID:24783890

Procedure-specific Surgical Site Infection Incidence Varies Widely within Certain National Healthcare Safety Network Surgery Groups

PubMed Central

Saeed, Mohammed J; Dubberke, Erik R; Fraser, Victoria J; Olsen, Margaret A

2015-01-01

Background The National Healthcare Safety Network (NHSN) classifies surgical procedures into 40 categories. The objective of this study was to determine surgical site infection (SSI) incidence for clinically defined subgroups within 5 heterogeneous NHSN surgery categories. Methods This is a retrospective cohort study using the longitudinal State Inpatient Database. We identified 5 groups of surgical procedures (amputation; biliary, liver and pancreas [BILI]; breast; colon and hernia) using ICD-9-CM procedure codes in community hospitals in California, Florida and New York from January 2009 through September 2011 in persons aged ≥18 years. Each of these 5 categories was classified to more specific surgical procedures within the group. 90-day SSI rates were calculated using ICD-9-CM diagnosis codes. Results There were 62,901 amputation, 33,358 BILI, 72,058 breast, 125,689 colon and 85,745 hernia surgeries in 349,298 people. 90-day SSI rates varied significantly within each of the 5 subgroups. Within the BILI category, bile duct, pancreas and laparoscopic liver procedures had SSI rates of 7.2%, 17.2%, and 2.2%, respectively (p<0.0001 for each) compared to open liver procedures (11.1% SSI). Conclusion 90-day SSI rates varied widely within certain NHSN categories. Risk adjustment for specific surgery type is needed in order to make valid comparisons between hospitals. PMID:25818024

A novel approach to leveraging electronic health record data to enhance pediatric surgical quality improvement bundle process compliance.

PubMed

Fisher, Jason C; Godfried, David H; Lighter-Fisher, Jennifer; Pratko, Joseph; Sheldon, Mary Ellen; Diago, Thelma; Kuenzler, Keith A; Tomita, Sandra S; Ginsburg, Howard B

2016-06-01

Quality improvement (QI) bundles have been widely adopted to reduce surgical site infections (SSI). Improvement science suggests when organizations achieve high-reliability to QI processes, outcomes dramatically improve. However, measuring QI process compliance is poorly supported by electronic health record (EHR) systems. We developed a custom EHR tool to facilitate capture of process data for SSI prevention with the aim of increasing bundle compliance and reducing adverse events. Ten SSI prevention bundle processes were linked to EHR data elements that were then aggregated into a snapshot display superimposed on weekly case-log reports. The data aggregation and user interface facilitated efficient review of all SSI bundle elements, providing an exact bundle compliance rate without random sampling or chart review. Nine months after implementation of our custom EHR tool, we observed centerline shifts in median SSI bundle compliance (46% to 72%). Additionally, as predicted by high reliability principles, we began to see a trend toward improvement in SSI rates (1.68 to 0.87 per 100 operations), but a discrete centerline shift was not detected. Simple informatics solutions can facilitate extraction of QI process data from the EHR without relying on adjunctive systems. Analyses of these data may drive reductions in adverse events. Pediatric surgical departments should consider leveraging the EHR to enhance bundle compliance as they implement QI strategies. Copyright © 2016 Elsevier Inc. All rights reserved.

[Incidence of surgical site infection in ambulatory surgery: results of the INCISCO surveillance network in 1999-2000].

PubMed

Sewonou, A; Rioux, C; Golliot, F; Richard, L; Massault, P P; Johanet, H; Cherbonnel, G; Botherel, A H; Farret, D; Astagneau, P

2002-04-01

To estimate the incidence of surgical-site infections (SSI) in ambulatory surgery and to identify risk factors based on the surveillance network INCISO in 1999-2000. Annually, during a three-month period, each surgical ward had to include 200 consecutive operations. Patients were surveyed over the month following surgery. For each patient, data including peri-operative factors, type of procedure and SSI occurrence were collected on a standardized form by a surgical staff committed for the study. Of the 5,183 patients who underwent an ambulatory surgery, the SSI incidence ratio was 0.4% (95% CI [0.3-0.7]). Orthopedic, gynecologic/obstetrics, head and neck, skin and soft tissues surgery accounted for 83% of all ambulatory procedures. 93% of patients belonged to the 0 risk category of the National Nosocomial Infections Surveillance system (NNIS) index. Emergency, age, american anesthesia risk score (ASA), Altemeier wound class, and procedure duration were not found to be risk factors for SSI in ambulatory surgery. Based on these surveillance data, infectious risk was low in ambulatory surgery and was not associated with known SSI risk factors.

High-temperature hot spots on Io as seen by the Galileo solid state imaging (SSI) experiment

USGS Publications Warehouse

McEwen, A.S.; Simonelli, D.P.; Senske, D.R.; Klaasen, K.P.; Keszthelyi, L.; Johnson, T.V.; Geissler, P.E.; Carr, M.H.; Belton, M.J.S.

1997-01-01

High-temperature hot spots on Io have been imaged at ???50 km spatial resolution by Galileo's CCD imaging system (SSI). Images were acquired during eclipses (Io in Jupiter's shadow) via the SSI clear filter (???0.4-1.0 ??m), detecting emissions from both small intense hot spots and diffuse extended glows associated with Io's atmosphere and plumes. A total of 13 hot spots have been detected over ???70% of Io's surface. Each hot spot falls precisely on a low-albedo feature corresponding to a caldera floor and/or lava flow. The hot-spot temperatures must exceed ???700 K for detection by SSI. Observations at wavelengths longer than those available to SSI require that most of these hot spots actually have significantly higher temperatures (???1000 K or higher) and cover small areas. The high-temperature hot spots probably mark the locations of active silicate volcanism, supporting suggestions that the eruption and near-surface movement of silicate magma drives the heat flow and volcanic activity of Io. Copyright 1997 by the American Geophysical Union.

Further evidence for a broader concept of somatization disorder using the somatic symptom index.

PubMed

Hiller, W; Rief, W; Fichter, M M

1995-01-01

Somatization syndromes were defined in a sample of 102 psychosomatic inpatients according to the restrictive criteria of DSM-III-R somatization disorder and the broader diagnostic concept of the Somatic Symptom Index (SSI). Both groups showed a qualitatively similar pattern of psychopathological comorbidity and had elevated scores on measures of depression, hypochondriasis, and anxiety. A good discrimination between mild and severe forms of somatization was found by using the SSI criterion. SSI use accounted for a substantial amount of comorbidity variance, with rates of 15%-20% for depression, 16% for hypochondriasis, and 13% for anxiety. The results provide further evidence for the validity of the SSI concept, which reflects the clinical relevance of somatization in addition to the narrow definition of somatization disorder.

49 CFR 15.15 - SSI disclosed by DOT.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Information Act. (h) Disclosure of Critical Infrastructure Information. Disclosure of information that is both SSI and has been designated as critical infrastructure information under section 214 of the Homeland...

49 CFR 15.15 - SSI disclosed by DOT.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Information Act. (h) Disclosure of Critical Infrastructure Information. Disclosure of information that is both SSI and has been designated as critical infrastructure information under section 214 of the Homeland...

49 CFR 15.15 - SSI disclosed by DOT.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Information Act. (h) Disclosure of Critical Infrastructure Information. Disclosure of information that is both SSI and has been designated as critical infrastructure information under section 214 of the Homeland...

Translation, Assessment and Deployment of Stuttering Instruments into Different Languages: Comments Arising from Bakhtiar et al., "Investigation of the Reliability of the SSI-3 for Preschool Persian-Speaking Children Who Stutter" ["J. Fluency Disord." 35 (2010) 87-91

ERIC Educational Resources Information Center

Karimi, Hamid; Nilipour, Reza; Shafiei, Bijan; Howell, Peter

2011-01-01

Bakhtiar, Seifpanahi, Ansari, Ghanadzade and Packman (2010) reported high inter-, and intra-judge agreement of a translation of the Stuttering Severity Instrument (SSI-3) for preschool Persian-speaking children who stutter. Translation of SSI-3 into Persian is desirable as there is no standardised stuttering severity test for that language.…

20 CFR 416.204 - Redeterminations of SSI eligibility.

Code of Federal Regulations, 2013 CFR

2013-04-01

... AGED, BLIND, AND DISABLED Eligibility General § 416.204 Redeterminations of SSI eligibility. (a... requirements for eligibility other than whether you are still disabled or blind. Continuation of disability or...

20 CFR 416.204 - Redeterminations of SSI eligibility.

Code of Federal Regulations, 2011 CFR

2011-04-01

... AGED, BLIND, AND DISABLED Eligibility General § 416.204 Redeterminations of SSI eligibility. (a... requirements for eligibility other than whether you are still disabled or blind. Continuation of disability or...

20 CFR 416.204 - Redeterminations of SSI eligibility.

Code of Federal Regulations, 2012 CFR

2012-04-01

... AGED, BLIND, AND DISABLED Eligibility General § 416.204 Redeterminations of SSI eligibility. (a... requirements for eligibility other than whether you are still disabled or blind. Continuation of disability or...

20 CFR 416.204 - Redeterminations of SSI eligibility.

Code of Federal Regulations, 2014 CFR

2014-04-01

... AGED, BLIND, AND DISABLED Eligibility General § 416.204 Redeterminations of SSI eligibility. (a... requirements for eligibility other than whether you are still disabled or blind. Continuation of disability or...

Development of remote sensing techniques for assessment of salinity induced plant stresses

NASA Astrophysics Data System (ADS)

Stong, Matthew Harold

Salinity has been shown to reduce vegetative growth, crop quality, and yield in agricultural crops. Remote sensing is capable of providing data about large areas. This project was designed to induce salinity stress in a crop, pak choi, and thereafter monitor the response of the crop as expressed by its spectral reflectances. The project was conducted in the National Taiwan University Phytotron, and spectral data was collected using a GER 2600. Yield and soil salinity (ECe) were also measured. After three seasons of data were collected, wavelengths sensitive to salinity were selected. These wavelengths, which are within the spectral response of biochemicals produced by plants as a response to soil salinity, were used to create two indices, the Salinity Stress Index (SSI) and the Normalized Salinity Stress Index (NSSI). After creating the indices tests were conducted to determine the efficacy of these indices in detecting salinity and drought stresses as compared to existing indices (SRVI and NDVI). This project induced salinity and drought stress in a crop, pak choi, and thereafter monitored the response of the crop as expressed by its spectral reflectances. The SSI and NSSI correlated well to both ECe and marketable yield. Additionally the SSI and NSSI were found to provide statistical differences between salinity stressed treatments and the control treatment. Drought stress was not detected well by any of the indices reviewed although the SSI and NSSI indices tended to increase with drought stress and decrease with salinity stress. As a final test, specific ion toxicities of sodium and chloride were tested against the developed indices (SSI and NSSI) and existing indices (NDVI, SRVI, and NDWI). There were no differences in SSI and NSSI responses to specific ion concentration in the high salinity treatments. These results indicated that the SSI and NSSI are not sensitive to the specific ion concentration in irrigation water. However, the SSI and NSSI were higher for the sodium water than the choride water in the low salinity treatments. It is likely that this difference was caused by the fact that the high SAR water decreased infiltration and caused water stress.

Seismic soil structure interaction analysis for asymmetrical buildings supported on piled raft for the 2015 Nepal earthquake

NASA Astrophysics Data System (ADS)

Badry, Pallavi; Satyam, Neelima

2017-01-01

Seismic damage surveys and analyses conducted on modes of failure of structures during past earthquakes observed that the asymmetrical buildings show the most vulnerable effect throughout the course of failures (Wegner et al., 2009). Thus, all asymmetrical buildings significantly fails during the shaking events and it is really needed to focus on the accurate analysis of the building, including all possible accuracy in the analysis. Apart from superstructure geometry, the soil behavior during earthquake shaking plays a pivotal role in the building collapse (Chopra, 2012). Fixed base analysis where the soil is considered to be infinitely rigid cannot simulate the actual scenario of wave propagation during earthquakes and wave transfer mechanism in the superstructure (Wolf, 1985). This can be well explained in the soil structure interaction analysis, where the ground movement and structural movement can be considered with the equal rigor. In the present study the object oriented program has been developed in C++ to model the SSI system using the finite element methodology. In this attempt the seismic soil structure interaction analysis has been carried out for T, L and C types piled raft supported buildings in the recent 25th April 2015 Nepal earthquake (M = 7.8). The soil properties have been considered with the appropriate soil data from the Katmandu valley region. The effect of asymmetry of the building on the responses of the superstructure is compared with the author's research work. It has been studied/observed that the shape or geometry of the superstructure governs the response of the superstructure subjected to the same earthquake load.

49 CFR 15.9 - Restrictions on the disclosure of SSI.

Code of Federal Regulations, 2012 CFR

2012-10-01

... DOT or DHS component or agency. (d) Additional requirements for critical infrastructure information. In the case of information that is both SSI and has been designated as critical infrastructure...

49 CFR 15.9 - Restrictions on the disclosure of SSI.

Code of Federal Regulations, 2013 CFR

2013-10-01

... DOT or DHS component or agency. (d) Additional requirements for critical infrastructure information. In the case of information that is both SSI and has been designated as critical infrastructure...

49 CFR 15.9 - Restrictions on the disclosure of SSI.

Code of Federal Regulations, 2014 CFR

2014-10-01

... DOT or DHS component or agency. (d) Additional requirements for critical infrastructure information. In the case of information that is both SSI and has been designated as critical infrastructure...

Epidemiology of Surgical Site Infections With Staphylococcus aureus in Europe: Protocol for a Retrospective, Multicenter Study.

PubMed

Mellinghoff, Sibylle C; Vehreschild, Jörg Janne; Liss, Blasius J; Cornely, Oliver A

2018-03-12

Surgical site infections (SSIs) are among the most common hospital acquired infections. While the incidence of SSI in certain indicator procedures is the subject of ongoing surveillance efforts in hospitals and health care systems around the world, SSI rates vary markedly within surgical categories and are poorly represented by routinely monitored indicator procedures (eg, mastectomy or hernia surgery). Therefore, relying on indicator procedures to estimate the burden of SSI is imprecise and introduces bias as hospitals may take special precautions to achieve lower SSI rates. The most common cause of SSI is Staphylococcus aureus (S. aureus), as recently confirmed by a Europe-wide point-prevalence study conducted by the European Centre for Disease Prevention and Control (ECDC). The primary objective of this study is to determine the overall and procedure-specific incidence of S. aureus SSI in Europe. Secondary objectives are the overall and procedure-specific outcomes as well as the economic burden of S. aureus SSI in Europe. Explorative objectives are to characterize the composition of the surgical patient population and to estimate the number of patients at risk for S. aureus SSI. A retrospective, multinational, multicenter cohort study (Staphylococcus aureus Surgical Site Infection Multinational Epidemiology in Europe [SALT] study) with a nested case-control part will be conducted. The study will include all surgical procedures at a participating center in order to prevent selection bias and strengthen the understanding of SSI risk by determining the incidence for all common surgical procedures. Data will be assessed in the cohort population, including 150,000 adult patients who underwent any surgical procedure in 2016, and the case-control population. We will match patients establishing S. aureus SSI 1:1 with controls from the same center. Data on demographics, surgery, and microbiology will be exported from electronic files. More detailed data will be captured from the case-control population. The SALT study will include 13 major or academic surgical centers in Europe, comprising 3 in France, 4 in Germany, 2 in Italy, 3 in Spain, and 1 in the United Kingdom. Sites were selected using a feasibility questionnaire. The SALT study is currently recruiting patients. The aim is to complete recruitment in February 2018 and to close the database in September 2018. The final results are expected by the end of 2018. Results of the SALT study will help to better understand the precise risk of certain procedures. They will also provide insight into the overall and procedure-specific incidence and outcome as well as the economic burden of S. aureus SSI in Europe. Findings of the study may help guide the design of clinical trials for S. aureus vaccines. ClinicalTrials.gov NCT03353532; https://clinicaltrials.gov/ct2/show/NCT03353532 (Archived by WebCite at http://www.webcitation.org/6xAK3gVmO). ©Sibylle C Mellinghoff, Jörg Janne Vehreschild, Blasius J Liss, Oliver A Cornely. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 12.03.2018.

The diagnostic performance of shear-wave elastography for liver fibrosis in children and adolescents: A systematic review and diagnostic meta-analysis.

PubMed

Kim, Jeong Rye; Suh, Chong Hyun; Yoon, Hee Mang; Lee, Jin Seong; Cho, Young Ah; Jung, Ah Young

2018-03-01

To assess the diagnostic performance of shear-wave elastography for determining the severity of liver fibrosis in children and adolescents. An electronic literature search of PubMed and EMBASE was conducted. Bivariate modelling and hierarchical summary receiver-operating-characteristic modelling were performed to evaluate the diagnostic performance of shear-wave elastography. Meta-regression and subgroup analyses according to the modality of shear-wave imaging and the degree of liver fibrosis were also performed. Twelve eligible studies with 550 patients were included. Shear-wave elastography showed a summary sensitivity of 81 % (95 % CI: 71-88) and a specificity of 91 % (95 % CI: 83-96) for the prediction of significant liver fibrosis. The number of measurements of shear-wave elastography performed was a significant factor influencing study heterogeneity. Subgroup analysis revealed shear-wave elastography to have an excellent diagnostic performance according to each degree of liver fibrosis. Supersonic shear imaging (SSI) had a higher sensitivity (p<.01) and specificity (p<.01) than acoustic radiation force impulse imaging (ARFI). Shear-wave elastography is an excellent modality for the evaluation of the severity of liver fibrosis in children and adolescents. Compared with ARFI, SSI showed better diagnostic performance for prediction of significant liver fibrosis. • Shear-wave elastography is beneficial for determining liver fibrosis severity in children. • Shear-wave elastography showed summary sensitivity of 81 %, specificity of 91 %. • SSI showed better diagnostic performance than ARFI for significant liver fibrosis.

49 CFR 15.17 - Consequences of unauthorized disclosure of SSI.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SECURITY INFORMATION § 15.17 Consequences of unauthorized disclosure of SSI. Violation of this part is... actions for Federal employees. Corrective action may include issuance of an order requiring retrieval of...

49 CFR 1520.17 - Consequences of unauthorized disclosure of SSI.

Code of Federal Regulations, 2014 CFR

2014-10-01

... TRANSPORTATION PROTECTION OF SENSITIVE SECURITY INFORMATION § 1520.17 Consequences of unauthorized disclosure of... issuance of an order requiring retrieval of SSI to remedy unauthorized disclosure or an order to cease...

49 CFR 1520.17 - Consequences of unauthorized disclosure of SSI.

Code of Federal Regulations, 2012 CFR

2012-10-01

... TRANSPORTATION PROTECTION OF SENSITIVE SECURITY INFORMATION § 1520.17 Consequences of unauthorized disclosure of... issuance of an order requiring retrieval of SSI to remedy unauthorized disclosure or an order to cease...

49 CFR 15.17 - Consequences of unauthorized disclosure of SSI.

Code of Federal Regulations, 2014 CFR

2014-10-01

... SECURITY INFORMATION § 15.17 Consequences of unauthorized disclosure of SSI. Violation of this part is... actions for Federal employees. Corrective action may include issuance of an order requiring retrieval of...

49 CFR 15.17 - Consequences of unauthorized disclosure of SSI.

Code of Federal Regulations, 2012 CFR

2012-10-01

... SECURITY INFORMATION § 15.17 Consequences of unauthorized disclosure of SSI. Violation of this part is... actions for Federal employees. Corrective action may include issuance of an order requiring retrieval of...

49 CFR 1520.17 - Consequences of unauthorized disclosure of SSI.

Code of Federal Regulations, 2013 CFR

2013-10-01

... TRANSPORTATION PROTECTION OF SENSITIVE SECURITY INFORMATION § 1520.17 Consequences of unauthorized disclosure of... issuance of an order requiring retrieval of SSI to remedy unauthorized disclosure or an order to cease...

49 CFR 15.17 - Consequences of unauthorized disclosure of SSI.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SECURITY INFORMATION § 15.17 Consequences of unauthorized disclosure of SSI. Violation of this part is... actions for Federal employees. Corrective action may include issuance of an order requiring retrieval of...

49 CFR 15.17 - Consequences of unauthorized disclosure of SSI.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SECURITY INFORMATION § 15.17 Consequences of unauthorized disclosure of SSI. Violation of this part is... actions for Federal employees. Corrective action may include issuance of an order requiring retrieval of...

49 CFR 1520.17 - Consequences of unauthorized disclosure of SSI.

Code of Federal Regulations, 2011 CFR

2011-10-01

... TRANSPORTATION PROTECTION OF SENSITIVE SECURITY INFORMATION § 1520.17 Consequences of unauthorized disclosure of... issuance of an order requiring retrieval of SSI to remedy unauthorized disclosure or an order to cease...

49 CFR 1520.15 - SSI disclosed by TSA or the Coast Guard.

Code of Federal Regulations, 2013 CFR

2013-10-01

... under the Freedom of Information Act. (h) Disclosure of Critical Infrastructure Information. Disclosure of information that is both SSI and has been designated as critical infrastructure information under...

49 CFR 1520.15 - SSI disclosed by TSA or the Coast Guard.

Code of Federal Regulations, 2011 CFR

2011-10-01

... under the Freedom of Information Act. (h) Disclosure of Critical Infrastructure Information. Disclosure of information that is both SSI and has been designated as critical infrastructure information under...

49 CFR 1520.15 - SSI disclosed by TSA or the Coast Guard.

Code of Federal Regulations, 2012 CFR

2012-10-01

... under the Freedom of Information Act. (h) Disclosure of Critical Infrastructure Information. Disclosure of information that is both SSI and has been designated as critical infrastructure information under...

49 CFR 1520.15 - SSI disclosed by TSA or the Coast Guard.

Code of Federal Regulations, 2014 CFR

2014-10-01

... under the Freedom of Information Act. (h) Disclosure of Critical Infrastructure Information. Disclosure of information that is both SSI and has been designated as critical infrastructure information under...

Excess cost and inpatient stay of treating deep spinal surgical site infections.

PubMed

Barnacle, James; Wilson, Dianne; Little, Christopher; Hoffman, Christopher; Raymond, Nigel

2018-05-18

To determine the excess cost and hospitalisation associated with surgical site infections (SSI) following spinal operations in a New Zealand setting. We identified inpatients treated for deep SSI following primary or revision spinal surgery at a regional tertiary spinal centre between 2009 and 2016. Excess cost and excess length of stay (LOS) were calculated via a clinical costing system using procedure-matched controls. Twenty-eight patients were identified. Twenty-five had metalware following spinal fusion surgery, while three had non-instrumented decompression and/or discectomy. Five were diagnosed during their index hospitalisation and 23 (82%) were re-admitted. The average excess SSI cost was NZ$51,434 (range $1,398-$262,206.16) and LOS 37.1 days (range 7-275 days). Infections following metalware procedures had a greater excess cost (average $56,258.90 vs. $11,228.61) and LOS (average 40.4 days vs. 9.7 days) than procedures without metalware. The costs associated with spinal SSI are significant and comparable to a previous New Zealand study of hip and knee prosthesis SSI. More awareness of the high costs involved should encourage research and implementation of infection prevention strategies.

Socioscientific Issues as a Vehicle for Promoting Character and Values for Global Citizens

NASA Astrophysics Data System (ADS)

Lee, Hyunju; Yoo, Jungsook; Choi, Kyunghee; Kim, Sung-Won; Krajcik, Joseph; Herman, Benjamin C.; Zeidler, Dana L.

2013-08-01

Our guiding presupposition in this study was that socioscientific issues (SSI) instruction, given the humanistic features that comprise this type of instruction, could play a role as a vehicle for cultivating character and values as global citizens. Our main objective was to observe how and to what extent SSI instruction might contribute to this. In order to achieve this aim, we implemented a SSI program on genetic modification technology for 132 ninth-grade students over 3-4 weeks and identified its educational effects using a mixed method approach. Data sources included student responses to questionnaire items that measure the students' character and values, records of student discussions, and semi-structured interviews with the students and their teachers. Results indicated that the students became more sensitive to moral and ethical aspects of scientific and technological development and compassionate to diverse people who are either alienated by the benefits of advanced technology or who are vulnerable to the dangers of its unintended effects. In addition, the students felt more responsible for the future resolution of the genetic SSI. However, the students struggled to demonstrate willingness and efficacy to participate within broader communities that entailed action toward SSI resolution.

Morphology and morphometrics of Heterodorus qinghaiensis n. sp. (Dorylaimida, Nordiidae) from soil samples in China.

PubMed

Wu, W J; Yan, L; Xu, C L; Yu, L; Wang, K; Jin, S Y; Xie, H

2016-07-01

One new species of the family Nordiidae Jairajpuri & Siddiqi, 1964 from the enclosure grassland of Qinghai Province, China, Heterodorus qinghaiensis n. sp., is described and illustrated. The new species is characterized by the slender body, 1.29-1.46 mm in length; the granular lateral chord with numerous large depression plaques throughout its entirety; the lip region offset by a distinct depression; amphid goblet-shaped with aperture about half to two-thirds of corresponding body diameter; odontostyle 11-13 μm long; rod-like odontophore without basal flanges; pharyngeal basal expansion about one-third of the total neck length; didelphic genital system containing sperm; ovaries generally not reaching the sphincter level; vulva transversed and sclerotized; female tail conoid with round terminus; 3-5 spaced ventromedial supplements and spicule 32-41 μm long. It is close to H. liangi (Ahmad, Wu & Shaheen, 2002) Andrássy, 2009, H. brevidentatus (Thorne, 1939) Andrássy, 2009, H. monticola Andrássy, 2011, H. morgensis (Loof, 1988) Andrássy, 2009 and H. meghalayensis (Mushtaq, Baniyamuddin & Ahmad, 2007) Andrássy, 2009 in having inconspicuous or no lateral body pores, smaller odontostyle and ventrally curved tail.

Degradation and Deformation of Scarps and Slopes on Io: New Results

NASA Technical Reports Server (NTRS)

Moore, J. M.; Sullivan, R. J.; Pappalardo, R. T.; Turtle, E. P.

2000-01-01

Initial analysis of degradational processes on scarps and slopes on Io using just-acquired images by the Galileo SSI team. Among other results, is evidence for sublimation, sapping, and perhaps "glacial" flow of interstitial volatiles in relief-forming materials.

20 CFR 416.202 - Who may get SSI benefits.

Code of Federal Regulations, 2014 CFR

2014-04-01

... have more resources than are permitted (subpart L). (e) You are disabled, drug addiction or alcoholism... treatment was available or 36 months of SSI benefits on the basis of disability where drug addiction or...

20 CFR 416.202 - Who may get SSI benefits.

Code of Federal Regulations, 2013 CFR

2013-04-01

... have more resources than are permitted (subpart L). (e) You are disabled, drug addiction or alcoholism... treatment was available or 36 months of SSI benefits on the basis of disability where drug addiction or...

20 CFR 416.202 - Who may get SSI benefits.

Code of Federal Regulations, 2012 CFR

2012-04-01

... have more resources than are permitted (subpart L). (e) You are disabled, drug addiction or alcoholism... treatment was available or 36 months of SSI benefits on the basis of disability where drug addiction or...

20 CFR 416.202 - Who may get SSI benefits.

Code of Federal Regulations, 2011 CFR

2011-04-01

... have more resources than are permitted (subpart L). (e) You are disabled, drug addiction or alcoholism... treatment was available or 36 months of SSI benefits on the basis of disability where drug addiction or...

Post-operative MRSA infections in head and neck surgery.

PubMed

Lin, Sharon; Melki, Sami; Lisgaris, Michelle V; Ahadizadeh, Emily N; Zender, Chad A

Surgical site infection (SSI) with methicillin-resistant Staphylococcus aureus (MRSA) is a serious post-operative complication, with head and neck cancer patients at greater risk due to the nature of their disease. Infection with MRSA has been shown to be costly and impart worse outcomes on patients who are affected. This study investigates incidence and risks for MRSA SSIs at a tertiary medical institution. This study reviewed 577 head and neck procedures from 2008 to 2013. Twenty-one variables (i.e. tumor characteristics, patient demographics, operative course, cultures) were analyzed with SPSS to identify trends. A multivariate analysis controlled for confounders (age, BMI, ASA class, length of stay) was completed. We identified 113 SSIs of 577 procedures, 24 (21.23%) of which were MRSA. Of all analyzed variables, hospital exposure within the preceding year was a significant risk factor for MRSA SSI development (OR 2.665, 95% CI: 1.06-6.69, z statistic 2.086, p=0.0369). Immunosuppressed patients were more prone to MRSA infections (OR 14.1250, 95%CI: 3.8133-52.3217, p<0.001), and patients with a history of chemotherapy (OR 3.0268, 95% CI: 1.1750-7.7968, p=0.0218). Furthermore, MRSA SSI resulted in extended post-operative hospital stays (20.8±4.72days, p=0.031). Patients who have a history of chemotherapy, immunosuppression, or recent hospital exposure prior to their surgery are at higher risk of developing MRSA-specific SSI and may benefit from prophylactic antibiotic therapy with appropriate coverage. Additionally, patients who develop MRSA SSIs are likely to have an extended postoperative inpatient stay. Copyright © 2017 Elsevier Inc. All rights reserved.

Cost-effectiveness analysis alongside a pilot study of prophylactic negative pressure wound therapy.

PubMed

Heard, Christopher; Chaboyer, Wendy; Anderson, Vinah; Gillespie, Brigid M; Whitty, Jennifer A

2017-02-01

Negative pressure wound therapy (NPWT) is increasingly used prophylactically following surgery despite limited evidence of clinical or cost-effectiveness. To evaluate whether NPWT is cost-effective compared to standard care, for the prevention of surgical site infection (SSI) in obese women undergoing elective caesarean section, and inform development of a larger trial. An economic evaluation was conducted alongside a pilot randomised controlled trial at one Australian hospital, in which women were randomised to NPWT (n = 44) or standard care (n = 43). A public health care provider perspective and time horizon to four weeks post-discharge was adopted. Cost-effectiveness assessment was based on incremental cost per SSI prevented and per quality-adjusted life year (QALY) gained. Patients receiving NPWT each received health care costing AU$5887 (±1038) and reported 0.069 (±0.010) QALYs compared to AU$5754 (±1484) and 0.066 (±0.010) QALYs for patients receiving standard care. NPWT may be slightly more costly and more effective than standard care, with estimated incremental cost-effectiveness ratios (ICERs) of AU$1347 (95%CI dominant- $41,873) per SSI prevented and AU$42,340 (95%CI dominant- $884,019) per QALY gained. However, there was considerable uncertainty around these estimates. NPWT may be cost-effective in the prophylactic treatment of surgical wounds following elective caesarean section in obese women. Larger trials could clarify the cost-effectiveness of NPWT as a prophylactic treatment for SSI. Sensitive capture of QALYs and cost offsets will be important given the high level of uncertainty around the point estimate cost-effectiveness ratio which was close to conventional thresholds. ACTRN12612000171819. Copyright © 2016 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

Utilization of the NSQIP-Pediatric Database in Development and Validation of a New Predictive Model of Pediatric Postoperative Wound Complications.

PubMed

Maizlin, Ilan I; Redden, David T; Beierle, Elizabeth A; Chen, Mike K; Russell, Robert T

2017-04-01

Surgical wound classification, introduced in 1964, stratifies the risk of surgical site infection (SSI) based on a clinical estimate of the inoculum of bacteria encountered during the procedure. Recent literature has questioned the accuracy of predicting SSI risk based on wound classification. We hypothesized that a more specific model founded on specific patient and perioperative factors would more accurately predict the risk of SSI. Using all observations from the 2012 to 2014 pediatric National Surgical Quality Improvement Program-Pediatric (NSQIP-P) Participant Use File, patients were randomized into model creation and model validation datasets. Potential perioperative predictive factors were assessed with univariate analysis for each of 4 outcomes: wound dehiscence, superficial wound infection, deep wound infection, and organ space infection. A multiple logistic regression model with a step-wise backwards elimination was performed. A receiver operating characteristic curve with c-statistic was generated to assess the model discrimination for each outcome. A total of 183,233 patients were included. All perioperative NSQIP factors were evaluated for clinical pertinence. Of the original 43 perioperative predictive factors selected, 6 to 9 predictors for each outcome were significantly associated with postoperative SSI. The predictive accuracy level of our model compared favorably with the traditional wound classification in each outcome of interest. The proposed model from NSQIP-P demonstrated a significantly improved predictive ability for postoperative SSIs than the current wound classification system. This model will allow providers to more effectively counsel families and patients of these risks, and more accurately reflect true risks for individual surgical patients to hospitals and payers. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

In the Absence of a Mechanical Bowel Prep, Does the Addition of Pre-Operative Oral Antibiotics to Parental Antibiotics Decrease the Incidence of Surgical Site Infection after Elective Segmental Colectomy?

PubMed

Atkinson, Sarah J; Swenson, Brian R; Hanseman, Dennis J; Midura, Emily F; Davis, Bradley R; Rafferty, Janice F; Abbott, Daniel E; Shah, Shimul A; Paquette, Ian M

2015-12-01

Pre-operative oral antibiotics administered the day prior to elective colectomy have been shown to decrease the incidence of surgical site infections (SSI) if a mechanical bowel prep (MBP) is used. Recently, the role for mechanical bowel prep has been challenged as being unnecessary and potentially harmful. We hypothesize that if MBP is omitted, oral antibiotics do not alter the incidence of SSI following colectomy. We selected patients who underwent an elective segmental colectomy from the 2012 and 2013 National Surgical Quality Improvement Program colectomy procedure targeted database. Indications for surgery included colon cancer, diverticulitis, inflammatory bowel disease, or benign polyp. Patients who received mechanical bowel prep were excluded. The primary outcome measured was surgical site infection, defined as the presence of superficial, deep or, organ space infection within 30 d from surgery. A total of 6,399 patients underwent elective segmental colectomy without MBP. The incidence of SSI differed substantially between patients who received oral antibiotics, versus those who did not (9.7% vs. 13.7%, p=0.01). Multivariate analysis indicated that age, smoking status, operative time, perioperative transfusions, oral antibiotics, and surgical approach were associated with post-operative SSI. When controlling for confounding factors, the use of pre-operative oral antibiotics decreased the incidence of surgical site infection (odds ratio=0.66, 95% confidence interval=0.48-0.90, p=0.01). Even in the absence of mechanical bowel prep, pre-operative oral antibiotics appear to reduce the incidence of surgical site infection following elective colectomy.

Postoperative Outcomes in Vedolizumab-Treated Patients Undergoing Major Abdominal Operations for Inflammatory Bowel Disease: Retrospective Multicenter Cohort Study.

PubMed

Lightner, Amy L; Mathis, Kellie L; Tse, Chung Sang; Pemberton, John H; Shen, Bo; Kochlar, Gursimran; Singh, Amandeep; Dulai, Parambir S; Eisenstein, Samuel; Sandborn, William J; Parry, Lisa; Stringfield, Sarah; Hudesman, David; Remzi, Feza; Loftus, Edward V

2018-03-19

Vedolizumab is now widely available for the treatment of moderate to severe ulcerative colitis (UC) and Crohn's disease (CD). We sought to quantify the rates of postoperative complications with preoperative vedolizumab compared with anti-tumor necrosis factor (anti-TNF) therapy. A multicenter retrospective review of adult inflammatory bowel disease (IBD) patients who underwent an abdominal operation between May 20, 2014, and December 31, 2015, was performed. The study cohort was comprised of patients who had received vedolizumab within 12 weeks of their abdominal operation, and the control cohort was IBD patients who had received anti-TNF therapy. A total of 146 patients received vedolizumab within 12 weeks before an abdominal operation (64% female; n = 93; median age, 33 years; range, 15-74 years), and 289 patients received anti-TNF therapy (49% female; n = 142; median age, 36 years; range, 17-73 years). Vedolizumab-treated patients were younger (P = 0.015) and were more likely to have taken corticosteroids (P < 0.01) within the 12 weeks before surgery. Vedolizumab-treated patients had a significantly increased risk of any postoperative surgical site infection (SSI; P < 0.01), superficial SSI (P < 0.01), deep space SSI (P = 0.39), and mucocutaneous separation of the diverting stoma (P < 0.00) as compared with patients taking anti-TNF therapy. On multivariate analysis, after adjusting for body mass index, steroids at the time of operation, and institution, exposure to vedolizumab remained a significant predictor of postoperative SSI (P < 0.01). We observed that vedolizumab-treated patients were at significantly increased risk of postoperative SSIs after a major abdominal operation, as compared with anti-TNF-treated patients.

Decreased Hospital Costs and Surgical Site Infection Incidence With a Universal Decolonization Protocol in Primary Total Joint Arthroplasty.

PubMed

Stambough, Jeffrey B; Nam, Denis; Warren, David K; Keeney, James A; Clohisy, John C; Barrack, Robert L; Nunley, Ryan M

2017-03-01

Staphylococcus aureus colonization has been identified as a key modifiable risk factor in the reduction of surgical site infections (SSI) related to elective total joint arthroplasty (TJA). We investigated the incidence of SSIs and cost-effectiveness of a universal decolonization protocol without screening consisting of nasal mupirocin and chlorhexidine before elective TJA compared to a program in which all subjects were screened for S aureus and selectively treated if positive. We reviewed 4186 primary TJAs from March 2011 through July 2015. Patients were divided into 2 cohorts based on the decolonization regimen used. Before May 2013, 1981 TJA patients were treated under a "screen and treat" program while the subsequent 2205 patients were treated under the universal protocol. We excluded the 3 months around the transition to control for treatment bias. Outcomes of interest included SSI and total hospital costs. With a universal decolonization protocol, there was a significant decrease in both the overall SSI rate (5 vs 15 cases; 0.2% vs 0.8%; P = .013) and SSIs caused by S aureus organisms (2 vs 10; 0.09% vs 0.5%; P = .01). A cost analysis accounting for the cost to administer the universal regimen demonstrated an actual savings of $717,205.59. TJA complicated by SSI costs 4.6× more to treat than that of an uncomplicated primary TJA. Our universal decolonization paradigm for elective TJA is effective in reducing the overall rate of SSIs and promoting economic gains for the health system related to the downstream savings accrued from limiting future reoperations and hospitalizations. Copyright © 2016 Elsevier Inc. All rights reserved.

Comparison of intravenous versus combined oral and intravenous antimicrobial prophylaxis (COMBINE) for the prevention of surgical site infection in elective colorectal surgery: study protocol for a multicentre, double-blind, randomised controlled clinical trial

PubMed Central

Vignaud, Marie; Paugam-Burtz, Catherine; Garot, Matthias; Jaber, Samir; Slim, Karem; Panis, Yves; Lucet, Jean-Christophe; Bourdier, Justine; Morand, Dominique; Pereira, Bruno; Futier, Emmanuel

2018-01-01

Introduction Surgical site infections (SSIs) account for 30% of all healthcare-associated infections, with reported rates ranging from 8% and 30% after colorectal surgery and are associated with increased morbidity and mortality rates, length of hospital stay and costs in healthcare. Administration of systemic antimicrobial prophylaxis before surgery is recommended to reduce the risk of SSI, but the optimal regimen remains unclear. We aim to evaluate whether a combined oral and intravenous antimicrobial prophylaxis could be more effective to reduce the incidence of SSI after colorectal surgery, as compared with the standard practice of intravenous antimicrobial prophylaxis alone. Methods and analysis Comparison of intravenous versus combined oral and intravenous antimicrobial prophylaxis (COMBINE) trial is a randomised, placebo-controlled, parallel, double-blind, multicentre study of 960 patients undergoing elective colorectal surgery. Patients will be randomly allocated in a 1:1 ratio to receive either combined oral and intravenous antimicrobial prophylaxis or intravenous antibiotic prophylaxis alone, stratified by centre, the surgical procedure (laparoscopic or open surgery) and according to the surgical skin antisepsis (chlorexidine–alcohol or povidione-iodine alcoholic solution). The primary endpoint is the rate of SSI by day 30 following surgery, with SSI defined by the criteria developed by the Centers for Disease Control and Prevention. Data will be analysed on the intention-to-treat principle and a per-protocol basis. Ethics and dissemination COMBINE trial has been approved by an independent ethics committee for all study centres. Participant recruitment began in May 2016. Results will be published in international peer-reviewed medical journals. Trial registration number EudraCT 2015-002559-84; NCT02618720. PMID:29654027

Complete Genome Sequence and Comparative Genomics of a Streptococcus pyogenes emm3 Strain M3-b isolated from a Japanese Patient with Streptococcal Toxic Shock Syndrome.

PubMed

Ogura, Kohei; Watanabe, Shinya; Kirikae, Teruo; Miyoshi-Akiyama, Tohru

2017-01-01

Epidemiologic typing of Streptococcus pyogenes (GAS) is frequently based on the genotype of the emm gene, which encodes M/Emm protein. In this study, the complete genome sequence of GAS emm3 strain M3-b, isolated from a patient with streptococcal toxic shock syndrome (STSS), was determined. This strain exhibited 99% identity with other complete genome sequences of emm3 strains MGAS315, SSI-1, and STAB902. The complete genomes of five additional strains isolated from Japanese patients with and without STSS were also sequences. Maximum-likelihood phylogenetic analysis showed that strains M3-b, M3-e, and SSI-1, all which were isolated from STSS patients, were relatively close.

Does Administration of Oral Versus Intravenous Antibiotics for Third Molar Removal Have an Effect on the Incidence of Alveolar Osteitis or Postoperative Surgical Site Infections?

PubMed

Reiland, Matthew D; Ettinger, Kyle S; Lohse, Christine M; Viozzi, Christopher F

2017-09-01

To compare the incidence of postoperative alveolar osteitis (AO) and surgical site infections (SSIs) in 2 separate cohorts of patients undergoing elective third molar removal: those who received postoperative oral (PO) antibiotics and those who received perioperative intravenous (IV) antibiotics. A retrospective cohort study of all patients 14 to 30 years old undergoing elective outpatient third molar removal under a single surgeon's service over a 12-year period was completed. Patients undergoing third molar removal during the first 72 months received postoperative PO antibiotics alone. Patients undergoing third molar removal during the second 72 months received perioperative IV antibiotics alone. The primary predictor variable for the study was the antibiotic regimen used at the time of third molar removal. The primary outcome variable was the postoperative development of AO or SSI. Covariates included age and gender. Univariable and multivariable regression models assessed for associations between the antibiotic regimen used and the presence of AO and SSI. The study sample consisted of 1,895 patients (1,020 patients receiving postoperative PO antibiotics and 875 patients receiving perioperative IV antibiotics). Of patients receiving postoperative PO antibiotics, 6.4% developed AO an average of 5.7 days after the procedure and 2.6% developed an SSI an average of 23.2 days after the procedure. Of patients receiving perioperative IV antibiotics, 5.5% developed AO an average of 6.2 days after the procedure and 3.3% developed an SSI an average of 18.2 days after the procedure. No statistically significant associations between the antibiotic regimen used and the presence of AO or SSI were identified in univariable (P = 0.42 for AO, P = 0.32 for SSI) or multivariable (P = 0.65 for AO, P = 0.26 for SSI) analyses. In the postoperative PO antibiotic cohort, older age (P < .001) and female gender (P < .001) were significantly associated with the development of AO, and female gender (P = .015) was significantly associated with the presence of an SSI. In the perioperative IV antibiotic cohort, female gender was significantly associated with the development of AO (P = .011), and younger age was significantly associated with the presence of an SSI (P = .011). The use of a postoperative PO versus a perioperative IV antibiotic regimen does not significantly alter the incidence of AO or SSI after elective third molar removal. If the surgeon chooses to use antibiotics in the setting of third molar surgery, then perioperative IV antibiotics are preferable over postoperative PO antibiotics because they obviate any issues with patient compliance and might be less costly. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Postoperative Changes in Presepsin Level and Values Predictive of Surgical Site Infection After Spinal Surgery: A Single-Center, Prospective Observational Study.

PubMed

Koakutsu, Tomoaki; Sato, Tetsuya; Aizawa, Toshimi; Itoi, Eiji; Kushimoto, Shigeki

2018-04-15

Single-institutional, prospective observational study. To elucidate the perioperative kinetics of presepsin (PSEP) in patients undergoing spinal surgery, and to evaluate the possibility of PSEP in the early diagnosis of surgical site infection (SSI). Early diagnosis of SSI after spinal surgery is important. Although several biomarkers have been used as early indicators of SSI, the specificity of these markers in SSI diagnosis was not high. PSEP was found as a novel diagnostic marker for bacterial sepsis in 2004. However, its kinetics after spinal surgery and its usefulness in early diagnosis of SSI have never been evaluated. A total of 118 patients who underwent elective spinal surgery were enrolled. PSEP was measured before, immediately after, 1 day after, and 1 week after surgery. In patients without postoperative infection, perioperative kinetics of PSEP were analyzed. PSEP levels in patients with postoperative infection were also recorded separately, and their utility in SSI diagnosis was evaluated. In the 115 patients without postoperative infection, the median PSEP value was 126, 171, 194, and 147 pg/mL before, immediately after, 1 day after, and 1 week after surgery, respectively. Compared with the preoperative value, PSEP was significantly higher immediately after surgery and the next day, and return to the preoperative level 1 week after surgery. The estimated reference value for 95 percentile in patients without postoperative infection was 297 pg/mL 1 week after surgery. In three patients with postoperative infection, higher levels (>300 pg/mL) were observed 1 week after surgery. In patients after spinal surgery without infectious complications, blood levels of PSEP may immediately increase and return to preoperative levels 1 week after surgery. The PSEP value of 300 pg/mL 1 week after surgery might be used as a novel indicator for suspected SSI. 4.

Effect of the application of a bundle of three measures (intraperitoneal lavage with antibiotic solution, fascial closure with Triclosan-coated sutures and Mupirocin ointment application on the skin staples) on the surgical site infection after elective laparoscopic colorectal cancer surgery.

PubMed

Ruiz-Tovar, Jaime; Llavero, Carolina; Morales, Vicente; Gamallo, Carlos

2018-01-18

Surgical site infection (SSI) prevention bundles include the simultaneous use of different measures, which individually have demonstrated an effect on prevention of SSI. The implementation of bundles can yield superior results to the implementation of individual measures. The aim of this study was to address the effect of the application of a bundle including intraperitoneal lavage with antibiotic solution, fascial closure with Triclosan-coated sutures and Mupirocin ointment application on the skin staples, on the surgical site infection after elective laparoscopic colorectal cancer surgery. A prospective, randomized study was performed, including patients with diagnosis of colorectal neoplasms and plans to undergo an elective laparoscopic surgery. The patients were randomized into two groups: those patients following standard bundles (Group 1) and those ones following the experimental bundle with three additional measures, added to the standard bundle. Incisional and organ space SSI were investigated. The study was assessor-blinded. A total of 198 patients were included in the study, 99 in each group. The incisional SSI rate was 16% in Group 1 and 2% in Group 2 [p = 0.007; RR = 5.6; CI 95% (1.4-17.8)]. The organ-space SSI rate was 4% in Group 1 and 0% in Group 2 [p = 0.039; RR = 1.7; CI 95% (1.1-11.6)]. Median hospital stay was 5.5 days in Group 1 and 4 days in Group 2 (p = 0.028). The addition of intraperitoneal lavage with antibiotic solution, fascial closure with Triclosan-coated sutures and Mupirocin ointment application on the skin staples, to a standard bundle of SSI prevention, reduces the incisional and organ-space SSI and consequently the hospital stay, after elective laparoscopic colorectal cancer surgery (ClinicalTrials.gov Identifier: NCT03081962).

Reforming Science and Mathematics Education

NASA Astrophysics Data System (ADS)

Lagowski, J. J.

1995-09-01

Since 1991, the National Science Foundation has signed cooperative agreements with 26 states to undertake ambitious and comprehensive initiatives to reform science, mathematics, and technology education. Collectively, those agreements are known as the State Systemic Initiatives (SSI's). Two complimentary programs, The Urban and Rural Systemic Initiatives (USI's and RSI's), address similar reforms in the nation's largest cities and poorest rural areas. The SSI Program departs significantly from past NSF practice in several ways. The funding is for a longer term and is larger in amount, and the NSF is taking a more activist role, seeking to leverage state and private funds and promote the coordination of programs within states. The Initiatives also have a stronger policy orientation than previous NSF programs have had. The NSF strategy is a reflection of the growing and widely held view that meaningful reforms in schools are most likely to be achieved through state initiatives that set clear and ambitious learning goals and standards; align all of the available policy levers in support of reform; stimulate school-level initiatives; and mobilize human and financial resources to support these changes. Two premises underlie systemic reform: (1) all children can meet significantly higher standards if they are asked to do so and given adequate opportunities to master the content, and (2) state and local policy changes can create opportunities by giving schools strong and consistent signals about the changes in practice and performance that are expected. Because this is an enormous investment of Federal resources that is intended to bring about deep, systemic improvement in the nation's ability to teach science and mathematics effectively, the NSF has contracted with a consortium of independent evaluators to conduct a review of the program. The first of the SSI's were funded in 1991, sufficiently long ago to begin to formulate some initial impressions of their impact. Take, for example, the various SSI's statements of "good educational practice." Most SSI's began their initiatives by establishing clear goals for what students should know and be able to do, reflecting the emergence of a national consensus for broad standards for just about every aspect of the educational process. The concerned persons in each SSI--policy-makers, educators, mathematicians, and scientists--have not necessarily reached the same conclusions about what children should learn or even what efforts are needed to put the necessary changes in place, but they are focused on common goals as expressed locally. The recent national dialogues about goals and standards have provided the basis for a remarkably consistent image of what states--at least the SSI states--consider good educational practice. The differences that do occur across states reflect variations in demographics, geography, resources, values, and educational structure. All the states with SSI's, regardless of their primary strategy, have address the professional development of teachers. Collectively, the SSI's reported that professional development services were provided to more than 50,000 teachers during the past year, which is approximately eight percent of the public school teachers in the participating states. The number of teachers participating varied by grade level and subject matter. Some states, for example, reported reaching more than one in every five middle-school mathematics teachers, but only one in every 20 high-school mathematics teachers. Focusing SSI resources on the professional development of classroom teachers implies changing their skill levels, knowledge, and beliefs. Attitudes and perceptions of administrators also changed in the process. The challenge lies in developing a strategy that provides on-going, in-depth professional development that reaches a significant portion of those who teach mathematics and the sciences. Not only must an effective development model(s), be provided, the infrastructure to accommodate all teachers must be created as well. Most states' strategies include building statewide capacity for professional development beyond the opportunities sponsored directly by the SSI's. Three factors are explicitly recognized: (1) the SSI's do not have the resources to reach all teachers in most states, (2) the SSI's funding will eventually run out, and (3) the need for professional development will be on-going. Some states have developed regional centers to serve the on-going professional development needs of teachers. Another capacity-building strategy involves the use of technology to support teachers' efforts to change their practices. New non-governmental organizations are also playing key leadership roles in a number of states. Such organizations are of particular interest because they have the potential to build broad-based, bipartisan support that can sustain the SSI vision and its activities across electoral cycles. One of the central tenets of systematic reform is the alignment of the myriad of public policies governing the educational enterprise, from teacher credentiality to student assessment to textbook adoption, with the new goals and standards. In localities where the revision of state policies is simply not considered a fruitful strategy, strong traditions of local control are to be found. Some SSI's are working to improve the preparation of teachers. A common strategy has been to issue a request for proposals (RFP) to institutions for higher education to design and implement innovative pre-service teacher education programs. Scientists and mathematicians can have an enormous impact on this aspect of the SSI's mission, by becoming intimately involved in the development of courses that are meaningful for would-be teachers. This is the area where scientists and mathematicians can leverage their technical knowledge and skills to help educate teachers. Creating and sustaining a coalition of groups powerful enough to launch fundamental reforms in public education is challenging. The coalition must be able to reach consensus on a vision of reform and, then, sustain the reform over an extended period of time. This is not easy when power and authority are highly fragmented (and perhaps at odds), where interest groups live or die on confromtation politics, when public and private sectors exhibit a basic distrust of one another, and when everyone is an expert--real or imagined--on topics more-or-less related to education. In addition, the SSI's are operating in a turbulent climate. Policy makers may be working on standards-based reforms in K-12 education at the same time they are seeking efficiencies in state government, consider deregulation, and experiment with integrated social services. Criminal justice, health, and welfare are competing in state capitols for the resources required to bring about education reforms. And, within this shifting policy landscape, the SSI's are seeking higher priority for mathematics and science, as well as attempting to develop the infrastructure and capacity to support change in the schools. Simply keeping mathematics and science education high on the agenda of state policy-makers is a challenge. Each of these component strategies of the SSI's is important. The critical question is whether, in a given state, the SSI strategies, when combined with other state reform initiatives, form a coherent, comprehensive plan for improving public education. While the oldest of the SSI's are only in their fourth year of activity, it is already clear that the reforms they are seeking will take longer than five years to accomplish. (The SSI's are supported by five-year grants from the NSF.) The instructional reforms advocated by the SSI's require time to implement, and once in place, additional time to produce results. Elected officials often focus on the short-term, and they can become impatient when the results are slow. There appears to be no ready solution to the conflict between the long-run agendas of school reforms and the short-term needs of legislators. This is clearly a race for long-distance runners.

Summary of Requirements for Sewage Sludge Incinerators (SSI): New Source Performance Standards (NSPS) and Emission Guidelines (EG)

EPA Pesticide Factsheets

This November 2011 document summarizes the various requirements of the sewage sludge incinerators (SSI) new source performance standards (NSPS) and emission guidelines (EG), broken down into compliance categories.

Two Highly-Complementary Future Instruments for Climate Studies

NASA Astrophysics Data System (ADS)

Kopp, Greg; Pilewskie, Peter

2017-04-01

Measurements of the total solar irradiance (TSI) provide the most accurate knowledge of the net energy powering the Earth's climate system and thus give the incoming side of the Earth's radiative energy balance. The spectral distribution of this radiant energy, the spectral solar irradiance (SSI), determines how that incoming energy interacts with different components of the Earth's coupled ocean-atmosphere-surface climate system. Spatially- and spectrally-resolved Earth-reflected measurements of this shortwave radiation indicate the relative amount of the incident sunlight that is absorbed by different spatial regions and ecosystems around the globe. Particularly if very accurate and acquired over sufficiently long periods of time, those outgoing radiance measurements can lead to improved quantification of and physical understandings of the local and global processes causing climate change. Two upcoming and very complementary missions provide these measurements. The soon-to-be-launched Total and Spectral Solar Irradiance Sensor (TSIS) acquires the solar-irradiance measurements, with the Total Irradiance Monitor (TIM) providing highly-accurate values of the TSI and the Spectral Irradiance Monitor (SIM) measuring the SSI. The recently-selected CLARREO Pathfinder (CPF) is a technology-demonstration mission that measures the solar-reflected radiation via spatially- and spectrally-resolved observations of Earth scenes from its HyperSpectral Imager for Climate Science (HySICS), a spaceflight version of a high-altitude balloon-flight imaging spectrometer that achieves high radiometric accuracies via in-flight cross-calibrations directly tied to the SSI. We give an overview of the TSIS and the CPF, describing their instruments, the high complementarity of their measurements and intended uncertainties, and their planned timelines and current status.

Surgical Site Infection Reduction Bundle: Implementation and Challenges at Ventura County Medical Center.

PubMed

Losh, Joseph M; Gough, Amy; Rutherford, Richard; Romero, Javier; Diaz, Graal; Schweitzer, Jeremy

2017-10-01

Surgical Site Infections (SSIs) are a significant cause of morbidity and increased cost in the postoperative patient occurring in 2-5 per cent of those undergoing inpatient surgery. Ventura County Medical Center (VCMC) initiated an SSI reduction bundle in 2013, to try to reduce the incidence of SSI. The bundle is a series of best practices including preoperative, perioperative, intraoperative, and postoperative components, as well as items focused on the staff and electronic medical record. VCMC started with a 6.1 per cent SSI rate in 2013. A consistent reduction in SSI rate followed each quarter after that for a rate of less than 2.0 per cent in early 2016. The most critical aspect of this process was the necessary collaboration between disparate departments and the ongoing investment of the staff to this challenging process; the people at the heart of the collaborative process were the key to its success.

Socioscientific Argumentation: The effects of content knowledge and morality

NASA Astrophysics Data System (ADS)

Sadler, Troy D.; Donnelly, Lisa A.

2006-10-01

Broad support exists within the science education community for the incorporation of socioscientific issues (SSI) and argumentation in the science curriculum. This study investigates how content knowledge and morality contribute to the quality of SSI argumentation among high school students. We employed a mixed-methods approach: 56 participants completed tests of content knowledge and moral reasoning as well as interviews, related to SSI topics, which were scored based on a rubric for argumentation quality. Multiple regression analyses revealed no statistically significant relationships among content knowledge, moral reasoning, and argumentation quality. Qualitative analyses of the interview transcripts supported the quantitative results in that participants very infrequently revealed patterns of content knowledge application. However, most of the participants did perceive the SSI as moral problems. We propose a “Threshold Model of Knowledge Transfer” to account for the relationship between content knowledge and argumentation quality. Implications for science education are discussed.

Can Measurements of the Near-Infrared Solar Spectral Irradiance be Reconciled? A New Ground-Based Assessment Between 4,000 and 10,000 cm-1

NASA Astrophysics Data System (ADS)

Elsey, Jonathan; Coleman, Marc D.; Gardiner, Tom; Shine, Keith P.

2017-10-01

The near-infrared solar spectral irradiance (SSI) is of vital importance for understanding the Earth's radiation budget, and in Earth observation applications. Differences between previously published solar spectra (including the commonly used ATLAS3 spectrum) reach up to 10% at the low wavenumber end of the 4,000-10,000 cm-1 (2.5-1 μm) spectral region. The implications for the atmospheric sciences are significant, since this spectral region contains 25% of the incoming total solar irradiance. This work details an updated analysis of the CAVIAR SSI, featuring additional analysis techniques and an updated uncertainty budget using a Monte Carlo method. We report good consistency with ATLAS3 in the 7,000-10,000 cm-1 region where there is confidence in these results due to agreement with other spectra, but 7% lower in the 4,000-7,000 cm-1 region, in general agreement with several other analyses.

Modeling SSI financial eligibility and simulating the effect of policy options.

PubMed

Davies, P S; Huynh, M; Newcomb, C; O'Leary, P; Rupp, K; Sears, J

This article simulates eligibility for Supplemental Security Income (SSI) among the elderly, analyzes factors affecting participation, and looks at the potential effects of various options to modify financial eligibility standards for the federal SSI program. We find that in the estimated noninstitutional elderly population of 30.2 million in the United States in 1991, approximately 2 million individuals aged 65 or older were eligible for SSI (a 6.6 percent rate of eligibility). Our overall estimate of the rate of participation among eligible elderly is approximately 63 percent, suggesting that more than a third of those who are eligible do not participate in the program. The results of our analysis of factors affecting participation among the eligible elderly show that expected SSI benefits and a number of demographic and socioeconomic variables are associated with the probability of participation. We also simulate the effects of various policy options on the poverty rate, poverty gap, annual program cost, the number of participants, and the average estimated benefits among participants. The simulations consider the potential effects of five policy alternatives: Increase the general income exclusion (GIE) from $20 to $80. Increase the earned income exclusion (EIE) from $65 to $260. Increase the federal benefit rate (FBR) by $50 for individuals and $75 for couples and eliminate the GIE. Increase the asset threshold to $3,000 for individuals and $4,500 for couples. Increase the asset threshold to $6,000 for individuals and $9,000 for couples. Using 1991 microdata from the Survey of Income and Program Participation (SIPP) matched to Social Security Administration administrative records and making adjustments reflecting aggregate program statistics, we present the results of our simulations for December 1999. The results show substantial variation in the simulated effects of the five policy alternatives along the various outcome dimensions considered. The simulated effects on the poverty gap of the elderly population range from a 7.9 percent reduction ("Increase the GIE from $20 to $80") to a 0.1 percent reduction ("Increase the EIE from $65 to $260"). All simulated interventions are expected to increase the rate of SSI participation among the elderly from a high of 20.3 percent ("Increase the GIE from $20 to $80") to a low of 0.5 percent ("Increase the EIE from $65 to $260"). We also find that the interventions that have greater estimated effects in terms of increased participation and reduced poverty tend to cost more. At the high end, we estimate that increasing the GIE from $20 to $80 could raise annual federal SSI cash benefit outlays by about 46 percent, compared with only 0.9 percent for increasing the EIE from $65 to $260. Similar to the EIE intervention, raising the resource thresholds by 50 percent would reduce the overall poverty gap of the elderly by only 0.2 percent, would increase SSI participation only modestly (by 1.3 percent), but would entail slightly higher program costs (by 1.4 percent). Increasing the asset threshold by 200 percent would have higher estimated effects on all three outcomes, but it would still be associated with relatively low increases in both costs and benefits. Finally, the simulated effects on the three key outcomes of increasing the FBR by $50 for individuals and $75 for couples, combined with eliminating the GIE, are relatively large but are clearly less substantial than increasing the GIE from $20 to $80. This work relies on data from the SIPP matched to administrative data on federal SSI benefits that provide a more accurate picture of SSI participation than has been feasible for previous studies. We simulate eligibility for federal SSI benefits by applying the program rules to detailed information on the characteristics of individuals and couples based on the rich array of demographic and socioeconomic data in the SIPP, particularly the comprehensive information SIPP provides on assets and monthly income. A probit model is estimated to analyze factors affecting participation among the eligible elderly. Finally, we conduct the policy simulations using altered program rules represented by the policy alternatives and predicted participation probabilities to estimate outcomes under simulated program rules. We compare those simulated outcomes to observed outcomes under current program rules. The results of our simulations are conditional on the characteristics of participants and eligibles in 1991, but they also reflect aggregate adjustments capturing substantial changes in overall participation and program benefit levels between 1991 and 1999.

SORCE 11 years after launch: What's new? What's next?

NASA Astrophysics Data System (ADS)

Cahalan, Robert; Kopp, Greg; Pilewskie, Peter; Richard, Erik; Woods, Tom

2014-05-01

We discuss recent changes in estimates of the Total Solar Irradiance (TSI) and the energy budget. We highlight the historic closing of the calibration gap between the suite of TSI instruments, due largely to comparisons made with a cryogenic Transfer Radiometer Facility (TRF) located at the University of Colorado, built by UCO/LASP with support from NASA and NIST. The resulting continuous record of TSI promises to be a milestone in improving understanding of the Sun's impact on Earth's climate. Climate models are sensitive not only to TSI, but also to variations in the Spectral Solar Irradiance (SSI), and the vertical profiles of temperature and ozone are especially sensitive to SSI variations. Variations in SSI need further study before they may be considered as firmly established as TSI variations, which themselves remain controversial, despite a strengthening consensus over the SORCE epoch. The TSIS SIM has recently undergone comprehensive end-to-end calibration in the LASP SSI Radiometry Facility (SRF) utilizing the NIST SIRCUS laser system covering 210 - 2400 nm for SSI, a facility not yet available when SORCE launched in 2003. With SORCE follow-on missions such as the Total and Spectral Solar Irradiance Sensor (TSIS), we anticipate narrowing uncertainties in SSI variability that will be important to improving our understanding of the climate responses to solar forcing. The long-term goal of improving the ability to monitor Earth's energy balance, and the energy imbalance that drives global warming, will need continued improvements in the measurement of both shortwave solar and longwave earth-emitted radiation.

Perioperative antibiotics for surgical site infection in pancreaticoduodenectomy: does the SCIP-approved regimen provide adequate coverage?

PubMed

Donald, Graham W; Sunjaya, Dharma; Lu, Xuyang; Chen, Formosa; Clerkin, Barbara; Eibl, Guido; Li, Gang; Tomlinson, James S; Donahue, Timothy R; Reber, Howard A; Hines, Oscar J

2013-08-01

The Joint Commission Surgical Care Improvement Project (SCIP) includes performance measures aimed at reducing surgical site infections (SSI). One measure defines approved perioperative antibiotics for general operative procedures. However, there may be a subset of procedures not adequately covered with the use of approved antibiotics. We hypothesized that piperacillin-tazobactam is a more appropriate perioperative antibiotic for pancreaticoduodenectomy (PD). In collaboration with hospital epidemiology and the Division of Infectious Diseases, we retrospectively reviewed records of 34 patients undergoing PD between March and May 2008 who received SCIP-approved perioperative antibiotics and calculated the SSI rate. After changing our perioperative antibiotic to piperacillin-tazobactam, we prospectively reviewed PDs performed between June 2008 and March 2009 and compared the SSI rates before and after the change. For 34 patients from March through May 2008, the SSI rate for PD was 32.4 per 100 cases. Common organisms from wound cultures were Enterobacter and Enterococcus (50.0% and 41.7%, respectively), and these were cefoxitin resistant. From June 2008 through March 2009, 106 PDs were performed. During this period, the SSI rate was 6.6 per 100 surgeries, 80% lower than during March through May 2008 (relative risk, 0.204; 95% confidence interval [CI], 0.086-0.485; P = .0004). Use of piperacillin-tazobactam as a perioperative antibiotic in PD may reduce SSI compared with the use of SCIP-approved antibiotics. Continued evaluation of SCIP performance measures in relationship to patient outcomes is integral to sustained quality improvement. Copyright © 2013 Mosby, Inc. All rights reserved.

Children with Special Health Care Needs, Supplemental Security Income, and Food Insecurity.

PubMed

Rose-Jacobs, Ruth; Fiore, Jennifer Goodhart; de Cuba, Stephanie Ettinger; Black, Maureen; Cutts, Diana B; Coleman, Sharon M; Heeren, Timothy; Chilton, Mariana; Casey, Patrick; Cook, John; Frank, Deborah A

2016-01-01

To assess food insecurity in low-income households with young children with/without special health care needs (SHCN) and evaluate relationships between child Supplemental Security Income (SSI) receipt and food insecurity. A cross-sectional survey (2013-2015) of caregivers was conducted at 5 medical centers. Eligibility included index child age <48 months without private health insurance and a caregiver fluent in English or Spanish. Interviews included sociodemographics, 5-item Children with Special Health Care Needs Screener, 18-item US Food Security Survey Module, household public assistance program participation, and child SSI receipt. Household and child food insecurity, each, were evaluated using multivariable logistic regression models. Of 6724 index children, 81.5% screened negative for SHCN, 14.8% positive for SHCN (no SSI), and 3.7% had SHCN and received SSI. After covariate control, households, with versus without a child with SHCN, were more likely to experience household (Adjusted odds ratios [AOR] 1.24, 95% confidence intervals [CI], 1.03-1.48) and child (AOR 1.35, 95% CI, 1.11-1.63) food insecurity. Among households with children with SHCN, those with children receiving, versus not receiving SSI, were more likely to report household (AOR 1.42, 95% CI, 0.97-2.09) but not child food insecurity. Low-income households with young children having SHCN are at risk for food insecurity, regardless of child SSI receipt and household participation in other public assistance programs. Policy recommendations include reevaluation of assistance programs' income and medical deduction criteria for households with children with SHCN to decrease the food insecurity risk faced by these children and their families.

The population genetics of sporophytic self-incompatibility in Senecio squalidus L. (Asteraceae): the number, frequency, and dominance interactions of S alleles across its British range.

PubMed

Brennan, Adrian C; Harris, Stephen A; Hiscock, Simon J

2006-02-01

Sporophytic self-incompatibility (SSI) was studied in 11 British Senecio squalidus populations to quantify mating system variation and determine how its recent colonization of the United Kingdom has influenced its mating behavior. S allele number, frequency, and dominance interactions in populations were assessed using full diallels of controlled pollinations. A mean of 5.1 S alleles per population was observed, and no population contained more than six S alleles. Numbers of S alleles within populations of S. squalidus declined with increasing distance from the center of its introduction (Oxford). Cross-classification of S alleles allowed an estimate of approximately seven and no more than 11 S alleles for the entire British S. squalidus population. The low number of S alleles observed in British S. squalidus compared to other SI species is consistent with the population bottleneck associated with S. squalidus' introduction to the Oxford Botanic Garden and subsequent colonization of Britain. Extensive S allele dominance interactions were observed to be a feature of the S. squalidus SSI system and may represent an adaptive response to improve limited mate availability imposed by the presence of so few S alleles. Multilocus allozyme genotypes were also identified for individuals in all populations and geographic patterns of S locus and allozyme loci variation investigated. Less interpopulation structure was observed for the S locus than for allozyme diversity--a finding indicative of the effects of negative frequency-dependent selection at the S locus maintaining equal S phenotypes within populations and enhancing effective migration between populations.

The role of Amicar in same-day anterior and posterior spinal fusion for idiopathic scoliosis.

PubMed

Thompson, George H; Florentino-Pineda, Ivan; Poe-Kochert, Connie; Armstrong, Douglas G; Son-Hing, Jochen P

2008-09-15

A retrospective study of the effectiveness of Amicar (epsilon aminocaproic acid). Evaluate the effectiveness of Amicar in decreasing perioperative blood loss and transfusion requirements in same-day anterior (ASF) and posterior spinal fusion (PSF) with segmental spinal instrumentation (SSI) for idiopathic scoliosis. Preliminary prospective, prospective randomized double-blind, and fibrinogen studies have demonstrated Amicar to be effective in decreasing perioperative blood loss in patients with idiopathic scoliosis undergoing PSF with SSI. Increased fibrinogen secretion is a possible explanation. There were 73 consecutive patients divided into 3 study groups based on the administration of Amicar: Group 1 (n = 16), no Amicar; Group 2 (n = 18), Amicar for the PSF with SSI only; and Group 3 (n = 39), Amicar for both ASF and PSF with SSI. All patients were managed using the same general anesthesia technique, intraoperative procedure, postoperative care path, and indications for transfusion (hemoglobin <7 g/dL). Total perioperative blood loss (estimated intraoperative blood loss for both procedures and measured postoperative chest tube and PSF wound suction drainage) and total transfusion requirements between groups were compared using one-way ANOVA. There were statistically significant decreases in mean estimated intraoperative PSF with SSI, total perioperative blood loss, and transfusion requirements in the 2 Amicar groups. However, Amicar had no significant effect on estimated intraoperative ASF blood loss, chest tube drainage, or PSF wound suction drainage. Total perioperative blood loss and transfusion requirements (cell saver, autologous, directed, and allogeneic blood) were: 3442.8 +/- 1344.0 mL and 1537.1 +/- 905.1 mL in Group 1; 2089.8 +/- 684.0 mL and 485.2 +/- 349.8 mL in Group 2; and 2184.1 +/- 1163.7 mL and 531.5 +/- 510.5 mL in Group 3. There were no Amicar related complications. Amicar was highly effective in decreasing total perioperative blood loss and transfusion requirements in same-day ASF and PSF with SSI for idiopathic scoliosis. It results in less preoperative autologous blood donation, perioperative blood transfusion, costs, and potential transfusion-related complications. It was most effective in decreasing intraoperative estimated PSF with SSI blood loss. It had no significant effect during the ASF, postoperative chest tube, or PSF wound suction drainage. We now recommend that it be used for the PSF with SSI procedure only.

Analysis of Multispectral Galileo SSI Images of the Conamara Chaos Region, Europa

NASA Technical Reports Server (NTRS)

Spaun, N. A.; Phillips, C. B.

2003-01-01

Multispectral imaging of Europa s surface by Galileo s Solid State Imaging (SSI) camera has revealed two major surface color units, which appear as white and red-brown regions in enhanced color images of the surface (see figure). The Galileo Near- Infrared Mapping Spectrometer (NIMS) experiment suggests that the whitish material is icy, almost pure water ice, while the spectral signatures of the reddish regions are dominated by a non-ice material. Two endmember models have been proposed for the composition of the non-ice material: magnesium sulfate hydrates [1] and sulfuric acid and its byproducts [2]. There is also debate concerning whether the origin of this non-ice material is exogenic or endogenic [3].Goals: The key questions this work addresses are: 1) Is the non-ice material exogenic or endogenic in origin? 2) Once emplaced, is this non-ice material primarily modified by exogenic or endogenic processes? 3) Is the non-ice material within ridges, bands, chaos, and lenticulae the same non-ice material across all such geological features? 4) Does the distribution of the non-ice material provide any evidence for or against any of the various models for feature formation? 5) To what extent do the effects of scattered light in SSI images change the spectral signatures of geological features?

Spatiotemporal analysis of hydro-meteorological drought in the Johor River Basin, Malaysia

NASA Astrophysics Data System (ADS)

Tan, Mou Leong; Chua, Vivien P.; Li, Cheng; Brindha, K.

2018-02-01

Assessment of historical hydro-meteorological drought is important to develop a robust drought monitoring and prediction system. This study aims to assess the historical hydro-meteorological drought of the Johor River Basin (JRB) from 1975 to 2010, an important basin for the population of southern Peninsular Malaysia and Singapore. The Standardized Precipitation Index (SPI) and Standardized Streamflow Index (SSI) were selected to represent the meteorological and hydrological droughts, respectively. Four absolute homogeneity tests were used to assess the rainfall data from 20 stations, and two stations were flagged by these tests. Results indicate the SPI duration to be comparatively low (3 months), and drier conditions occur over the upper JRB. The annual SSI had a strong decreasing trend at 95% significance level, showing that human activities such as reservoir construction and agriculture (oil palm) have a major influence on streamflow in the middle and lower basin. In addition, moderate response rate of SSI to SPI was found, indicating that hydrological drought could also have occurred in normal climate condition. Generally, the El Niño-Southern Oscillation and Madden Julian Oscillation have greater impacts on drought events in the basin. Findings of this study could be beneficial for future drought projection and water resources management.

Citizenship Education and Socioscientific Issues: Implicit Concept of Citizenship in the Curriculum, Views of French Middle School Teachers

NASA Astrophysics Data System (ADS)

Barrue, Catherine; Albe, Virginie

2013-05-01

The educative goal of citizenship education through science education converges to the declared purpose of the SSI research movement. Socioscientific issues formulated in science education research covering topics as biotechnology, environmental issues, sustainable development, energy choices, have been introduced in French Middle Schools. But citizenship is often not clarified and can be multiple. After having clarified who is the citizen targeted by SSI research movement, the concept of citizen in the French curriculum needs to be clarify. What do these citizens have in common with the citizen that a sociology literature review let see oscillating between obedience and critical thinking has also been investigated. The paper also looks at the teachers' views and their contribution to citizenship education through socioscientific topics described in the national curriculum. From the analysis, different teachers' views of citizenship education have been highlighted: a normative citizenship education in connection with civility and rules and an emancipatory citizenship education to develop pupils' skills such as searching and evaluating information, argumentation and critical thinking in order to enable pupils to build their own argued opinion and to participate to public debates. This last emancipatory view of citizenship education is congruent with the aim of social empowerment within the SSI research movement.

Investigating the Intertwinement of Knowledge, Value, and Experience of Upper Secondary Students' Argumentation Concerning Socioscientific Issues

NASA Astrophysics Data System (ADS)

Rundgren, Carl-Johan; Eriksson, Martin; Rundgren, Shu-Nu Chang

2016-12-01

This study aims to explore students' argumentation and decision-making relating to an authentic socioscientific issue (SSI)—the problem of environmental toxins in fish from the Baltic Sea. A multi-disciplinary instructional module, designed in order to develop students' skills to argue about complex SSI, was successfully tested. Seven science majors in the final year of their upper secondary studies participated in this study. Their argumentation and decision-making processes were followed closely, and data were collected during multiple stages of the instructional module: group discussions were audio recorded, the participants wrote reports on their decision making, and postexercise interviews were conducted with individual students. The analysis focused on the skill of evaluation demonstrated by the students during the exercise and the relationships between the knowledge, values, and experiences that they used in their argumentation. Even though all of the students had access to the same information and agreed on the factual aspects of the issue, they came to different decisions. All of the students took counter-arguments and the limitations of their claims into account and were able to extend their claims where appropriate. However, their decisions differed depending on their background knowledge, values, and experiences (i.e., their intellectual baggage). The implication to SSI teaching and learning is discussed.

Chemical characteristics of Northeast Asian fly ash particles: Implications for their long-range transportation

NASA Astrophysics Data System (ADS)

Inoue, Jun; Momose, Azusa; Okudaira, Takamoto; Murakami-Kitase, Akiko; Yamazaki, Hideo; Yoshikawa, Shusaku

2014-10-01

The chemical compositions of fly ash particles emitted in Northeast Asia were studied to better understand the long-range transportation of atmospheric pollutants. We examined the compositions of spheroidal carbonaceous particles (SCPs), a type of fly ash from several to ˜20 μm in diameter found in surface sediments in or near the main industrial cities of Japan, China, South Korea, and Taiwan. SCPs from different countries were found to vary; SCPs from Japan and South Korea were characterized by low Ti/Si and high S/Si ratios, whereas SCPs in China exhibited high Ti/Si and low S/Si ratios and particles from Taiwan showed high Ti/Si and S/Si ratios. We also examined the SCPs found in remote islands in the Sea of Japan, at least 100 km from any industrial city. On the basis of their chemical compositions, these SCPs were classified as Japan and Korea, China, and Taiwan types using discriminant analysis. The results indicated that 30-50% of the particles found in these islands were assigned to the China type, suggesting that most of these SCPs were probably transported from Chinese industrial regions to these islands. It implies that even large particulate pollutants of ˜10 μm, such as SCPs, could be transported long distances of ˜1000 km.

20 CFR 416.1321 - Suspension for not giving us permission to contact financial institutions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... we think it is necessary to determine your SSI eligibility or payment amount, or if you cancel the... financial records about that person when we think it is necessary to determine your SSI eligibility or...

49 CFR 1520.13 - Marking SSI.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Transportation Other Regulations Relating to Transportation (Continued) TRANSPORTATION SECURITY ADMINISTRATION, DEPARTMENT OF HOMELAND SECURITY SECURITY RULES FOR ALL MODES OF TRANSPORTATION PROTECTION OF SENSITIVE SECURITY INFORMATION § 1520.13 Marking SSI. (a) Marking of paper records. In the case of paper records...

49 CFR 1520.19 - Destruction of SSI.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Transportation Other Regulations Relating to Transportation (Continued) TRANSPORTATION SECURITY ADMINISTRATION, DEPARTMENT OF HOMELAND SECURITY SECURITY RULES FOR ALL MODES OF TRANSPORTATION PROTECTION OF SENSITIVE SECURITY INFORMATION § 1520.19 Destruction of SSI. (a) DHS. Subject to the requirements of the Federal...

The Army Study Program Fiscal Year 1984 Report. Volume 2.

DTIC Science & Technology

1984-01-01

TRADOC COMBINED ARMS I& A NUCLEAR ENVIRONMENT (CAKE) FDTE ATORT-D-001 TRADOC COMMAND CLIMATE ASSESSMENT DAPEH-E-042 DCSPER COMMUNICATIONS VISSION AREA ...ANALYSIS 2538 TRADOC COMMUNICATIONS MISSION AREA ANALYSIS. LEVEL II. ATZHC-E-002 TRADOC COMMUNICATIONS SUPPORT REQUIREMENTS ATZLC-E-002 TRADOC COMC...CORPS (EAC) AWCIS-D-002 SSI ECHELONS AFCVE CCRFS COMMUNICATIONS PISSION AREA ANALYSIS (EUROPE) CCOPS-D-002 USACC ECONOMIC IMPACT GENERATED AGAINST

Differences of standard values of Supersonic shear imaging and ARFI technique - in vivo study of testicular tissue.

PubMed

Trottmann, M; Rübenthaler, J; Marcon, J; Stief, C G; Reiser, M F; Clevert, D A

2016-01-01

To investigate the difference of standard values of Supersonic shear imaging (SSI) and Acoustic Radiation Force Impulse (ARFI) technique in the evaluation of testicular tissue stiffness in vivo. 58 healthy male testes were examined using B-mode sonography and ARFI and SSI. B-mode sonography was performed in order to scan the testis for pathologies followed by performance of real-time elastography in three predefined areas (upper pole, central portion and lower pole) using the SuperSonic® Aixplorer ultrasound device (SuperSonic Imagine, Aix-en-Provence, France). Afterwards a second assessment of the same testicular regions by elastography followed using the ARFI technique of the Siemens Acuson 2000™ ultrasound device (Siemens Health Care, Germany). Values of shear wave velocity were described in m/s. Parameters of elastography techniques were compared using paired sample t-test. The values of SSI were all significantly higher in all measured areas compared to ARFI (p < 0.001 to p = 0.015). Quantitatively there was a higher mean SSI wave velocity value of 1,1 compared to 0.8 m/s measured by ARFI. SSI values are significantly higher than ARFI values when measuring the stiffness of testicular tissue and should only be compared with caution.

Prophylactic Bracing Has No Effect on Lower Extremity Alignment or Functional Performance.

PubMed

Hueber, Garrett A; Hall, Emily A; Sage, Brad W; Docherty, Carrie L

2017-07-01

Prophylactic ankle bracing is commonly used during physical activity. Understanding how bracing affects body mechanics is critically important when discussing both injury prevention and sport performance. The purpose is to determine if ankle bracing affects lower extremity mechanics during the Landing Error Scoring System test (LESS) and Sage Sway Index (SSI). Thirty physically active participants volunteered for this study. Participants completed the LESS and SSI in both a braced and unsupported conditions. Total errors were recorded for the LESS. Total errors and time (seconds) were recorded for the SSI. The Wilcoxon signed-rank test was utilized to evaluate any differences between the brace conditions for each dependent variable. A priori alpha level was set at p<0.05. The Wilcoxon signed-rank test yielded no significant difference between the braced and unsupported conditions for the LESS (Z=-0.35, p=0.72), SSI time (Z=-0.36, p=0.72), or SSI Errors (Z=-0.37, p=0.71). Ankle braces had no effect on subjective clinical assessments of lower extremity alignment or postural stability. Utilization of a prophylactic support at the ankle did not substantially alter the proximal components of the lower kinetic chain. © Georg Thieme Verlag KG Stuttgart · New York.

Students' Participation in an Interdisciplinary, Socioscientific Issues Based Undergraduate Human Biology Major and Their Understanding of Scientific Inquiry

NASA Astrophysics Data System (ADS)

Eastwood, Jennifer L.; Sadler, Troy D.; Sherwood, Robert D.; Schlegel, Whitney M.

2013-06-01

The purpose of this study was to examine whether Socioscientific Issues (SSI) based learning environments affect university students' epistemological understanding of scientific inquiry differently from traditional science educational contexts. We identify and compare conceptions of scientific inquiry of students participating in an interdisciplinary, SSI-focused undergraduate human biology major (SSI) and those participating in a traditional biology major (BIO). Forty-five SSI students and 50 BIO students completed an open-ended questionnaire examining their understanding of scientific inquiry. Eight general themes including approximately 60 subthemes emerged from questionnaire responses, and the numbers of students including each subtheme in their responses were statistically compared between groups. A subset of students participated in interviews, which were used to validate and triangulate questionnaire data and probe students' understanding of scientific inquiry in relation to their majors. We found that both groups provided very similar responses, differing significantly in only five subthemes. Results indicated that both groups held generally adequate understandings of inquiry, but also a number of misconceptions. Small differences between groups supported by both questionnaires and interviews suggest that the SSI context contributed to nuanced understandings, such as a more interdisciplinary and problem-centered conception of scientific inquiry. Implications for teaching and research are discussed.

Supplemental security income and social security disability insurance coverage among long-term childhood cancer survivors.

PubMed

Kirchhoff, Anne C; Parsons, Helen M; Kuhlthau, Karen A; Leisenring, Wendy; Donelan, Karen; Warner, Echo L; Armstrong, Gregory T; Robison, Leslie L; Oeffinger, Kevin C; Park, Elyse R

2015-06-01

Supplemental security income (SSI) and social security disability insurance (DI) are federal programs that provide disability benefits. We report on SSI/DI enrollment in a random sample of adult, long-term survivors of childhood cancer (n = 698) vs a comparison group without cancer (n = 210) from the Childhood Cancer Survivor Study who completed a health insurance survey. A total of 13.5% and 10.0% of survivors had ever been enrolled on SSI or DI, respectively, compared with 2.6% and 5.4% of the comparison group. Cranial radiation doses of 25 Gy or more were associated with a higher risk of current SSI (relative risk [RR] = 3.93, 95% confidence interval [CI] = 2.05 to 7.56) and DI (RR = 3.65, 95% CI = 1.65 to 8.06) enrollment. Survivors with severe/life-threatening conditions were more often enrolled on SSI (RR = 3.77, 95% CI = 2.04 to 6.96) and DI (RR = 2.73, 95% CI = 1.45 to 5.14) compared with those with mild/moderate or no health conditions. Further research is needed on disability-related financial challenges after childhood cancer. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Socioscientific Issues: A Path Towards Advanced Scientific Literacy and Improved Conceptual Understanding of Socially Controversial Scientific Theories

NASA Astrophysics Data System (ADS)

Pinzino, Dean William

This thesis investigates the use of socioscientific issues (SSI) in the high school science classroom as an introduction to argumentation and socioscientific reasoning, with the goal of improving students' scientific literacy (SL). Current research is reviewed that supports the likelihood of students developing a greater conceptual understanding of scientific theories as well as a deeper understanding of the nature of science (NOS), through participation in informal and formal forms of argumentation in the context of SSI. Significant gains in such understanding may improve a student's ability to recognize the rigor, legitimacy, and veracity of scientific claims and better discern science from pseudoscience. Furthermore, students that participate in significant SSI instruction by negotiating a range of science-related social issues can make significant gains in content knowledge and develop the life-long skills of argumentation and evidence-based reasoning, goals not possible in traditional lecture-based science instruction. SSI-based instruction may therefore help students become responsible citizens. This synthesis also suggests that that the improvements in science literacy and NOS understanding that develop from sustained engagement in SSI-based instruction will better prepare students to examine and scrutinize socially controversial scientific theories (i.e., evolution, global warming, and the Big Bang).

Comment on the Article by Thuillier et al. "The Infrared Solar Spectrum Measured by the SOLSPEC Spectrometer onboard the International Space Station". Invited Review

NASA Astrophysics Data System (ADS)

Weber, M.

2015-06-01

Thuillier et al. ( Solar Phys., 2015, DOI:10.1007/s11207-015-0704-1) discuss the apparent discrepancy between the ATLAS-3 composite solar spectral irradiances (SSI) covering the ultraviolet/visible/near-infrared (NIR) spectral region with more recent SSI measurements in the NIR. Recent measurements from IRSPERAD, CAVIAR, SCIAMACHY, SOLSPEC/ISS (the SOLAR2 spectrum from 2008), and unadjusted SIM show that above about 1600 nm, SSI is lower by about 8 % with respect to ATLAS-3. A new correction is presented in Thuillier et al. (2015) that leads to SOLSPEC/ISS (SOLAR2rev) which is in better agreement with ATLAS-3. SOLSPEC/ISS SSI underwent a +10 % change from 2008 to 2010, leading to better agreement with ATLAS-3, but it remains unclear which year provided the proper radiometric level, 2008 (SOLAR2) or 2010 (SOLAR2rev) as no link to pre-launch calibration is established. Before interpreting the NIR SSI observations using our current physical understanding (constraints by the total solar irradiance and solar models), the cause for the discrepancy between the early ATLAS-3 and all recent measurements (without a-posteriori adjustments) needs to be understood considering instrument and calibration performance alone.

Burden of Surgical Site Infections Associated with Arthroplasty and the Contribution of Staphylococcus aureus.

PubMed

Patel, Harshila; Khoury, Hanane; Girgenti, Douglas; Welner, Sharon; Yu, Holly

2016-02-01

Patients undergoing arthroplasty are at considerable risk of experiencing post-operative complications, including surgical site infections (SSIs). In addition to potential economic consequences, SSIs can have a negative impact on patient outcomes and may potentially be life-threatening. Staphylococcus aureus has been consistently shown as the leading cause of SSIs associated with orthopedic surgery, with an important contribution from methicillin-resistant S. aureus (MRSA). This study evaluated the global burden of SSIs among patients undergoing orthopedic surgical procedures, and specifically those undergoing knee and hip arthroplasties. An extensive search of PubMed and recent conference proceedings was conducted. English articles published between 2003 and 2013 pertaining to SSI epidemiology, patient outcomes, and healthcare resource utilization and costs were reviewed. Overall, 81 studies were included, mainly from North America and Europe. Median SSI and S. aureus SSI rates, calculated as percentage of all arthroplasty procedures, were 1.7% (range: 0.25%-4.4%; 15 studies) and 0.6% (range: 0.1%-23%), respectively. Median SSI rates were 1.3% (range: 0.05%-19%; 22 studies) after knee arthroplasty, and 2.1% (range: 0.05%-28%; 24 studies) after hip arthroplasty. S. aureus SSI rates ranged from 0.2%-2.4% and 0.18%-3.8% for patients undergoing knee and hip arthroplasty, respectively. The percentage of S. aureus SSIs because of MRSA varied widely within each patient category. SSI-related mortality data (14 studies) showed that in-hospital mortality rates were low (1.2%-2.5%), but increased with time after index arthroplasty procedure (up to 56% over 1 y). Studies assessing healthcare resource utilization (n = 21) revealed that developing post-orthopedic SSIs resulted in a two- to three-fold increase in length of hospital stay (LOS) compared with non-infected patients (median LOS: 18.9 d vs. 6 d for non-SSI patients). Patients with SSIs because of methicillin-resistant staphylococci incurred greater mean LOS compared with SSIs because of methicillin-sensitive organisms. Readmission rates reported in 11 studies indicate a greater likelihood in the presence of SSIs; comparison across studies was not feasible because of differences in data reporting. Consistent with increased healthcare resource utilization (LOS and readmission) associated with SSIs, cost studies (n = 23) revealed that the presence of SSIs was associated with up to three-fold cost increase compared with the absence of SSI across all orthopedic patient categories assessed. SSIs are associated with increased morbidity, mortality rates, healthcare resource utilization, and costs. Despite the relatively low SSI incidence following orthopedic surgery and specifically arthroplasty, preventive methods, specifically those targeting S. aureus, would serve to minimize costs and improve patient outcomes.

A Novel Wound Retractor Combining Continuous Irrigation and Barrier Protection Reduces Incisional Contamination in Colorectal Surgery.

PubMed

Papaconstantinou, Harry T; Ricciardi, Rocco; Margolin, David A; Bergamaschi, Roberto; Moesinger, Robert C; Lichliter, Warren E; Birnbaum, Elisa H

2018-03-09

Surgical site infection (SSI) remains a persistent and morbid problem in colorectal surgery. Key to its pathogenesis is the degree of intraoperative bacterial contamination at the surgical site. The purpose of this study was to evaluate a novel wound retractor at reducing bacterial contamination. A prospective multicenter pilot study utilizing a novel wound retractor combining continuous irrigation and barrier protection was conducted in patients undergoing elective colorectal resections. Culture swabs were collected from the incision edge prior to device placement and from the exposed and protected incision edge prior to device removal. The primary and secondary endpoints were the rate of enteric and overall bacterial contamination on the exposed incision edge as compared to the protected incision edge, respectively. The safety endpoint was the absence of serious device-related adverse events. A total of 86 patients were eligible for analysis. The novel wound retractor was associated with a 66% reduction in overall bacterial contamination at the protected incision edge compared to the exposed incision edge (11.9 vs. 34.5%, P < 0.001), and 71% reduction in enteric bacterial contamination (9.5% vs. 33.3%, P < 0.001). The incisional SSI rate was 2.3% in the primary analysis and 1.2% in those that completed the protocol. There were no adverse events attributed to device use. A novel wound retractor combining continuous irrigation and barrier protection was associated with a significant reduction in bacterial contamination. Improved methods to counteract wound contamination represent a promising strategy for SSI prevention (NCT 02413879).

Cost Analysis and Surgical Site Infection Rates in Total Knee Arthroplasty Comparing Traditional vs. Single-Use Instrumentation.

PubMed

Siegel, Geoffrey W; Patel, Neil N; Milshteyn, Michael A; Buzas, David; Lombardo, Daniel J; Morawa, Lawrence G

2015-12-01

Surgical site infections (SSIs) are a significant complications in total knee arthroplasty (TKA). The purpose of this study was to evaluate if traditional vs. single-use instrumentation had an effect on SSI's. We compared SSI rates and costs of TKAs performed with single-use (449) and traditional (169) TKA instrumentation trays. Total OR Time was, on average, 30 min less when single-use instrumentation was used. SSIs decreased in the single-use group (n=1) compared to the traditional group (n=5) (P=0.006). Single-use instrumentation added $490 in initial costs; however it saved between $480 and $600. Single-use instrumentation may provide a benefit to the patient by potentially decreasing the risk of infection and reducing the overall hospital costs. Copyright © 2015 Elsevier Inc. All rights reserved.

MarsQuest: Bringing the Excitement of Mars Exploration to the Public

NASA Astrophysics Data System (ADS)

Dusenbery, P. B.; Morrow, C. A.; Harold, J. B.; Klug, S. L.

2002-12-01

We are living in an extraordinary era of Mars exploration. NASA's Odyssey spacecraft has recently discovered vast amounts of hydrogen beneath the surface of Mars, suggesting the presence of sub-surface ice. Two Mars Exploration Rovers are scheduled to land in early 2004. To bring the excitement and discoveries of Mars exploration to the public, the Space Science Institute (SSI) of Boulder, CO, has developed a comprehensive Mars Education Program that includes: 1) large and small traveling exhibits, 2) workshops for museum and classroom educators (in partnership with the Mars Education Program at Arizona State University (ASU)), and 3) an interactive Website called MarsQuest Online (in partnership with TERC and JPL). All three components will be presented and offered as a good model for actively involving scientists and their discoveries to improve science education in museums and the classroom. The centerpiece of SSI's Mars Education Program is the 5,000-square-foot traveling exhibition, MarsQuest: Exploring the Red Planet, which was developed with support from the National Science Foundation (NSF), NASA, and several corporate donors. The MarsQuest exhibit is nearing the end of a highly successful, fully-booked three-year tour. The Institute plans to send an enhanced and updated MarsQuest on a second three-year tour and is also developing Destination: Mars, a mini-version of MarsQuest designed for smaller venues. Workshops for museum educators, docents, and local teachers are conducted at host sites. These workshops were developed collaboratively by Dr. Cheri Morrow, SSI's Education and Public Outreach Manager, and Sheri Klug, Director of the Mars K-12 Education Program at ASU. They are designed to inspire and empower participants to extend the excitement and science content of the exhibitions into classrooms and museum-based education programs in an ongoing fashion. The MarsQuest Online project is developing a Website that will use the MarsQuest exhibit as a context for online interactives that delve deeper into Mars science. This project, supported by NSF, will explore the potential for in-depth, Web-based studies that extend museum exhibit content onto the Web.

MarsQuest: Bringing the Excitement of Mars Exploration to the Public

NASA Astrophysics Data System (ADS)

Dusenbery, P. B.; Morrow, C. A.; Harold, J. B.; Klug, S. L.

2002-09-01

We are living in an extraordinary era of Mars exploration. NASA's Odyssey spacecraft has recently discovered vast amounts of hydrogen beneath the surface of Mars, suggesting the presence of sub-surface ice. Two Mars Exploration Rovers are scheduled to land in early 2004. To bring the excitement and discoveries of Mars exploration to the public, the Space Science Institute (SSI) of Boulder, CO, has developed a comprehensive Mars Education Program that includes: 1) large and small traveling exhibits, 2) workshops for museum and classroom educators (in partnership with the Mars Education Program at Arizona State University (ASU)), and 3) an interactive Website called MarsQuest Online (in partnership with TERC and JPL). All three components will be presented and offered as a good model for actively involving scientists and their discoveries to improve science education in museums and the classroom. The centerpiece of SSI's Mars Education Program is the 5,000-square-foot traveling exhibition, MarsQuest: Exploring the Red Planet, which was developed with support from the National Science Foundation (NSF), NASA, and several corporate donors. The MarsQuest exhibit is nearing the end of a highly successful, fully-booked three-year tour. The Institute plans to send an enhanced and updated MarsQuest on a second three-year tour and is also developing Destination: Mars, a mini-version of MarsQuest designed for smaller venues. Workshops for museum educators, docents, and local teachers are conducted at host sites. These workshops were developed collaboratively by Dr. Cheri Morrow, SSI's Education and Public Outreach Manager, and Sheri Klug, Director of the Mars K-12 Education Program at ASU. They are designed to inspire and empower participants to extend the excitement and science content of the exhibitions into classrooms and museum-based education programs in an ongoing fashion. The MarsQuest Online project is developing a Website that will use the MarsQuest exhibit as a context for online interactives that delve deeper into Mars science. This project, supported by NSF, will explore the potential for in-depth, Web-based studies that extend museum exhibit content onto the Web.

Is hospital information system relevant to detect surgical site infection? Findings from a prospective surveillance study in posterior instrumented spinal surgery.

PubMed

Boetto, J; Chan-Seng, E; Lonjon, G; Pech, J; Lotthé, A; Lonjon, N

2015-11-01

Spinal instrumentation has a high rate of surgical site infection (SSI), but results greatly vary depending on surveillance methodology, surgical procedures, or quality of follow-up. Our aim was to study true incidence of SSI in spinal surgery by significant data collection, and to compare it with the results obtained through the hospital information system. This work is a single center prospective cohort study that included all patients consecutively operated on for spinal instrumentation by posterior approach over a six-month period regardless the etiology. For all patients, a "high definition" prospective method of surveillance was performed by the infection control (IC) department during at least 12 months after surgery. Results were then compared with findings from automatic surveillance though the hospital information system (HIS). One hundred and fifty-four patients were included. We found no hardly difference between "high definition" and automatic surveillance through the HIS, even if HIS tended to under-estimate the infection rate: rate of surgical site infection was 2.60% and gross SSI incidence rate via the hospital information system was 1.95%. Smoking and alcohol consumption were significantly related to a SSI. Our SSI rates to reflect the true incidence of infectious complications in posterior instrumented adult spinal surgery in our hospital and these results were consistent with the lower levels of published infection rate. In-house surveillance by surgeons only is insufficiently sensitive. Further studies with more patients and a longer inclusion time are needed to conclude if SSI case detection through the HIS could be a relevant and effective alternative method. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Sorce Observations of Solar Cycles 23 and 24 - What's New? What's Next?

NASA Astrophysics Data System (ADS)

Cahalan, R. F.; Kopp, G.; Pilewskie, P.; Richard, E. C.; Woods, T. N.

2014-12-01

We discuss recent changes in estimates of the Total Solar Irradiance (TSI, formerly "solar constant") and the energy budget. This more accurate value of TSI implies a more accurate estimate of the Sun's luminosity, and lifetime. We highlight the historic closing of the calibration gap between the suite of TSI instruments, due largely to comparisons made with a cryogenic Transfer Radiometer Facility (TRF) located at the University of Colorado, built by UCO/LASP with support from NASA and NIST. The resulting continuous record of TSI promises to be a milestone in improving understanding of the Sun's impact on Earth's climate. Climate models are sensitive not only to TSI, but also to variations in the Spectral Solar Irradiance (SSI), and the vertical profiles of temperature and ozone are especially sensitive to SSI variations. Variations in SSI need further study before they may be considered as firmly established as TSI variations, which themselves remain controversial, despite a strengthening consensus over the SORCE epoch. The TSIS SIM has recently undergone comprehensive end-to-end calibration in the LASP SSI Radiometry Facility (SRF) utilizing the NIST SIRCUS laser system covering 210-2400 nm for SSI, a facility not yet available when SORCE launched in 2003. With SORCE follow-on missions such as the Total and Spectral Solar Irradiance Sensor (TSIS), we anticipate narrowing uncertainties in SSI variability that will be important to improving our understanding of the climate responses to solar forcing. The long-term goal of improving the ability to monitor Earth's energy balance, and the energy imbalance that drives global warming, will need continued improvements in the measurement of both shortwave solar and longwave earth-emitted radiation.

Prophylaxis of surgical site infection in adult spine surgery: A systematic review.

PubMed

Yao, Reina; Tan, Terence; Tee, Jin Wee; Street, John

2018-06-01

Surgical site infection (SSI) remains a significant source of morbidity in spine surgery, with reported rates varying from 0.7 to 16%. To systematically review and evaluate the evidence for strategies for prophylaxis of SSI in adult spine surgery in the last twenty years. Two independent systematic searches were conducted, at two international spine centers, encompassing PubMed, ClinicalTrials.gov, Cochrane Database, EBSCO Medline, ScienceDirect, Ovid Medline, EMBASE (Ovid), and MEDLINE. References were combined and screened, then distilled to 69 independent studies for final review. 11 randomized controlled trials (RCTs), 51 case-controlled studies (CCS), and 7 case series were identified. Wide variation exists in surgical indications, approaches, procedures, and even definitions of SSI. Intra-wound vancomycin powder was the most widely studied intervention (19 studies, 1 RCT). Multiple studies examined perioperative antibiotic protocols, closed-suction drainage, povidone-iodine solution irrigation, and 2-octyl-cyanoacrylate skin closure. 18 interventions were examined by a single study only. There is limited evidence for the efficacy of intra-wound vancomycin. There is strong evidence that closed-suction drainage does not affect SSI rates, while there is moderate evidence for the efficacy of povidone-iodine irrigation and that single-dose preoperative antibiotics is as effective as multiple doses. Few conclusions can be drawn about other interventions given the paucity and poor quality of studies. While a small body of evidence underscores a select few interventions for SSI prophylaxis in adult spine surgery, most proposed measures have not been investigated beyond a single study. Further high level evidence is required to justify SSI preventative treatments. Copyright © 2018 Elsevier Ltd. All rights reserved.

Implementation of Preoperative Screening Criteria Lowers Infection and Complication Rates Following Elective Total Hip Arthroplasty and Total Knee Arthroplasty in a Veteran Population.

PubMed

Nussenbaum, Fernando D; Rodriguez-Quintana, David; Fish, Sara M; Green, David M; Cahill, Catherine W

2018-01-01

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common procedures with a risk of complications. Attempting to minimize complications, our institution implemented preoperative screening criteria for patients undergoing elective total joint replacement. Our study aimed to determine if screening criteria lowered total complications and/or surgical site infections (SSI). Two groups of consecutive patients undergoing TKA and THA at a single Veterans Affairs facility were evaluated prior to and after implementation of screening criteria, 520 and 475 respectively. Screening criteria included hemoglobin A1c ≤7, hemoglobin ≥11, body mass index ≤35, and albumin ≥3.5. Groups were analyzed for demographics, preoperative comorbidities, and postoperative complications. Rates of total complications and SSI were compared. Average follow-up was at least 2 years with minimum of 1 year. Demographics and comorbidities outside the screening criteria were similar. Total complication rate was reduced from 35.4% to 14.8% (P < .01) after implementation of screening criteria. For TKA, total complications were reduced from 33.1% to 15.0% (P < .01) and for THA they were reduced from 42.4% to 14.2% (P < .01). SSI rates for combined TKA and THA were reduced from 4.4% to 1.3% (P < .01). For knees, SSI was reduced from 4.6% to 1.3% (P = .01) and was statistically significant. For THA, SSI decreased from 3.8% to 1.2% (P < .05). Our institution saw a statistically significant decrease in both SSI and total complications following implementation of preoperative screening criteria for elective TKA and THA. Published by Elsevier Inc.

Does surgical site infection after Caesarean section in Polish hospitals reflect high-quality patient care or poor postdischarge surveillance? Results from a 3-year multicenter study.

PubMed

Różańska, Anna; Jarynowski, Andrzej; Kopeć-Godlewska, Katarzyna; Wójkowska-Mach, Jadwiga; Misiewska-Kaczur, Agnieszka; Lech, Marzena; Rozwadowska, Małgorzata; Karwacka, Marlena; Liberda, Joanna; Domańska, Joanna

2018-01-01

Caesarean sections (CSs) are associated with a high infection risk. Surgical site infection (SSI) incidence is among the markers of effectiveness of infection prevention efforts. The aim of this study was to analyze risk factors for SSI, incidence, and microbiology in patients who underwent CS. The study was conducted during 2013-2015 using active infection surveillance in 5 Polish hospitals according to the European Centre for Disease Prevention and Control surveillance network known as HAI-Net. For each procedure, the following data were registered: age, American Society of Anesthesiologists score, procedure time, elective or emergency procedure, use of perioperative antibiotic prophylaxis, microbiology, the treatment used, and other information. SSI incidence was 0.5% and significant differences were noted among hospitals (between 0.1% and 1.8%), for different American Society of Anesthesiologists scales (between 0.2% and 4.8%) and different values of standardized SSI risk index (between 0.0% and 0.8%). In 3.1% of procedures, with no antibiotic prophylaxis, SSI risk was significantly higher. Deep infections dominated: 61.5% with superficial infections in only approximately 30% of cases and 2.6% of infections were detected postdischarge without readmissions. Results showed high incidence of SSI in Poland without perioperative antibiotic prophylaxis, and secondly, ineffective surveillance according to CS status, considering outpatient obstetric care. Without postdischarge surveillance, it is not possible to recognize the epidemiologic situation, and further, to set priorities and needs when it comes to infection prophylaxis, especially because such low incidence may indicate no need for improvement in infection control. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

A retrospective study of antibiotic prophylaxis value in surgical treatment of lower limb fracture.

PubMed

Bandalović, Ante; Zindović, Antonija; Boschi, Vladimir; Bakota, Bore; Marinović, Marin; Čoklo, Miran; Rošin, Matko; Parać, Zlatko; Čukelj, Fabijan

2015-11-01

Surgical site infections (SSI) are nosocomial infections that cause considerable problems in orthopaedic surgery. Antibiotic prophylaxis can be used to reduce the risk for SSI. There is no universal antibiotic that can be recommended for prophylaxis in terms of coverage of all possible pathogens because of antibiotic resistance, and there are no universal recommendations for different types of patients in terms of injury type, selected operation and risk factors for development of SSI. The aim of this study was to analyse the effectiveness of antibiotic prophylaxis in surgical treatment (ORIF) of closed lower limb fractures in young, healthy patients. Patient details were collected from the patient histories. Inclusion criteria for participants were age 20-30 years, not suffering from any type of chronic disease or state that may affect postoperative infection and ISS≤9. Antibiotic prophylaxis use and outcome (SSI) were compared between two groups of patients. Data were analysed using descriptive statistics, Fisher's exact test and t-test for proportions. A total of 347 patients with closed lower limb fractures treated with ORIF met the inclusion criteria. There were 290 male and 57 female patients, with an average age of 24.47 years. Prophylactic antibiotics were given to 242 patients (69.74%); 2g ceftriaxone was administered to 88.02% of the patients who received antibiotic prophylaxis. Ten patients developed postoperative infection (eight out of 242 with antibiotic prophylaxis and two out of 105 without antibiotic prophylaxis). The difference between the two groups was not statistically significant (Fisher's exact test, P=0.749). Antibiotic prophylaxis was ineffective in preventing SSI in patients with no risk factors for SSI who were undergoing ORIF for closed lower limb fractures. Copyright © 2015 Elsevier Ltd. All rights reserved.

SSI/MSI/LSI/VLSI/ULSI.

ERIC Educational Resources Information Center

Alexander, George

1984-01-01

Discusses small-scale integrated (SSI), medium-scale integrated (MSI), large-scale integrated (LSI), very large-scale integrated (VLSI), and ultra large-scale integrated (ULSI) chips. The development and properties of these chips, uses of gallium arsenide, Josephson devices (two superconducting strips sandwiching a thin insulator), and future…

76 FR 60755 - Air Cargo Screening; Reopening of Comment Period

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-30

... activities, the disclosure of which would constitute an unwarranted invasion of privacy, reveal trade secrets... secrets, confidential commercial or financial information, or SSI to the public regulatory docket. Please.... TSA will hold documents containing SSI, confidential business information, or trade secrets in a...

Risk factors associated with surgical site infection and the development of short-term complications in macaques undergoing indwelling vascular access port placement.

PubMed

Graham, M L; Rieke, E F; Wijkstrom, M; Dunning, M; Aasheim, T C; Graczyk, M J; Pilon, K J; Hering, B J

2008-08-01

Risk factors associated with surgical site infection (SSI) and the development of short-term complications in macaques undergoing vascular access port (VAP) placement are evaluated in this study. Records from 80 macaques with VAPs were retrospectively reviewed. Logistic regression was used to identify factors associated with short-term post-operative complications. The primary outcome was SSI, which occurred in 21.6% (52.6% in the first 12 months vs. 13% thereafter) of procedures. SSI was associated with major secondary complications including VAP removal (11.4%), wound dehiscence (5.7%), and mechanical catheter occlusion (5.7%). In multivariate modeling, only surgical program progress was a statistically significant predictor of SSI, while animal compliance had a slightly protective effect. Vascular access ports have a moderate risk of complications, provided the surgical program optimizes best practices. Under complex experimental conditions, VAPs represent an important refinement, both improving animals' overall well-being and environment and reducing stress.

Elderly Immigrants' Labor Supply Response to Supplemental Security Income.

PubMed

Kaushal, Neeraj

2010-01-01

This paper examined how the 1996 Personal Responsibility and Work Opportunity Reconciliation Act, which banned Supplemental Security Income to the majority of elderly immigrants, affected their employment, retirement, and family incomes. The policy was found to be associated with a 3.5 percentage point (9.5 percent) increase in the employment and a 3.8 percentage point (7 percent) decrease in the retirement of foreign-born elderly men. Partly as a result of their employment response, SSI ineligibility and the consequent decline in SSI receipt did not have any statistically significant effects on the family incomes of elderly foreign-born men. Noncitizen elderly women, on the other hand, did not experience any increase in employment, and those without family support suffered a 10 to 17 percent decline in income. These findings suggest that access to SSI did not create work disincentives for noncitizen elderly women and that SSI restrictions have imposed financial hardship on those without any family support, many of whom perhaps cannot effectively increase their employment.

Plastic freezer bags: a cost-effective method to protect extraction sites in laparoscopic colorectal procedures?

PubMed

Huynh, Hai P; Musselman, Reilly P; Trottier, Daniel C; Soto, Claudia M; Poulin, Eric C; Mamazza, Joseph; Boushey, Robin P; Auer, Rebecca C; Moloo, Husein

2013-10-01

To review surgical-site infection (SSI) and retrieval-site tumor recurrence rates in laparoscopic colorectal procedures when using a plastic freezer bag as a wound protector. Laparoscopic colorectal procedures where a plastic freezer bag used as a wound protector at the extraction site were reviewed between 1991 and 2008 from a prospectively collected database. χ test was used to compare SSI and tumor recurrence rates between groups. Costing data were obtained from the operating room supplies department. A total of 936 cases with 51 (5.45%) surgical-site infections were identified. SSI rates did not differ when comparing groups based on demographic factors, diagnosis, or location of procedure. Retrieval-site tumor recurrence rate was 0.21% (1/474). Cost of plastic freezer bags including sterilization ranged from $0.25 to $3. Plastic freezer bags as wound protectors in laparoscopic colorectal procedures are cost effective and have SSI and retrieval-site tumor recurrence rates that compare favorably to published data.

Reflectance spectroscopy for the assessment of soil salt content in soils of the yellow river delta of China

USGS Publications Warehouse

Weng, Yongling; Gong, P.; Zhu, Z.

2008-01-01

There has been growing interest in the use of reflectance spectroscopy as a rapid and inexpensive tool for soil characterization. In this study, we collected 95 soil samples from the Yellow River Delta of China to investigate the level of soil salinity in relation to soil spectra. Sample plots were selected based on a field investigation and the corresponding soil salinity classification map to maximize variations of saline characteristics in the soil. Spectral reflectances of air-dried soil samples were measured using an Analytical Spectral Device (ASD) spectrometer (350-2500 nm) with an artificial light source. In the Yellow River Delta, the dominant chemical in the saline soil was NaCl and MgCl2. Soil spectra were analysed using two-thirds of the available samples, with the remaining one-third withheld for validation purposes. The analysis indicated that with some preprocessing, the reflectance at 1931-2123 nm and 2153-2254 nm was highly correlated with soil salt content (SSC). In the spectral region of 1931-2123 nm, the correlation R ranged from -0.80 to -0.87. In the region of 2153-2254 nm, the SSC was positively correlated with preprocessed reflectance (0.79-0.88). The preprocessing was done by fitting a convex hull to the reflectance curve and dividing the spectral reflectance by the value of the corresponding convex hull band by band. This process is called continuum removal, and the resulting ratio is called continuum removed reflectance (CR reflectance). However, the SSC did not have a high correlation with the unprocessed reflectance, and the correlation was always negative in the entire spectrum (350-2500 nm) with the strongest negative correlation at 1981 nm (R = -0.63). Moreover, we found a strong correlation (R=0.91) between a soil salinity index (SSI: Constructed using CR reflectance at 2052 nm and 2203 nm) and SSC. We estimated SSC as a function of SSI and SSI' (SSI': Constructed using unprocessed reflectance at 2052 nm and 2203 nm) using univariate regression. Validation of the estimation of SSC was conducted by comparing the estimated SSC with the holdout sample points. The comparison produced an estimated root mean squared error (RMSE) of 0.986 (SSC ranging from 0.06 to 12.30 g kg-1) and R2 of 0.873 for SSC with SSI as independent variable and RMSE of 1.248 and R2 of 0.8 for SSC with SSI' as independent variable. This study showed that a soil salinity index developed for CR reflectance at 2052 nm and 2203 nm on the basis of spectral absorption features of saline soil can be used as a quick and inexpensive method for soil salt-content estimation.

Teacher candidates' beliefs about including socioscientific issues in physics and chemistry

NASA Astrophysics Data System (ADS)

Barrett, Sarah Elizabeth

Teaching science for social justice involves a deliberate effort to reconstruct society into something more equitable and just. Introducing socioscientific issues (SSI) into science is one strategy toward this end. However, research indicates that SSI are rarely discussed in the physical sciences even though they exist. This may be due to the beliefs of chemistry and physics teachers with respect to what belongs in these subjects. If we wish to begin to influence these beliefs through initial teacher education, it is essential for teacher educators to understand the origins of these beliefs. In this qualitative study 12 teacher candidates were interviewed at 3 points during a 9 month teacher education program: at the beginning of the course (in September), after the first practicum (in November) and after the second practicum (in March). Teacher candidates' beliefs did not change significantly from the beginning of the study to the end. They displayed varying degrees of commitment to including SSI in their teaching. Based on their (a) conception of the ethics of science, (b) goals for science education, (c) idea of the place of ethics in science (education), and (d) beliefs about including SSI, the teacher candidates were divided into four groups. Four archetypes were derived: "Model Scientist/Engineer", "Model Individual", "Model Teacher", and "Model Citizen". Since these groups are archetypes, none of the participants fits into the categories perfectly but individual teacher candidates demonstrated more characteristics of one archetype than others. Only the 3 Model Citizens were committed to including SSI in their teaching while the others placed the priority on preparing students for the next level of schooling. A model was developed to serve as a microgeneology of teacher candidates' beliefs about including SSI in their teaching. It traced their beliefs from (a) life experiences to (b) conception of ethics and nature of science to (c) goals for science education to (d) inclusion or non-inclusion of SSI. Based on the archetypes, current beliefs were extrapolated into future beliefs. How teacher educators could use this model to influence the future beliefs of their students is discussed.

Software aspects of the Geant4 validation repository

NASA Astrophysics Data System (ADS)

Dotti, Andrea; Wenzel, Hans; Elvira, Daniel; Genser, Krzysztof; Yarba, Julia; Carminati, Federico; Folger, Gunter; Konstantinov, Dmitri; Pokorski, Witold; Ribon, Alberto

2017-10-01

The Geant4, GeantV and GENIE collaborations regularly perform validation and regression tests for simulation results. DoSSiER (Database of Scientific Simulation and Experimental Results) is being developed as a central repository to store the simulation results as well as the experimental data used for validation. DoSSiER is easily accessible via a web application. In addition, a web service allows for programmatic access to the repository to extract records in JSON or XML exchange formats. In this article, we describe the functionality and the current status of various components of DoSSiER as well as the technology choices we made.

Software Aspects of the Geant4 Validation Repository

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dotti, Andrea; Wenzel, Hans; Elvira, Daniel

2016-01-01

The Geant4, GeantV and GENIE collaborations regularly perform validation and regression tests for simulation results. DoSSiER (Database of Scientic Simulation and Experimental Results) is being developed as a central repository to store the simulation results as well as the experimental data used for validation. DoSSiER is easily accessible via a web application. In addition, a web service allows for programmatic access to the repository to extract records in JSON or XML exchange formats. In this article, we describe the functionality and the current status of various components of DoSSiER as well as the technology choices we made.

Active Volcanism on Io as Seen by Galileo SSI

USGS Publications Warehouse

McEwen, A.S.; Keszthelyi, L.; Geissler, P.; Simonelli, D.P.; Carr, M.H.; Johnson, T.V.; Klaasen, K.P.; Breneman, H.H.; Jones, T.J.; Kaufman, J.M.; Magee, K.P.; Senske, D.A.; Belton, M.J.S.; Schubert, G.

1998-01-01

Active volcanism on Io has been monitored during the nominal Galileo satellite tour from mid 1996 through late 1997. The Solid State Imaging (SSI) experiment was able to observe many manifestations of this active volcanism, including (1) changes in the color and albedo of the surface, (2) active airborne plumes, and (3) glowing vents seen in eclipse. About 30 large-scale (tens of kilometers) surface changes are obvious from comparison of the SSI images to those acquired by Voyager in 1979. These include new pyroclastic deposits of several colors, bright and dark flows, and caldera-floor materials. There have also been significant surface changes on Io during the Galileo mission itself, such as a new 400-km-diameter dark pyroclastic deposit around Pillan Patera. While these surface changes are impressive, the number of large-scale changes observed in the four months between the Voyager 1 and Voyager 2 flybys in 1979 suggested that over 17 years the cumulative changes would have been much more impressive. There are two reasons why this was not actually the case. First, it appears that the most widespread plume deposits are ephemeral and seem to disappear within a few years. Second, it appears that a large fraction of the volcanic activity is confined to repeated resurfacing of dark calderas and flow fields that cover only a few percent of Io's surface. The plume monitoring has revealed 10 active plumes, comparable to the 9 plumes observed by Voyager. One of these plumes was visible only in the first orbit and three became active in the later orbits. Only the Prometheus plume has been consistently active and easy to detect. Observations of the Pele plume have been particularly intriguing since it was detected only once by SSI, despite repeated attempts, but has been detected several times by the Hubble Space Telescope at 255 nm. Pele's plume is much taller (460 km) than during Voyager 1 (300 km) and much fainter at visible wavelengths. Prometheus-type plumes (50-150 km high, long-lived, associated with high-temperature hot spots) may result from silicate lava flows or shallow intrusions interacting with near-surface SO2. A major and surprising result is that ~30 of Io's volcanic vents glow in the dark at the short wavelengths of SSI. These are probably due to thermal emission from surfaces hotter than 700 K (with most hotter than 1000 K), well above the temperature of pure sulfur volcanism. Active silicate volcanism appears ubiquitous. There are also widespread diffuse glows seen in eclipse, related to the interaction of energetic particles with the atmosphere. These diffuse glows are closely associated with the most active volcanic vents, supporting suggestions that Io's atmopshere is dominated by volcanic outgassing. Globally, volcanic centers are rather evenly distributed. However, 14 of the 15 active plumes seen by Voyager and/or Galileo are within 30?? of the equator, and there are concentrations of glows seen in eclipse at both the sub- and antijovian points. These patterns might be related to asthenospheric tidal heating or tidal stresses. Io will continue to be observed during the Galileo Europa Mission, which will climax with two close flybys of Io in late 1999. ?? 1998 Academic Press.

Active Volcanism on Io as Seen by Galileo SSI

NASA Astrophysics Data System (ADS)

McEwen, Alfred S.; Keszthelyi, Laszlo; Geissler, Paul; Simonelli, Damon P.; Carr, Michael H.; Johnson, Torrence V.; Klaasen, Kenneth P.; Breneman, H. Herbert; Jones, Todd J.; Kaufman, James M.; Magee, Kari P.; Senske, David A.; Belton, Michael J. S.; Schubert, Gerald

1998-09-01

Active volcanism on Io has been monitored during the nominal Galileo satellite tour from mid 1996 through late 1997. The Solid State Imaging (SSI) experiment was able to observe many manifestations of this active volcanism, including (1) changes in the color and albedo of the surface, (2) active airborne plumes, and (3) glowing vents seen in eclipse. About 30 large-scale (tens of kilometers) surface changes are obvious from comparison of the SSI images to those acquired by Voyager in 1979. These include new pyroclastic deposits of several colors, bright and dark flows, and caldera-floor materials. There have also been significant surface changes on Io during the Galileo mission itself, such as a new 400-km-diameter dark pyroclastic deposit around Pillan Patera. While these surface changes are impressive, the number of large-scale changes observed in the four months between the Voyager 1 and Voyager 2 flybys in 1979 suggested that over 17 years the cumulative changes would have been much more impressive. There are two reasons why this was not actually the case. First, it appears that the most widespread plume deposits are ephemeral and seem to disappear within a few years. Second, it appears that a large fraction of the volcanic activity is confined to repeated resurfacing of dark calderas and flow fields that cover only a few percent of Io's surface. The plume monitoring has revealed 10 active plumes, comparable to the 9 plumes observed by Voyager. One of these plumes was visible only in the first orbit and three became active in the later orbits. Only the Prometheus plume has been consistently active and easy to detect. Observations of the Pele plume have been particularly intriguing since it was detected only once by SSI, despite repeated attempts, but has been detected several times by the Hubble Space Telescope at 255 nm. Pele's plume is much taller (460 km) than during Voyager 1 (300 km) and much fainter at visible wavelengths. Prometheus-type plumes (50-150 km high, long-lived, associated with high-temperature hot spots) may result from silicate lava flows or shallow intrusions interacting with near-surface SO2. A major and surprising result is that ∼30 of Io's volcanic vents glow in the dark at the short wavelengths of SSI. These are probably due to thermal emission from surfaces hotter than 700 K (with most hotter than 1000 K), well above the temperature of pure sulfur volcanism. Active silicate volcanism appears ubiquitous. There are also widespread diffuse glows seen in eclipse, related to the interaction of energetic particles with the atmosphere. These diffuse glows are closely associated with the most active volcanic vents, supporting suggestions that Io's atmopshere is dominated by volcanic outgassing. Globally, volcanic centers are rather evenly distributed. However, 14 of the 15 active plumes seen by Voyager and/or Galileo are within 30° of the equator, and there are concentrations of glows seen in eclipse at both the sub- and antijovian points. These patterns might be related to asthenospheric tidal heating or tidal stresses. Io will continue to be observed during the Galileo Europa Mission, which will climax with two close flybys of Io in late 1999.

20 CFR 416.266 - Continuation of SSI status for Medicaid

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Continuation of SSI status for Medicaid 416.266 Section 416.266 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility Special Provisions for People Who Work Despite A...

42 CFR 407.42 - Buy-in groups available to the 50 States, the District of Columbia, and the Northern Mariana...

Code of Federal Regulations, 2010 CFR

2010-10-01

... following categories: (1) Category A: Individuals who— (i) Receive SSI or SSP or both; and (ii) Are covered... they were receiving SSI or SSP; and (ii) Are covered under the State's Medicaid plan as categorically...

Galileo SSI Observations of Io During Orbits C30 I33

NASA Technical Reports Server (NTRS)

Keszthelyi, L.; Turtle, E.; McEwen, A.; Simonelli, D.; Geissler, P.; Williams, D.; Milazzo, M.; Radebaugh, J.; Jaeger, W.; Klaasen, K. P.

2002-01-01

New Galileo SSI imaging of Io from orbits C30 I33 will be presented. The aging Galileo spacecraft continues to produce spectacular new results, including the tallest volcanic plume yet found on Io. Additional information is contained in the original extended abstract.

20 CFR 416.266 - Continuation of SSI status for Medicaid

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Continuation of SSI status for Medicaid 416.266 Section 416.266 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility Special Provisions for People Who Work Despite A...

20 CFR 416.266 - Continuation of SSI status for Medicaid

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Continuation of SSI status for Medicaid 416.266 Section 416.266 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility Special Provisions for People Who Work Despite A...

20 CFR 416.266 - Continuation of SSI status for Medicaid

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Continuation of SSI status for Medicaid 416.266 Section 416.266 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility Special Provisions for People Who Work Despite A...

The Effects of Local Warming on Surgical Site Infection

PubMed Central

Dellinger, E. Patchen; Weber, James; Swenson, Ron Edward; Kent, Christopher D.; Swanson, Paul E.; Harmon, Kurt; Perrin, Margot

2015-01-01

Abstract Background: Surgical site infections (SSI) account for a major proportion of hospital-acquired infections. They are associated with longer hospital stay, readmissions, increased costs, mortality, and morbidity. Reducing SSI is a goal of the Surgical Care Improvement Project and identifying interventions that reduce SSI effectively is of interest. In a single-blinded randomized controlled trial (RCT) we evaluated the effect of localized warming applied to surgical incisions on SSI development and selected cellular (immune, endothelial) and tissue responses (oxygenation, collagen). Methods: After Institutional Review Board approval and consent, patients having open bariatric, colon, or gynecologic-oncologic related operations were enrolled and randomly assigned to local incision warming (6 post-operative treatments) or non-warming. A prototype surgical bandage was used for all patients. The study protocol included intra-operative warming to maintain core temperature ≥36°C and administration of 0.80 FIO2. Patients were followed for 6 wks for the primary outcome of SSI determined by U.S. Centers for Disease Control (CDC) criteria and ASEPSIS scores (additional treatment; presence of serous discharge, erythema, purulent exudate, and separation of the deep tissues; isolation of bacteria; and duration of inpatient stay). Tissue oxygen (PscO2) and samples for cellular analyses were obtained using subcutaneous polytetrafluoroethylene (ePTFE) tubes and oxygen micro-electrodes implanted adjacent to the incision. Cellular and tissue ePTFE samples were evaluated using flow cytometry, immunohistochemistry, and Sircol™ collagen assay (Biocolor Ltd., Carrickfergus, United Kingdom). Results: One hundred forty-six patients participated (n=73 per group). Study groups were similar on demographic parameters and for intra-operative management factors. The CDC defined rate of SSI was 18%; occurrence of SSI between groups did not differ (p=0.27). At 2 wks, warmed patients had better ASEPSIS scores (p=0.04) but this difference was not observed at 6 wks. There were no significant differences in immune, endothelial cell, or collagen responses between groups. On post-operative days one to two, warmed patients had greater PscO2 change scores with an average PscO2 increase of 9–10 mm Hg above baseline (p<0.04). Conclusions: Post-operative local warming compared with non-warming followed in this study, which included intra-operative warming to maintain normothermia and FIO2 level of 0.80, did not reduce SSI and had no effect on immune, endothelial cell presence, or collagen synthesis. PscO2 increased significantly with warming, however, the increase was modest and less than expected or what has been observed in studies testing other interventions. PMID:26125454

Prophylactic Groin Wound Vacuum-assisted Therapy in Vascular Surgery Patients at Enhanced Risk for Postoperative Wound Infection.

PubMed

Pesonen, Luke O; Halloran, Brian G; Aziz, Abdulhameed

2018-01-01

Vascular groin wounds have higher than expected surgical site infection (SSI) rates and some patients are at enhanced risk. The Wiseman et al. paper suggests an objective scoring system that identifies patients at enhanced risk of postdischarge SSI. We hypothesize that prophylactic groin wound vacuum-assisted closure (VAC) therapy in enhanced risk patients will decrease SSI and readmission and the Wiseman model provides potential evidence that enhanced risk patients can be objectively identified. A single institution, retrospective analysis was conducted from January 2013 to September 2016 utilizing procedure codes to identify patients with wound VACs placed in the operating room. Two distinct groups were identified. The first was a wound complication patient group with 15 limbs (13 patients) with a groin wound VAC placed within 45 days postoperatively for groin wound complications. Eleven of these limbs had the VAC placed at readmission. The second group was a prophylactic patient group that included 8 limbs (7 patients) who received a VAC prophylactically placed in the enhanced risk wounds. These wounds were determined to be enhanced risk based on clinical criteria judged by the operating surgeon such as a large overhanging panniculus and/or one of several ongoing medical issues. We calculated a Wiseman score for all patients, determined total cost of the readmissions, and determined 30-day postsurgical SSI incidence for the prophylactic VAC group. Per the Wiseman scores, 9 limbs with postoperative complications were high risk and 3 limbs were moderate/high risk. Eleven limbs had a VAC placed at readmission with an average readmission cost of $8876.77. For the prophylactic group, 8 limbs were high risk with no observed postdischarge SSI in the first 30 days from surgery. The Wiseman scores showed close correlation between the retrospective high and moderate/high risk groups versus the prophylactic VAC group (31.5 ± 7.3 vs. 32 ± 5.5, P = 0.87). The Wiseman scores showed objective validation in the prognosis of anticipating groin wound breakdown. Our initial results suggest that prophylactic groin wound VAC placement for enhanced risk vascular surgery patients may proactively decrease wound morbidity, decrease readmission secondary to groin wound complications, and provide some cost benefit. Copyright © 2017 Elsevier Inc. All rights reserved.

Impact of operative time on early joint infection and deep vein thrombosis in primary total hip arthroplasty.

PubMed

Wills, B W; Sheppard, E D; Smith, W R; Staggers, J R; Li, P; Shah, A; Lee, S R; Naranje, S M

2018-03-22

Infections and deep vein thrombosis (DVT) after total hip arthroplasty (THA) are challenging problems for both the patient and surgeon. Previous studies have identified numerous risk factors for infections and DVT after THA but have often been limited by sample size. We aimed to evaluate the effect of operative time on early postoperative infection as well as DVT rates following THA. We hypothesized that an increase in operative time would result in increased odds of acquiring an infection as well as a DVT. We conducted a retrospective analysis of prospectively collected data using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2006 to 2015 for all patients undergoing primary THA. Associations between operative time and infection or DVT were evaluated with multivariable logistic regressions controlling for demographics and several known risks factors for infection. Three different types of infections were evaluated: (1) superficial surgical site infection (SSI), an infection involving the skin or subcutaneous tissue, (2) deep SSI, an infection involving the muscle or fascial layers beneath the subcutaneous tissue, and (3) organ/space infection, an infection involving any part of the anatomy manipulated during surgery other than the incisional components. In total, 103,044 patients who underwent THA were included in our study. Our results suggested a significant association between superficial SSIs and operative time. Specifically, the adjusted odds of suffering a superficial SSI increased by 6% (CI=1.04-1.08, p<0.0001) for every 10-minute increase of operative time. When using dichotomized operative time (<90minutes or >90minutes), the adjusted odds of suffering a superficial SSI was 56% higher for patients with prolonged operative time (CI=1.05-2.32, p=0.0277). The adjusted odds of suffering a deep SSI increased by 7% for every 10-minute increase in operative time (CI=1.01-1.14, p=0.0335). No significant associations were detected between organ/space infection, wound dehiscence, or DVT and operative time either as continuous or as dichotomized. Prolonged operative times (>90min) are associated with increased rates of superficial SSIs, but not deep SSIs, organ/space infections, wound dehiscence, or DVT. III. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Prophylactic antibiotics to prevent surgical site infection after breast cancer surgery.

PubMed

Jones, Daniel J; Bunn, Frances; Bell-Syer, Sophie V

2014-03-09

Surgery has been used as part of breast cancer treatment for centuries; however any surgical procedure has the potential risk of infection. Infection rates for surgical treatment of breast cancer are documented at between 3% and 15%, higher than average for a clean surgical procedure. Pre- and perioperative antibiotics have been found to be useful in lowering infection rates in other surgical groups, yet there is no consensus on the use of prophylactic antibiotics for breast cancer surgery. To determine the effects of prophylactic (pre- or perioperative) antibiotics on the incidence of surgical site infection (SSI) after breast cancer surgery. For this third update we searched the Cochrane Wounds Group Specialised Register (5 December 2013); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); the Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. We applied no language or date restrictions. Randomised controlled trials of pre- and perioperative antibiotics for patients undergoing surgery for breast cancer were included. Primary outcomes were rates of surgical site infection (SSI) and adverse reactions. Two review authors independently examined the title and abstracts of all studies identified by the search strategy, then assessed study quality and extracted data from those that met the inclusion criteria. A total of eleven studies (2867 participants) were included in the review. Ten studies evaluated preoperative antibiotic compared with no antibiotic or placebo. One study evaluated perioperative antibiotic compared with no antibiotic. Pooling of the results demonstrated that prophylactic antibiotics administered preoperatively significantly reduce the incidence of SSI for patients undergoing breast cancer surgery without reconstruction (pooled risk ratio (RR) 0.67, 95% confidence interval (CI) 0.53 to 0.85). Analysis of the single study comparing perioperative antibiotic with no antibiotic found no statistically significant effect of antibiotics on the incidence of SSI (RR 0.11, 95% CI 0.01 to 1.95). No studies presented separate data for patients who underwent reconstructive surgery at the time of removal of the breast tumour. Prophylactic antibiotics administered preoperatively reduce the risk of SSI in patients undergoing surgery for breast cancer. Further studies involving patients undergoing immediate breast reconstruction are needed as studies have identified this group as being at higher risk of infection than those who do not undergo immediate breast reconstruction.

Randomized controlled trial of perioperative antimicrobial therapy based on the results of preoperative bile cultures in patients undergoing biliary reconstruction.

PubMed

Okamura, Kunishige; Tanaka, Kimitaka; Miura, Takumi; Nakanishi, Yoshitsugu; Noji, Takehiro; Nakamura, Toru; Tsuchikawa, Takahiro; Okamura, Keisuke; Shichinohe, Toshiaki; Hirano, Satoshi

2017-07-01

The high frequency of surgical site infections (SSIs) after hepato-pancreato-biliary (HPB) surgery is a problem that needs to be addressed. This prospective, randomized, controlled study examined whether perioperative prophylactic use of antibiotics based on preoperative bile culture results in HPB surgery could decrease SSI. Participants comprised 126 patients who underwent HPB (bile duct, gallbladder, ampullary, or pancreatic) cancer surgery with biliary reconstruction at Hokkaido University Hospital between August 2008 and March 2013 (UMIN Clinical Trial Registry #00001278). Before surgery, subjects were randomly allocated to a targeted group administered antibiotics based on bile culture results or a standard group administered cefmetazole. The primary endpoint was SSI rates within 30 days after surgery. Secondary endpoint was SSI rates for each operative procedure. Of the 126 patients, 124 were randomly allocated (targeted group, n = 62; standard group, n = 62). Frequency of SSI after surgery was significantly lower in the targeted group (27 patients, 43.5%) than in the standard group (44 patients, 71.0%; P = 0.002). Among patients who underwent pancreaticoduodenectomy and hepatectomy, SSI occurred significantly less frequently in the targeted group (P = 0.001 and P = 0.025, respectively). This study demonstrated that preoperative bile culture-targeted administration of prophylactic antibiotics decreased SSIs following HBP surgery with biliary reconstruction. © 2017 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

POSTURAL CONTROL ASSESSMENT IN PHYSICALLY ACTIVE AND SEDENTARY INDIVIDUALS WITH PARAPLEGIA.

PubMed

Magnani, Paola Errera; Cliquet, Alberto; de Abreu, Daniela Cristina Carvalho

2017-01-01

The aim of this study was to evaluate functional independence and trunk control during maximum-range tasks in individuals with spinal cord injuries, who were divided into sedentary (SSI, n=10) and physically active (PASI, n=10) groups . Anamnesis was conducted and level and type of injury were identified (according to the American Spinal Injury Association protocol, ASIA) and the Functional Independence Measure (FIM) questionnaire was applied. For the forward and lateral reach task, the subjects were instructed to reach as far as possible. Mean data were compared using the unpaired t test and Mann-Whitney test and differences were considered significant when p<0.05 . The PASI group performed better in self-care activities (PASI: 40.8±0.42 points, SSI: 38.0±3.58 points, p=0.01), sphincter control (PASI: 10.5±1.84 points, SSI: 8.2±3.04 points, p=0.02), transfers (PASI: 20.7±0.48 points, SSI: 16.9±4.27 points, p=0.04), and total FIM score (PASI: 104.0±2.30 points, SSI 105.1±8.56 points, p=0.01). On the maximum reach task, the PASI group had a greater average range in all directions evaluated (p<0.05) . The continuous practice of exercise increased motor function independence and trunk control in individuals with complete spinal cord injury. Level of Evidence II, Prospective Comparative Study.

Use of Negative Pressure Wound Therapy for Lower Limb Bypass Incisions.

PubMed

Tan, Kah Wei; Lo, Zhiwen Joseph; Hong, Qiantai; Narayanan, Sriram; Tan, Glenn Wei Leong; Chandrasekar, Sadhana

2017-12-25

Objective : The use of negative pressure wound therapy (NPWT) for post-surgical cardiothoracic, orthopedic, plastic, and obstetric and gynecologic procedures has been described. However, there are no data regarding its use for lower limb bypass incisions. We aimed to investigate the outcomes of NPWT in preventing surgical site infection (SSI) in patients with lower limb arterial bypass incisions. Materials and Methods : We retrospectively used data of 42 patients who underwent lower limb arterial bypass with reversed great saphenous vein between March 2014 and June 2016 and compared conventional wound therapy and NPWT with regard to preventing SSI. Results : Twenty-eight (67%) patients underwent conventional wound therapy and 14 (33%) underwent NPWT. There were no statistical differences regarding patient characteristics and mean SSI risk scores between the two patient groups (13.7% for conventional wound therapy vs. 13.4% for NPWT; P=0.831). In the conventional group, nine instances of SSI (32%) and three (11%) of these required subsequent surgical wound debridement, whereas in the NPWT group, there was no SSI incidence (P=0.019). Secondary outcomes such as the length of hospital stay, 30-day readmission rate, and need for secondary vascular procedures were not statistically different between the two groups. Conclusion : The use of NPWT for lower limb arterial bypass incisions is superior to that of conventional wound therapy because it may prevent SSIs.

Does intraoperative low arterial partial pressure of oxygen increase the risk of surgical site infection following emergency exploratory laparotomy in horses?

PubMed

Costa-Farré, Cristina; Prades, Marta; Ribera, Thaïs; Valero, Oliver; Taurà, Pilar

2014-04-01

Decreased tissue oxygenation is a critical factor in the development of wound infection as neutrophil mediated oxidative killing is an essential mechanism against surgical pathogens. The objective of this prospective case series was to assess the impact of intraoperative arterial partial pressure of oxygen (PaO2) on surgical site infection (SSI) in horses undergoing emergency exploratory laparotomy for acute gastrointestinal disease. The anaesthetic and antibiotic protocol was standardised. Demographic data, surgical potential risk factors and PaO2, obtained 1h after induction of anaesthesia were recorded. Surgical wounds were assessed daily for infection during hospitalisation and follow up information was obtained after discharge. A total of 84 adult horses were included. SSI developed in 34 (40.4%) horses. Multivariate logistic regression showed that PaO2, anaesthetic time and subcutaneous suture material were predictors of SSI (AUC=0.76, sensitivity=71%, specificity=65%). The use of polyglycolic acid sutures increased the risk and horses with a PaO2 value < 80 mm Hg [10.6 kPa] and anaesthetic time >2h had the highest risk of developing SSI (OR=9.01; 95% CI 2.28-35.64). The results of this study confirm the hypothesis that low intraoperative PaO2 contributes to the development of SSI following colic surgery. Copyright © 2014 Elsevier Ltd. All rights reserved.

Simulation of boreal Summer Monsoon Rainfall using CFSV2_SSiB model: sensitivity to Land Use Land Cover (LULC)

NASA Astrophysics Data System (ADS)

Chilukoti, N.; Xue, Y.

2016-12-01

The land surface play a vital role in determining the surface energy budget, accurate representation of land use and land cover (LULC) is necessary to improve forecast. In this study, we have investigated the influence of surface vegetation maps with different LULC on simulating the boreal summer monsoon rainfall. Using a National Centres for Environmental Prediction (NCEP) Coupled Forecast System version 2(CFSv2) model coupled with Simplified Simple Biosphere (SSiB) model, two experiments were conducted: one with old vegetation map and one with new vegetation map. The significant differences between new and old vegetation map were in semi-arid and arid areas. For example, in old map Tibetan plateau classified as desert, which is not appropriate, while in new map it was classified as grasslands or shrubs with bare soil. Old map classified the Sahara desert as a bare soil and shrubs with bare soil, whereas in new map it was classified as bare ground. In addition to central Asia and the Sahara desert, in new vegetation map, Europe had more cropped area and India's vegetation cover was changed from crops and forests to wooded grassland and small areas of grassland and shrubs. The simulated surface air temperature with new map shows a significant improvement over Asia, South Africa, and northern America by some 1 to 2ºC and 2 to 3ºC over north east China and these are consistent with the reduced rainfall biases over Africa, near Somali coast, north east India, Bangladesh, east China sea, eastern Pacific and northern USA. Over Indian continent and bay of Bengal dry rainfall anomalies that is the only area showing large dry rainfall bias, however, they were unchanged with new map simulation. Overall the CFSv2(coupled with SSiB) model with new vegetation map show a promising result in improving the monsoon forecast by improving the Land -Atmosphere interactions. To compare with the LULC forcing, experiment was conducted using the Global Forecast System (GFS) simulations forced with different observed Sea Surface Temperatures (SST) for the same period: one is from NCEP reanalysis and one from Hadley Center. They have substantial difference in Indian Ocean. Preliminary analysis shows that, the impact of these two SST data sets on Indian summer monsoon rainfall has no significant impact.

20 CFR 416.351 - Deemed filing date in a case of misinformation.

Code of Federal Regulations, 2013 CFR

2013-04-01

... misinformation. 416.351 Section 416.351 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY... calls a Social Security office to inquire about filing an application for SSI benefits. During her... benefits. Ms. Jones later reads about resource exclusions under the SSI program. She recontacts the Social...

20 CFR 416.351 - Deemed filing date in a case of misinformation.

Code of Federal Regulations, 2012 CFR

2012-04-01

... misinformation. 416.351 Section 416.351 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY... calls a Social Security office to inquire about filing an application for SSI benefits. During her... benefits. Ms. Jones later reads about resource exclusions under the SSI program. She recontacts the Social...

20 CFR 416.351 - Deemed filing date in a case of misinformation.

Code of Federal Regulations, 2014 CFR

2014-04-01

... misinformation. 416.351 Section 416.351 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY... calls a Social Security office to inquire about filing an application for SSI benefits. During her... benefits. Ms. Jones later reads about resource exclusions under the SSI program. She recontacts the Social...

20 CFR 416.351 - Deemed filing date in a case of misinformation.

Code of Federal Regulations, 2011 CFR

2011-04-01

... misinformation. 416.351 Section 416.351 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY... calls a Social Security office to inquire about filing an application for SSI benefits. During her... benefits. Ms. Jones later reads about resource exclusions under the SSI program. She recontacts the Social...

National Centers for Environmental Prediction

Science.gov Websites

Modeling Center continuously monitors its NWP model performance against different performance measures, and AIRCFT GFS SSI and forecast fits to RAOBS for last 7 days spatial bias maps for different regions different regions GFS SSI and forecast fits to RAOBS for calendar months (time series, spatial and vertical

Mental Retardation: Determining Eligibility for Social Security Benefits.

ERIC Educational Resources Information Center

Reschly, Daniel J., Ed.; Myers, Tracy G., Ed.; Hartel, Christine R., Ed.

The Social Security Administration (SSA) provides income support and medical benefits for adults with mental retardation unable to perform substantial gainful activity through the Disability Insurance (DI) program and the Supplemental Security Income (SSI) program. SSI benefits are also provided to families of children and adolescents who evidence…

20 CFR 416.264 - When does the special SSI eligibility status apply.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false When does the special SSI eligibility status apply. 416.264 Section 416.264 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility Special Provisions for People Who Work Despite A...

20 CFR 416.351 - Deemed filing date in a case of misinformation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... misinformation. 416.351 Section 416.351 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY... calls a Social Security office to inquire about filing an application for SSI benefits. During her... benefits. Ms. Jones later reads about resource exclusions under the SSI program. She recontacts the Social...

49 CFR 15.19 - Destruction of SSI.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Transportation Office of the Secretary of Transportation PROTECTION OF SENSITIVE SECURITY INFORMATION § 15.19... reconstruction of the information when the covered person no longer needs the SSI to carry out transportation security measures. (2) Exception. Paragraph (b)(1) of this section does not require a State or local...

20 CFR 416.1157 - Support and maintenance assistance.

Code of Federal Regulations, 2014 CFR

2014-04-01

... which an SSI claimant lives or an SSI claimant's ineligible spouse, parent, sponsor (or the sponsor's spouse) of an alien, or essential person. Private nonprofit agency means a religious, charitable... spouse) if you are an alien, or an essential person. We also do not consider certain support and...

A Socioscientific Curriculum Facilitating the Development of Distal and Proximal NOS Conceptualizations

ERIC Educational Resources Information Center

Schalk, Kelly A.

2012-01-01

This study reports the effects of an innovative introductory microbiology course for undergraduates that used a socioscientific issues (SSI)-based curriculum. The study illustrates how an SSI-based intervention provides learners with pragmatic opportunities for cultivating their scientific literacy subsuming the nature of science (NOS). Empirical…

20 CFR 416.1110 - What is earned income.

Code of Federal Regulations, 2010 CFR

2010-04-01

....1110 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED... else's employee. Wages are the same for SSI purposes as for the earnings test in the social security... under the SSI program are the same net earnings that we would count under the social security retirement...

49 CFR 15.19 - Destruction of SSI.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Transportation Office of the Secretary of Transportation PROTECTION OF SENSITIVE SECURITY INFORMATION § 15.19... reconstruction of the information when the covered person no longer needs the SSI to carry out transportation security measures. (2) Exception. Paragraph (b)(1) of this section does not require a State or local...

20 CFR 416.204 - Redeterminations of SSI eligibility.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Redeterminations of SSI eligibility. 416.204 Section 416.204 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE... benefits. (2) We may also redetermine your eligibility when you tell us (or we otherwise learn) of a change...

49 CFR 1520.9 - Restrictions on the disclosure of SSI.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SECURITY ADMINISTRATION, DEPARTMENT OF HOMELAND SECURITY SECURITY RULES FOR ALL MODES OF TRANSPORTATION PROTECTION OF SENSITIVE SECURITY INFORMATION § 1520.9 Restrictions on the disclosure of SSI. (a) Duty to... infrastructure information under section 214 of the Homeland Security Act, any covered person who is a Federal...

20 CFR 416.265 - Requirements for the special SSI eligibility status.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Requirements for the special SSI eligibility status. 416.265 Section 416.265 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility Special Provisions for People Who Work Despite A...

20 CFR 416.264 - When does the special SSI eligibility status apply.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false When does the special SSI eligibility status apply. 416.264 Section 416.264 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility Special Provisions for People Who Work Despite A...

20 CFR 416.262 - Eligibility requirements for special SSI cash benefits.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Eligibility requirements for special SSI cash benefits. 416.262 Section 416.262 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility Special Provisions for People Who Work Despite A...

20 CFR 416.265 - Requirements for the special SSI eligibility status.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Requirements for the special SSI eligibility status. 416.265 Section 416.265 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility Special Provisions for People Who Work Despite A...

20 CFR 416.265 - Requirements for the special SSI eligibility status.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Requirements for the special SSI eligibility status. 416.265 Section 416.265 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility Special Provisions for People Who Work Despite A...

20 CFR 416.264 - When does the special SSI eligibility status apply.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false When does the special SSI eligibility status apply. 416.264 Section 416.264 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility Special Provisions for People Who Work Despite A...

20 CFR 416.262 - Eligibility requirements for special SSI cash benefits.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Eligibility requirements for special SSI cash benefits. 416.262 Section 416.262 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility Special Provisions for People Who Work Despite A...

20 CFR 416.262 - Eligibility requirements for special SSI cash benefits.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Eligibility requirements for special SSI cash benefits. 416.262 Section 416.262 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility Special Provisions for People Who Work Despite A...

20 CFR 416.264 - When does the special SSI eligibility status apply.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false When does the special SSI eligibility status apply. 416.264 Section 416.264 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility Special Provisions for People Who Work Despite A...

Data analysis for GOPEX image frames

NASA Technical Reports Server (NTRS)

Levine, B. M.; Shaik, K. S.; Yan, T.-Y.

1993-01-01

The data analysis based on the image frames received at the Solid State Imaging (SSI) camera of the Galileo Optical Experiment (GOPEX) demonstration conducted between 9-16 Dec. 1992 is described. Laser uplink was successfully established between the ground and the Galileo spacecraft during its second Earth-gravity-assist phase in December 1992. SSI camera frames were acquired which contained images of detected laser pulses transmitted from the Table Mountain Facility (TMF), Wrightwood, California, and the Starfire Optical Range (SOR), Albuquerque, New Mexico. Laser pulse data were processed using standard image-processing techniques at the Multimission Image Processing Laboratory (MIPL) for preliminary pulse identification and to produce public release images. Subsequent image analysis corrected for background noise to measure received pulse intensities. Data were plotted to obtain histograms on a daily basis and were then compared with theoretical results derived from applicable weak-turbulence and strong-turbulence considerations. Processing steps are described and the theories are compared with the experimental results. Quantitative agreement was found in both turbulence regimes, and better agreement would have been found, given more received laser pulses. Future experiments should consider methods to reliably measure low-intensity pulses, and through experimental planning to geometrically locate pulse positions with greater certainty.

Repeat sample intraocular pressure variance in induced and naturally ocular hypertensive monkeys.

PubMed

Dawson, William W; Dawson, Judyth C; Hope, George M; Brooks, Dennis E; Percicot, Christine L

2005-12-01

To compare repeat-sample means variance of laser induced ocular hypertension (OH) in rhesus monkeys with the repeat-sample mean variance of natural OH in age-range matched monkeys of similar and dissimilar pedigrees. Multiple monocular, retrospective, intraocular pressure (IOP) measures were recorded repeatedly during a short sampling interval (SSI, 1-5 months) and a long sampling interval (LSI, 6-36 months). There were 5-13 eyes in each SSI and LSI subgroup. Each interval contained subgroups from the Florida with natural hypertension (NHT), induced hypertension (IHT1) Florida monkeys, unrelated (Strasbourg, France) induced hypertensives (IHT2), and Florida age-range matched controls (C). Repeat-sample individual variance means and related IOPs were analyzed by a parametric analysis of variance (ANOV) and results compared to non-parametric Kruskal-Wallis ANOV. As designed, all group intraocular pressure distributions were significantly different (P < or = 0.009) except for the two (Florida/Strasbourg) induced OH groups. A parametric 2 x 4 design ANOV for mean variance showed large significant effects due to treatment group and sampling interval. Similar results were produced by the nonparametric ANOV. Induced OH sample variance (LSI) was 43x the natural OH sample variance-mean. The same relationship for the SSI was 12x. Laser induced ocular hypertension in rhesus monkeys produces large IOP repeat-sample variance mean results compared to controls and natural OH.

Postdischarge surveillance for infection following cesarean section: A prospective cohort study comparing methodologies.

PubMed

Halwani, Muhammad A; Turnbull, Alison E; Harris, Meredith; Witter, Frank; Perl, Trish M

2016-04-01

To assess how enhanced postdischarge telephone follow-up calls would improve case finding for surgical site infection (SSI) surveillance after cesarean section. We conducted a prospective cohort study of all patients who delivered by cesarean section between April 22 and August 22, 2010. In addition to our routine surveillance, using clinical databases and electronic patient records, we also made follow-up calls to the patients at 7, 14, and 30 days postoperation. A standard questionnaire with questions about symptoms of SSI, health-seeking behaviors, and treatment received was administered. Descriptive statistics and univariate analysis were performed to assess the effect of the enhanced surveillance. One hundred ninety-three patients underwent cesarean section during this study period. Standard surveillance identified 14 infections with telephone follow-ups identifying an additional 5 infections. Using the call as a gold standard, the sensitivity of the standard methodology to capture SSI was 73.3%. The duration of the calls ranged from 1 to 5 minutes and were well received by the patients. Results suggest that follow-up telephone calls to patients following cesarean section identifies 26.3% of the total SSIs. Enhanced surveillance can provide more informed data to enhance performance and avoid underestimation of rates. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

The relationship between psychological comfort space and self-esteem in people with mental disorders.

PubMed

Kunikata, Hiroko; Shiraishi, Yuko; Nakajima, Kazuo; Tanioka, Tetsuya; Tomotake, Masahito

2011-02-01

The purpose of this study was to demonstrate a causal model of the sense of having psychological comfortable space that is call 'ibasho' in Japanese and self-esteem in people with mental disorders who had difficulty in social activities. The subjects were 248 schizophrenia patients who were living in the community and receiving day care treatment. Data were collected from December 2007 to April 2009 using the Scale for the Sense of ibasho for persons with mentally ill (SSI) and the Rosenberg Self-Esteem Scale (RSES), and analyzed for cross-validation of construct validity by conducting covariance structure analysis. A relationship between the sense of having comfortable space and self-esteem was investigated. Multiple indicator models of the sense of having psychological comfortable space and self-esteem were evaluated using structural equation modeling. Furthermore, the SSI scores were compared between the high- and low-self-esteem groups. The path coefficient from the sense of having comfortable space to self-esteem was significant (0.80). High-self-esteem group scored significantly higher in the SSI subscales, 'the sense of recognizing my true self' and 'the sense of recognizing deep person-to-person relationships' than the low-self-esteem group. It was suggested that in order to help people with mental disorders improve self-esteem, it might be useful to support them in a way they can enhance the sense of having comfortable space.

Interactions and Feedbacks Between Land Surface Processes and Water Cycle Dynamics in Africa

NASA Astrophysics Data System (ADS)

Prince, S. D.; Xue, Y.; Song, G.; Cox, P. M.

2012-12-01

In the past three decades, numerous modeling sensitivity studies have established the importance of detailed vegetation and atmosphere interactions in West African water cycle dynamics. Recently, new evidence has emerged from satellite data analyses that indicate a fully coupled process is needed to explain the relationships discovered in these analyses. In order to elucidate the processes, we have applied the off-line Simplified Simple Biosphere Model version 4/Top-down Representation of Interactive Foliage and Flora Including Dynamics Model (SSiB4/TRIFFID). SSiB4 is a biophysical model based on surface water and energy balance which interacts with TRIFFID by providing the carbon assimilation. TRIFFID is a dynamic vegetation model based on carbon balance. The offline SSiB4/TRIFFID was integrated using the observed precipitation and reanalysis-based meteorological forcing from 1948 to 2006 over West Africa. West Africa has diverse climate and ecosystem regions. It suffered the most severe and longest drought in the world during the 20th century, and has the most pronounced decadal water cycle variability in the planet. The simulation results indicate that the water cycle variability has significant effects on the spatial distributions and temporal variations of plant functional types and leaf area index (LAI), which are generally consistent with those observed from satellites since the 1980s. The simulated vegetation conditions over Sahel region exhibited seasonal, inter-annual variations, consistent with West Africa monsoon variability, and the simulated inter-decadal variability in vegetation was consistent with the Sahel drought in the 1970s and 1980s and partial recovery in the 1990s and 2000s. To further understand the cause of decadal variability of climate, water cycle and vegetation dynamics, experiments were conducted to investigate the relationship between the LAI, atmospheric carbon dioxide increase and global warming. In one experiment, the 1948 atmospheric carbon dioxide was used (310 ppmv) and in another it was increased as observed. The LAI increased linearly between the fixed and elevated carbon dioxide, suggesting carbon dioxide fertilization. This increase was related to an increase in shrubs and decrease in C4 grasses. The greatest increases in LAI in the Sahel occurred during the winter. To understand how the warming trend affected decadal variability, we compared an experiment with observed temperature (with warming trend) and another in which the warming trend was removed. The simulations showed a reduction in LAI due to the warming after 1980, although it was not as strong as the carbon fertilization effects. High temperature created stress on vegetation over the Sahel, and especially over its transition zone. However, the fertilization effect dominated the global warming effect.

Eyeing the Sky's Water Vapor

NASA Technical Reports Server (NTRS)

2008-01-01

This image, and many like it, are one way NASA's Phoenix Mars Lander is measuring trace amounts of water vapor in the atmosphere over far-northern Mars. Phoenix's Surface Stereo Imager (SSI) uses solar filters, or filters designed to image the sun, to make these images. The camera is aimed at the sky for long exposures.

SSI took this image as a test on June 9, 2008, which was the Phoenix mission's 15th Martian day, or sol, since landing, at 5:20 p.m. local solar time. The camera was pointed about 38 degrees above the horizon. The white dots in the sky are detector dark current that will be removed during image processing and analysis.

The Phoenix Mission is led by the University of Arizona, Tucson, on behalf of NASA. Project management of the mission is by NASA's Jet Propulsion Laboratory, Pasadena, Calif. Spacecraft development is by Lockheed Martin Space

Randomized Effectiveness Study of Four Therapeutic Strategies for TMJ Closed Lock

PubMed Central

Schiffman, E.L.; Look, J.O.; Hodges, J.S.; Swift, J.Q.; Decker, K.L.; Hathaway, K.M.; Templeton, R.B.; Fricton, J.R.

2008-01-01

For individuals with temporomandibular joint (TMJ) disc displacement without reduction with limited mouth opening (closed lock), interventions vary from minimal treatment to surgery. In a single-blind trial, 106 individuals with TMJ closed lock were randomized among medical management, rehabilitation, arthroscopic surgery with post-operative rehabilitation, or arthroplasty with post-operative rehabilitation. Evaluations at baseline, 3, 6, 12, 18, 24, and 60 months used the Craniomandibular Index (CMI) and Symptom Severity Index (SSI) for jaw function and TMJ pain respectively. Using an intention-to-treat analysis, we observed no between-group difference at any follow-up for CMI (p ≥ 0.33) or SSI (p ≥ 0.08). Both outcomes showed within-group improvement (p < 0.0001) for all groups. The findings of this study suggest that primary treatment for individuals with TMJ closed lock should consist of medical management or rehabilitation. The use of this approach will avoid unnecessary surgical procedures. PMID:17189464

C-Reactive Protein and Procalcitonin as Early Markers of Septic Complications after Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients Within an Enhanced Recovery After Surgery Program.

PubMed

Muñoz, José Luis; Ruiz-Tovar, Jaime; Miranda, Elena; Berrio, Diana Lorena; Moya, Pedro; Gutiérrez, Manuel; Flores, Raquel; Picó, Carlos; Pérez, Ana

2016-05-01

The performance of most bariatric procedures within an Enhanced Recovery After Surgery (ERAS) programs has resulted in considerable advantages, including a reduction in the length of hospital stay to 2 to 3 days. However, some postoperative complications can appear after the patient has been discharged. The aim of this study was to investigate the efficacy of various acute-phase parameters determined 24 and 48 hours after laparoscopic sleeve gastrectomy (LSG) as bariatric procedure, for predicting septic complications, such a surgical site infection (SSI), in the postoperative course. A prospective study of 115 morbidly obese patients who underwent LSG within an ERAS program between 2012 and 2015 was conducted. Blood analysis was performed 24 and 48 hours after surgery. Acute-phase parameters (C-reactive protein [CRP], procalcitonin, and fibrinogen) and WBC count were investigated. Septic complications were observed in 13 patients (11.3%). Using receiver operating characteristic analysis at 24 hours postoperatively, a cutoff level of CRP at 70 mg/L achieved 85% sensitivity and 90% specificity for predicting SSI, and a cutoff level of procalcitonin at 0.2 ng/mL achieved 70% sensitivity and 90% specificity. At 48 hours postoperatively, a cutoff level of CRP at 150 mg/L and procalcitonin at 0.95 ng/mL achieved 100% sensitivity and 100% specificity for predicting SSI. The use of CRP and procalcitonin in the first day and especially in the second day postoperative can predict septic complications after LSG. This is most useful for patients within an ERAS program who will be discharged early. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Incidence and Risk Factors for Health-Care Associated Infections after Hip Operation.

PubMed

Hessels, Amanda J; Agarwal, Mansi; Liu, Jianfang; Larson, Elaine L

2016-12-01

Hip operation reduces pain and improves mobility and quality of life for more than 300,000 people annually, most of whom are more than 65 years old. Substantial increases in surgical volume are projected between 2005 and 2030 in primary total (174%) and revision (137%) procedures. This projection demands that the impact of increasing age on the relative risk of health-care associated infections (HAI) after hip surgical procedures be assessed. Our aim was to examine the incidence and risk factors of HAI among patients who underwent hip operations between 2006 and 2012. This secondary analysis included data from patients 18 years old or older and having a hip prosthesis procedure in three New York City hospitals between 2006 and 2012. Procedures were categorized as total or partial hip replacements or revision and re-surfacing procedures. Outcomes of interest were blood stream infections (BSI), urinary tract infections (UTI), or surgical site infections (SSI). Patients in whom an infection developed during the hospital visit in which the hip procedure occurred were counted as cases. Of 2021 patients, approximately 11% (n = 218) had an HAI. There was no difference in infection rates by admission year despite an increase in surgical volume. SSI was associated with younger age, previous hospitalization, and hip revision surgical procedure whereas UTI and BSI were associated with older age, greater co-morbidity, longer pre-operative length of stay and intensive care unit stay, (p < 0.05). HAI after hip operation affected approximately one in 10 patients over a 7-year period in three high-volume hospitals. SSI occurred least frequently, predominantly among patients who underwent revision surgery (without previous SSI), were younger, and had a history of previous hospitalization. Infections such as BSI and UTI, although rare, occurred more frequently and in patients with more co-morbidities, longer pre-operative length of stay, and who required higher level care. Further research to understand these unexpected findings and target interventions is warranted.

American College of Surgeons National Surgical Quality Improvement Program Pediatric: a beta phase report.

PubMed

Bruny, Jennifer L; Hall, Bruce L; Barnhart, Douglas C; Billmire, Deborah F; Dias, Mark S; Dillon, Peter W; Fisher, Charles; Heiss, Kurt F; Hennrikus, William L; Ko, Clifford Y; Moss, Lawrence; Oldham, Keith T; Richards, Karen E; Shah, Rahul; Vinocur, Charles D; Ziegler, Moritz M

2013-01-01

The American College of Surgeons (ACS) National Surgical Quality Improvement Program Pediatric (NSQIP-P) expanded to beta phase testing with the enrollment of 29 institutions. Data collection and analysis were aimed at program refinement and development of risk-adjusted models for inter-institutional comparisons. Data from the first full year of beta-phase NSQIP-P were analyzed. Patient accrual used ACS-NSQIP methodology tailored to pediatric specialties. Preliminary risk adjusted modeling for all pediatric and neonatal operations and pediatric (excluding neonatal) abdominal operations was performed for all cause morbidity (other than death) and surgical site infections (SSI) using hierarchical logistic regression methodology and eight predictor variables. Results were expressed as odds ratios with 95% confidence intervals. During calendar year 2010, 29 institutions enrolled 37,141 patients. 1644 total CPT codes were entered, of which 456 accounted for 90% of the cases. 450 codes were entered only once (1.2% of cases). For all cases, overall mortality was 0.25%, overall morbidity 7.9%, and the SSI rate 1.8%. For neonatal cases, mortality was 2.39%, morbidity 18.7%, and the SSI rate 3%. For the all operations model, risk-adjusted morbidity institutional odds ratios ranged 0.48-2.63, with 9/29 hospitals categorized as low outliers and 9/29 high outliers, while risk-adjusted SSI institutional odds ratios ranged 0.36-2.04, with 2/29 hospitals low outliers and 7/29 high outliers. This report represents the first risk-adjusted hospital-level comparison of surgical outcomes in infants and children using NSQIP-P data. Programmatic and analytic modifications will improve the impact of this program as it moves into full implementation. These results indicate that NSQIP-P has the potential to serve as a model for determining risk-adjusted outcomes in the neonatal and pediatric population with the goal of developing quality improvement initiatives for the surgical care of children. Copyright © 2013 Elsevier Inc. All rights reserved.

Postoperative Surgical Site Infections: Understanding the Discordance Between Surveillance Systems.

PubMed

Ali-Mucheru, Mariam N; Seville, Maria T; Miller, Vickie; Sampathkumar, Priya; Etzioni, David A

2018-04-18

To characterize agreement in the ascertainment of surgical site infections (SSIs) between the National Surgical Quality Improvement Program (NSQIP), National Healthcare Safety Network (NHSN), and administrative data. The NSQIP, NHSN, and administrative data are the primary systems used to monitor and report SSIs for the purpose of quality control and benchmarking of hospitals and surgeons. These systems have different methods for identifying SSIs. We queried the NHSN, NSQIP, and administrative data systems for patients who had an operation at 1 of 4 hospitals within a single health system between January 2013 and September 2015. The detection of an SSI during a postoperative hospitalization was the outcome of analysis. Any SSI detected by one (or more) of these systems was analyzed by 2 reviewers to determine the presence of discrete elements of documentation constituting evidence of SSI. Concordance between the 3 systems (NHSN, NSQIP, and administrative data) was analyzed using Cohen's kappa. After application of appropriate exclusion criteria, a cohort of 9447 inpatient operations was analyzed. In total, 130 SSIs were detected by 1 or more of the 3 systems, with reported SSI rates of 0.5% (NHSN), 0.7% (administrative data), and 1.0% (NSQIP). Of these 130 SSIs, only 17 SSIs were reported by all 3 systems. The concordance between these 3 systems was moderate (kappa values NSQIP-NHSN = 0.50 [0.40-0.60], administrative-NHSN = 0.36 [0.24-0.47], and administrative-NSQIP = 0.47 [0.38-0.57]). Chart review found that reasons for discordance were related to issues of different criteria as well as inaccuracies. There is significant discordance in the determination of SSIs reported by the NHSN, NSQIP, and administrative data. The differences and limitations of each of these systems have to be recognized, especially when using these data for quality reports and pay for performance.

Adhering to a national surgical care bundle reduces the risk of surgical site infections

PubMed Central

Hopmans, Titia E. M.; Soetens, Loes C.; Wille, Jan C.; Geerlings, Suzanne E.; Vos, Margreet C.; van Benthem, Birgit H. B.; de Greeff, Sabine C.

2017-01-01

Background In 2008, a bundle of care to prevent Surgical Site Infections (SSIs) was introduced in the Netherlands. The bundle consisted of four elements: antibiotic prophylaxis according to local guidelines, no hair removal, normothermia and ‘hygiene discipline’ in the operating room (i.e. number of door movements). Dutch hospitals were advised to implement the bundle and to measure the outcome. This study’s goal was to assess how effective the bundle was in reducing SSI risk. Methods Hospitals assessed whether their staff complied with each of the bundle elements and voluntary reported compliance data to the national SSI surveillance network (PREZIES). From PREZIES data, we selected data from 2009 to 2014 relating to 13 types of surgical procedures. We excluded surgeries with missing (non)compliance data, and calculated for each remaining surgery with reported (non)compliance data the level of compliance with the bundle (that is, being compliant with 0, 1, 2, 3, or 4 of the elements). Subsequently, we used this level of compliance to assess the effect of bundle compliance on the SSI risk, using multilevel logistic regression techniques. Results 217 489 surgeries were included, of which 62 486 surgeries (29%) had complete bundle reporting. Within this group, the SSI risk was significantly lower for surgeries with complete bundle compliance compared to surgeries with lower compliance levels. Odds ratios ranged from 0.63 to 0.86 (risk reduction of 14% to 37%), while a 13% risk reduction was demonstrated for each point increase in compliance-level. Sensitivity analysis indicated that due to analysing reported bundles only, we probably underestimated the total effect of implementing the bundle. Conclusions This study demonstrated that adhering to a surgical care bundle significantly reduced the risk of SSIs. Reporting of and compliance with the bundle compliance can, however, still be improved. Therefore an even greater effect might be achieved. PMID:28877223

Characterization of perioperative infection risk among patients undergoing radical cystectomy: Results from the national surgical quality improvement program.

PubMed

Parker, William P; Tollefson, Matthew K; Heins, Courtney N; Hanson, Kristine T; Habermann, Elizabeth B; Zaid, Harras B; Frank, Igor; Thompson, R Houston; Boorjian, Stephen A

2016-12-01

To evaluate the incidence, risk factors, and timing of infections following radical cystectomy (RC). The American College of Surgeons National Surgical Quality Improvement Project database was queried to identify patients undergoing RC for bladder cancer from 2006 to 2013. Characteristics including year of surgery, age, sex body mass index, diabetes, smoking, renal function, steroid usage, preoperative albumin, preoperative hematocrit, perioperative blood transfusion (PBT), and operative time were assessed for association with the risk of infection within 30 days of RC using multivariable logistic regression. A total of 3,187 patients who had undergone RC were identified, of whom 766 (24.0%) were diagnosed with a postoperative infection, at a median of 13 days (interquartile ranges 8-19) after RC. Infections included surgical site infection (SSI) (404; 12.7%), sepsis/septic shock (405; 12.7%), and urinary tract infection (UTI) (309; 9.7%). On multivariable analysis, body mass index≥30kg/m 2 (odds ratios [OR] = 1.52; P<0.01), receipt of a PBT (OR = 1.27; P<0.01), and operative time≥480 minutes (OR = 1.72; P<0.01) were significantly associated with the risk of infection. When the outcomes of UTI, SSI, and sepsis were analyzed separately, operative time≥480 minutes remained independently associated with increased infection risk in each model (OR = 2.11 for UTI, OR = 1.63 for SSI, and OR = 1.80 for sepsis/septic shock; all P<0.05), whereas PBT was associated with SSI and sepsis/septic shock (OR = 1.33 and OR = 1.29, respectively; both P< 0.05). Approximately 25% of patients undergoing RC experience an infection within 30 days of surgery. Several potentially modifiable risk factors for infection were identified, specifically PBT and prolonged operative time, which may represent opportunities for future care improvement. Copyright © 2016 Elsevier Inc. All rights reserved.

Intraoperative interventions for preventing surgical site infection: an overview of Cochrane Reviews.

PubMed

Liu, Zhenmi; Dumville, Jo C; Norman, Gill; Westby, Maggie J; Blazeby, Jane; McFarlane, Emma; Welton, Nicky J; O'Connor, Louise; Cawthorne, Julie; George, Ryan P; Crosbie, Emma J; Rithalia, Amber D; Cheng, Hung-Yuan

2018-02-06

Surgical site infection (SSI) rates vary from 1% to 5% in the month following surgery. Due to the large number of surgical procedures conducted annually, the costs of these SSIs can be considerable in financial and social terms. Many interventions are used with the aim of reducing the risk of SSI in people undergoing surgery. These interventions can be broadly delivered at three stages: preoperatively, intraoperatively and postoperatively. The intraoperative interventions are largely focused on decontamination of skin using soap and antiseptics; the use of barriers to prevent movement of micro-organisms into incisions; and optimising the patient's own bodily functions to promote best recovery. Both decontamination and barrier methods can be aimed at people undergoing surgery and operating staff. Other interventions focused on SSI prevention may be aimed at the surgical environment and include methods of theatre cleansing and approaches to managing theatre traffic. To present an overview of Cochrane Reviews of the effectiveness and safety of interventions, delivered during the intraoperative period, aimed at preventing SSIs in all populations undergoing surgery in an operating theatre. Published Cochrane systematic reviews reporting the effectiveness of interventions delivered during the intraoperative period in terms of SSI prevention were eligible for inclusion in this overview. We also identified Cochrane protocols and title registrations for future inclusion into the overview. We searched the Cochrane Library on 01 July 2017. Two review authors independently screened search results and undertook data extraction and 'Risk of bias' and certainty assessment. We used the ROBIS (risk of bias in systematic reviews) tool to assess the quality of included reviews, and we used GRADE methods to assess the certainty of the evidence for each outcome. We summarised the characteristics of included reviews in the text and in additional tables. We included 32 Cochrane Reviews in this overview: we judged 30 reviews as being at low risk of bias and two at unclear risk of bias. Thirteen reviews had not been updated in the past three years. Two reviews had no relevant data to extract. We extracted data from 30 reviews with 349 included trials, totaling 73,053 participants. Interventions assessed included gloving, use of disposable face masks, patient oxygenation protocols, use of skin antiseptics for hand washing and patient skin preparation, vaginal preparation, microbial sealants, methods of surgical incision, antibiotic prophylaxis and methods of skin closure. Overall, the GRADE certainty of evidence for outcomes was low or very low. Of the 77 comparisons providing evidence for the outcome of SSI, seven provided high- or moderate-certainty evidence, 39 provided low-certainty evidence and 31 very low-certainty evidence. Of the nine comparisons that provided evidence for the outcome of mortality, five provided low-certainty evidence and four very low-certainty evidence.There is high- or moderate-certainty evidence for the following outcomes for these intraoperative interventions. (1) Prophylactic intravenous antibiotics administered before caesarean incision reduce SSI risk compared with administration after cord clamping (10 trials, 5041 participants; risk ratio (RR) 0.59, 95% confidence interval (CI) 0.44 to 0.81; high-certainty evidence - assessed by review authors). (2) Preoperative antibiotics reduce SSI risk compared with placebo after breast cancer surgery (6 trials, 1708 participants; RR 0.74, 95% CI 0.56 to 0.98; high-certainty evidence - assessed by overview authors). (3) Antibiotic prophylaxis probably reduce SSI risk in caesarean sections compared with no antibiotics (82 relevant trials, 14,407 participants; RR 0.40, 95% CI 0.35 to 0.46; moderate-certainty evidence; downgraded once for risk of bias - assessed by review authors). (4) Antibiotic prophylaxis probably reduces SSI risk for hernia repair compared with placebo or no treatment (17 trials, 7843 participants; RR 0.67, 95% CI 0.54 to 0.84; moderate-certainty evidence; downgraded once for risk of bias - assessed by overview authors); (5) There is currently no clear difference in the risk of SSI between iodine-impregnated adhesive drapes compared with no adhesive drapes (2 trials, 1113 participants; RR 1.03, 95% CI 0.66 to 1.60; moderate-certainty evidence; downgraded once for imprecision - assessed by review authors); (6) There is currently no clear difference in SSI risk between short-term compared with long-term duration antibiotics in colorectal surgery (7 trials; 1484 participants; RR 1.05 95% CI 0.78 to 1.40; moderate-certainty evidence; downgraded once for imprecision - assessed by overview authors). There was only one comparison showing negative effects associated with the intervention: adhesive drapes increase the risk of SSI compared with no drapes (5 trials; 3082 participants; RR 1.23, 95% CI 1.02 to 1.48; high-certainty evidence - rated by review authors). This overview provides the most up-to-date evidence on use of intraoperative treatments for the prevention of SSIs from all currently published Cochrane Reviews. There is evidence that some interventions are useful in reducing SSI risk for people undergoing surgery, such as antibiotic prophylaxis for caesarean section and hernia repair, and also the timing of prophylactic intravenous antibiotics administered before caesarean incision. Also, there is evidence that adhesive drapes increase SSI risk. Evidence for the many other treatment choices is largely of low or very low certainty and no quality-of-life or cost-effectiveness data were reported. Future trials should elucidate the relative effects of some treatments. These studies should focus on increasing participant numbers, using robust methodology and being of sufficient duration to adequately assess SSI. Assessment of other outcomes such as mortality might also be investigated as part of non-experimental prospective follow-up of people with SSI of different severity, so the risk of death for different subgroups can be better understood.

Using Our Heads and HARTSS*: Developing Perspective-Taking Skills for Socioscientific Reasoning (*Humanities, ARTS, and Social Sciences)

ERIC Educational Resources Information Center

Kahn, Sami; Zeidler, Dana L.

2016-01-01

Functional scientific literacy demands an informed citizenry capable of negotiating controversial socioscientific issues (SSI). Perspective taking is critical to SSI implementation as it enables understanding of the diverse cognitive and emotional perspectives of others. Science teacher educators must therefore facilitate teachers' promotion of…

A Framework for Socio-Scientific Issues Based Education

ERIC Educational Resources Information Center

Presley, Morgan L.; Sickel, Aaron J.; Muslu, Nilay; Merle-Johnson, Dominike; Witzig, Stephen B.; Izci, Kemal; Sadler, Troy D.

2013-01-01

Science instruction based on student exploration of socio-scientific issues (SSI) has been presented as a powerful strategy for supporting science learning and the development of scientific literacy. This paper presents an instructional framework for SSI based education. The framework is based on a series of research studies conducted in a diverse…

Lack of Evolution Acceptance Inhibits Students' Negotiation of Biology-Based Socioscientific Issues

ERIC Educational Resources Information Center

Fowler, S. R.; Zeidler, D. L.

2016-01-01

The purpose of this study was to explore science content used during college students' negotiation of biology-based socioscientific issues (SSI) and examine how it related to students' conceptual understanding and acceptance of biological evolution. The Socioscientific Issues Questionnaire (SSI-Q) was developed to measure depth of evolutionary…

Students' Environmental NOS Views, Compassion, Intent, and Action: Impact of Place-Based Socioscientific Issues Instruction

ERIC Educational Resources Information Center

Herman, Benjamin C.

2018-01-01

Preparing students to achieve the lofty goal of functional scientific literacy entails addressing the normative and non-normative facets of socioscientific issues (SSI) such as scientific processes, the nature of science (NOS) and diverse sociocultural perspectives. SSI instructional approaches have demonstrated some efficacy for promoting…

77 FR 57178 - Agency Information Collection Activities: Proposed Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-17

...) maintain a written record of the request; (2) establish the relationship of the requester to the deceased... Maintain Home-- 20 CFR 416.212(b)(1)--0960-0516. When SSI recipients (1) enter a public institution or (2... from the recipient, the recipient's family, or friends confirming SSI payments are needed to maintain...

A Comparison between SRSS-IE and SSiS-PSG Scores: Examining Convergent Validity

ERIC Educational Resources Information Center

Lane, Kathleen Lynne; Oakes, Wendy Peia; Common, Eric Alan; Zorigian, Kris; Brunsting, Nelson C.; Schatschneider, Christopher

2015-01-01

We report findings of a validation study comparing two screening tools: the Student Risk Screening Scale-Internalizing and Externalizing (SRSS-IE, an adapted version of the Student Risk Screening Scale) and the Social Skills Improvement System-Performance Screening Guide (SSiS-PSG). Participants included 458 kindergarten through fifth-grade…

Additional Evidence of Convergent Validity between SRSS-IE and SSiS-PSG Scores

ERIC Educational Resources Information Center

Lane, Kathleen Lynne; Oakes, Wendy Peia; Ennis, Robin Parks; Royer, David James

2015-01-01

We report findings of a validity study comparing two screening tools: the Student Risk Screening Scale-Internalizing and Externalizing (SRSS-IE) and the Social Skills Improvement System-Performance Screening Guide (SSiS-PSG; Elliott & Gresham, 2007). Participants were 1,680 kindergarten through sixth-grade elementary students from three…

Promoting the Role of the Personal Narrative in Teaching Controversial Socio-Scientific Issues

ERIC Educational Resources Information Center

Levinson, Ralph

2008-01-01

Citizens participating in contemporary socio-scientific issues (SSI) need to draw on local knowledge and personal experience. If curricular developments in the teaching of controversial SSI are to reflect contemporary notions of citizenship then the personal narrative is an indispensable instrument in bridging the gap between the local/personal…

20 CFR 416.261 - What are special SSI cash benefits and when are they payable.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false What are special SSI cash benefits and when are they payable. 416.261 Section 416.261 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility Special Provisions for People Who...

49 CFR 15.9 - Restrictions on the disclosure of SSI.

Code of Federal Regulations, 2011 CFR

2011-10-01

... information under section 214 of the Homeland Security Act, any covered person who is a Federal employee in... Section 15.9 Transportation Office of the Secretary of Transportation PROTECTION OF SENSITIVE SECURITY INFORMATION § 15.9 Restrictions on the disclosure of SSI. (a) Duty to protect information. A covered person...

49 CFR 1520.9 - Restrictions on the disclosure of SSI.

Code of Federal Regulations, 2011 CFR

2011-10-01

... inform TSA or the applicable DOT or DHS component or agency. (d) Additional Requirements for Critical Infrastructure Information. In the case of information that is both SSI and has been designated as critical infrastructure information under section 214 of the Homeland Security Act, any covered person who is a Federal...

49 CFR 1520.9 - Restrictions on the disclosure of SSI.

Code of Federal Regulations, 2013 CFR

2013-10-01

... inform TSA or the applicable DOT or DHS component or agency. (d) Additional Requirements for Critical Infrastructure Information. In the case of information that is both SSI and has been designated as critical infrastructure information under section 214 of the Homeland Security Act, any covered person who is a Federal...

49 CFR 1520.9 - Restrictions on the disclosure of SSI.

Code of Federal Regulations, 2014 CFR

2014-10-01

... inform TSA or the applicable DOT or DHS component or agency. (d) Additional Requirements for Critical Infrastructure Information. In the case of information that is both SSI and has been designated as critical infrastructure information under section 214 of the Homeland Security Act, any covered person who is a Federal...

49 CFR 1520.9 - Restrictions on the disclosure of SSI.

Code of Federal Regulations, 2012 CFR

2012-10-01

... inform TSA or the applicable DOT or DHS component or agency. (d) Additional Requirements for Critical Infrastructure Information. In the case of information that is both SSI and has been designated as critical infrastructure information under section 214 of the Homeland Security Act, any covered person who is a Federal...

Secondary School Students' Understanding of Science and Their Socioscientific Reasoning

ERIC Educational Resources Information Center

Karahan, Engin; Roehrig, Gillian

2017-01-01

Research in socioscientific issue (SSI)-based interventions is relatively new (Sadler in "Journal of Research in Science Teaching" 41:513-536, 2004; Zeidler et al. in "Journal of Research in Science Teaching" 46:74-101, 2009), and there is a need for understanding more about the effects of SSI-based learning environments…

20 CFR 416.250 - Experimental, pilot, and demonstration projects in the SSI program.

Code of Federal Regulations, 2011 CFR

2011-04-01

... you are placed in a control group which is not subject to the alternative requirements, limitations... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Experimental, pilot, and demonstration... Because of Essential Persons § 416.250 Experimental, pilot, and demonstration projects in the SSI program...

20 CFR 416.250 - Experimental, pilot, and demonstration projects in the SSI program.

Code of Federal Regulations, 2013 CFR

2013-04-01

... you are placed in a control group which is not subject to the alternative requirements, limitations... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Experimental, pilot, and demonstration... Because of Essential Persons § 416.250 Experimental, pilot, and demonstration projects in the SSI program...

20 CFR 416.250 - Experimental, pilot, and demonstration projects in the SSI program.

Code of Federal Regulations, 2014 CFR

2014-04-01

... you are placed in a control group which is not subject to the alternative requirements, limitations... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Experimental, pilot, and demonstration... Because of Essential Persons § 416.250 Experimental, pilot, and demonstration projects in the SSI program...

20 CFR 416.250 - Experimental, pilot, and demonstration projects in the SSI program.

Code of Federal Regulations, 2012 CFR

2012-04-01

... you are placed in a control group which is not subject to the alternative requirements, limitations... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Experimental, pilot, and demonstration... Because of Essential Persons § 416.250 Experimental, pilot, and demonstration projects in the SSI program...

20 CFR 416.250 - Experimental, pilot, and demonstration projects in the SSI program.

Code of Federal Regulations, 2010 CFR

2010-04-01

... you are placed in a control group which is not subject to the alternative requirements, limitations... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Experimental, pilot, and demonstration... Because of Essential Persons § 416.250 Experimental, pilot, and demonstration projects in the SSI program...

49 CFR 15.9 - Restrictions on the disclosure of SSI.

Code of Federal Regulations, 2010 CFR

2010-10-01

... information under section 214 of the Homeland Security Act, any covered person who is a Federal employee in... Section 15.9 Transportation Office of the Secretary of Transportation PROTECTION OF SENSITIVE SECURITY INFORMATION § 15.9 Restrictions on the disclosure of SSI. (a) Duty to protect information. A covered person...

Earth-based and Galileo SSI multispectral observations of eastern mare serenitatis and the Apollo 17 landing site

NASA Technical Reports Server (NTRS)

Hiesinger, H.; Jaumann, R.; Neukum, G.

1993-01-01

Both the Apollo 17 and the Mare Serenitatis region were observed by Galileo during its fly-by in December 1992. We used earth-based multispectral data to define mare units which then can be compared with the results of the Galileo SSI data evaluation.

49 CFR 1520.15 - SSI disclosed by TSA or the Coast Guard.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SECURITY ADMINISTRATION, DEPARTMENT OF HOMELAND SECURITY SECURITY RULES FOR ALL MODES OF TRANSPORTATION PROTECTION OF SENSITIVE SECURITY INFORMATION § 1520.15 SSI disclosed by TSA or the Coast Guard. (a) In... allegations contained in a legal enforcement action document issued by TSA or the Coast Guard. (2) Security...

Socioscientific Issues-Based Instruction: An Investigation of Agriscience Students' Content Knowledge Based on Student Variables

ERIC Educational Resources Information Center

Shoulders, Catherine W.; Myers, Brian E.

2013-01-01

Numerous researchers in science education have reported student improvement in areas of scientific literacy resulting from socioscientific issues (SSI)-based instruction. The purpose of this study was to describe student agriscience content knowledge following a six-week SSI-based instructional unit focusing on the introduction of cultured meat…

Teaching with Socio-Scientific Issues in Physical Science: Teacher and Students' Experiences

ERIC Educational Resources Information Center

Talens, Joy

2016-01-01

Socio-scientific issues (SSI) are recommended by many science educators worldwide for learners to acquire first hand experience to apply what they learned in class. This investigated experiences of teacher-researcher and students in using SSI in Physical Science, Second Semester, School Year 2012-2013. Latest and controversial news articles on…

Galileo SSI/Ida Radiometrically Calibrated Images V1.0

NASA Astrophysics Data System (ADS)

Domingue, D. L.

2016-05-01

This data set includes Galileo Orbiter SSI radiometrically calibrated images of the asteroid 243 Ida, created using ISIS software and assuming nadir pointing. This is an original delivery of radiometrically calibrated files, not an update to existing files. All images archived include the asteroid within the image frame. Calibration was performed in 2013-2014.

Exploring Preservice Elementary Teachers' Critique and Adaptation of Science Curriculum Materials in Respect to Socioscientific Issues

ERIC Educational Resources Information Center

Forbes, Cory T.; Davis, Elizabeth A.

2008-01-01

The work presented here represents a preliminary effort undertaken to address the role of teachers in supporting students' learning and decision-making about socioscientific issues (SSI) by characterizing preservice elementary teachers' critique and adaptation of SSI-based science curriculum materials and identifying factors that serve to mediate…

20 CFR 416.265 - Requirements for the special SSI eligibility status.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Requirements for the special SSI eligibility status. 416.265 Section 416.265 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility Special Provisions for People Who Work Despite A Disabling Impairment § 416.265 Requirement...

20 CFR 416.262 - Eligibility requirements for special SSI cash benefits.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Eligibility requirements for special SSI cash benefits. 416.262 Section 416.262 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility Special Provisions for People Who Work Despite A Disabling Impairment § 416.262...

76 FR 446 - Supplemental Security Income (SSI) for the Aged, Blind, and Disabled; Dedicated Accounts and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-05

... SOCIAL SECURITY ADMINISTRATION 20 CFR Part 416 [Docket No. SSA-2008-0050] RIN 0960-AE59... Payments for Certain Past- Due SSI Benefits AGENCY: Social Security Administration (SSA). ACTION: Final rules. SUMMARY: These final rules adopt, with some minor changes, the interim final rules with request...

75 FR 1271 - Technical Revisions to the Supplemental Security Income (SSI) Regulations on Income and Resources

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-11

... SOCIAL SECURITY ADMINISTRATION 20 CFR Part 416 [Docket No. SSA 2008-0034] RIN 0960-AG66 Technical Revisions to the Supplemental Security Income (SSI) Regulations on Income and Resources AGENCY: Social... revisions reflect legislative changes found in the Consolidated Appropriations Act of 2001 (CAA), the...

20 CFR 416.261 - What are special SSI cash benefits and when are they payable.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false What are special SSI cash benefits and when are they payable. 416.261 Section 416.261 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility Special Provisions for People Who...

20 CFR 416.261 - What are special SSI cash benefits and when are they payable.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false What are special SSI cash benefits and when are they payable. 416.261 Section 416.261 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility Special Provisions for People Who...

20 CFR 416.261 - What are special SSI cash benefits and when are they payable.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false What are special SSI cash benefits and when are they payable. 416.261 Section 416.261 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility Special Provisions for People Who...

Influence of Shiftwork on Greek Nursing Personnel

PubMed Central

Korompeli, Anna; Muurlink, Olav; Tzavara, Chara; Velonakis, Emmanouel; Lemonidou, Chrysoula; Sourtzi, Panayota

2014-01-01

Background The aim of this study was to investigate the burden experienced by nursing personnel working irregular shifts in Greece and to conduct the first test of a Greek version of the Standard Shiftwork Index (SSI). Methods A cross-sectional survey was carried out. The SSI was completed by 365 nurses and nursing assistants working shifts, including nights. Results Female nursing personnel and those suffering from a chronic disease were most affected by working rotating shifts as they had elevated scores on the majority of the SSI scales, such as sleep, chronic fatigue, digestive and cardiovascular problems, general health questionnaire, cognitive and somatic anxiety, shift time satisfaction, engagement and disengagement strategies, languidity, flexibility, and neurotisicm. Nurses with longer working experience and those with family responsibilities also scored higher on some of the SSI scales, such as the sleep, shift time satisfaction, social and domestic disruption, disengagement strategies, morningness, and languidity scales. Conclusion Shiftwork affects female nurses, those with chronic disease, older age, and domestic responsibilities more severely. Therefore management should take these factors into account when designing work schedules to alleviate the burden caused by shiftwork. PMID:25180137

Correlation between classical rheometry and supersonic shear wave imaging in blood clots.

PubMed

Bernal, Miguel; Gennisson, Jean-Luc; Flaud, Patrice; Tanter, Mickael

2013-11-01

The assessment of coagulating blood elasticity has gained importance as a result of several studies that have correlated it to cardiovascular pathologic conditions. In this study we use supersonic shear wave imaging (SSI) to measure viscoelastic properties of blood clots. At the same time, classical rheometry experiments were carried out on the same blood samples taken within the first few seconds of coagulation. Using SSI, phase velocities of the shear wave indicated increasing dispersion with time. In all cases, the frequency bandwidth of propagating shear waves changed from 20-50 Hz at the first few min of coagulation to around 300 Hz toward the end of experiments. Using the values of G' and G″ from the rheometry studies, the theoretical shear wave velocities were calculated and correlated with SSI measurements. Results of the two techniques were in very good agreement, confirming that SSI provides accurate measurements of viscoelastic properties as corroborated by conventional rheometric measurements. Copyright © 2013 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Prophylactic antibiotics used in patients of hepatobiliary surgery.

PubMed

Ren, Jianjun; Bao, Lidao; Niu, Jianxiang; Wang, Yi; Ren, Xianhua

2013-09-01

To clarify the use of antibiotics in our hospital and to guide the prophylactic use in future hepatobiliary surgical procedures. A retrospective review of patients who underwent hepatobiliary surgery from January 2011 to June 2011 was included. Data were collected, and surgical site infection (SSI) was defined by the criteria of Center for Disease Control and Prevention. Patients were prescribed antibiotics for the clinical diagnosis of hepatobiliary system diseases. 1564 patients were identified, in which 784 patients (50.13%) did not receive preoperative antibiotic prophylaxis. Of these 355 patients with 784 surgical sites received either preoperative or both preoperative and postoperative antibiotic prophylaxis. The SSI rate of the patients who received prophylaxis alone (2.56%, 20 of 780 sites) was not statistically higher than that of the patients who have not received prophylaxis (2.68%, 21 of 784 sites), and the two groups were not statistically correlated (P=0.77). The number of the patients who developed SSI was relatively low, and no reduction in the SSI rate was observed among the patients who have received antibiotic prophylaxis.

Evaluation of anesthetic technique on surgical site infections (SSIs) at a single institution.

PubMed

Curry, Craig S; Smith, Kahsi A; Allyn, John W

2014-12-01

To determine whether the previously published relationship between anesthetic technique and rate of surgical site infections (SSIs) was influenced by institution specific effects. Retrospective Review of Quality Assurance and Hospital Epidemiology databases. Metropolitan medical center. The records of 7,751 patients who underwent knee or hip joint replacement from 2004 to 2010 were analyzed. Data regarding anesthetic technique, age, ASA status, gender, postoperative temperature, duration of anesthesia and type of surgery were from the department of anesthesiology quality assurance database and SSI cases were identified from the department of epidemiology database. The impact of anesthetic technique and other variables was assessed using bivariate and multivariate techniques. There was no association of anesthetic technique on the rate of SSI. Duration of anesthesia and ASA status were associated with effects on the rate of SSI. The impact of anesthetic technique on SSI following hip and knee replacement surgery may be site specific and using locally gathered quality data may assist in assessing specific institutional impact. Copyright © 2014 Elsevier Inc. All rights reserved.

SSI recipients in domiciliary care facilities: federally administered optional supplementation, March 1976.

PubMed

Kochhar, S

1977-12-01

Under the supplemental security income program, federally administered payments amounting to $24.7 million were made in March 1976 to 107,000 persons who were residing in domiciliary care facilities and under other supervised living arrangements. These persons were unable to function under totally independent living arrangements but did not require medical or nursing care on a regular basis. Of the total, $9.5 million was represented in Federal SSI payments and $15.2 million came from optional State supplements--with California paying $6.2 million and New York $4.6 million. The average payment to the residents of these facilities was $232 a month. Comparable data for four States show greater caseload growth for persons in domiciliary care facilities and under other supervised living arrangements than for the total SSI population. Nearly two-thirds of the States are adding funds to Federal SSI payments for persons under such care. Data are available, however, only from Social Security Administration program records for those States that have elected Federal administration of their optional programs.

Subaperture metrology technologies extend capabilities in optics manufacturing

NASA Astrophysics Data System (ADS)

Tricard, Marc; Forbes, Greg; Murphy, Paul

2005-10-01

Subaperture polishing technologies have radically changed the landscape of precision optics manufacturing and enabled the production of higher precision optics with increasingly difficult figure requirements. However, metrology is a critical piece of the optics fabrication process, and the dependence on interferometry is especially acute for computer-controlled, deterministic finishing. Without accurate full-aperture metrology, figure correction using subaperture polishing technologies would not be possible. QED Technologies has developed the Subaperture Stitching Interferometer (SSI) that extends the effective aperture and dynamic range of a phase measuring interferometer. The SSI's novel developments in software and hardware improve the capacity and accuracy of traditional interferometers, overcoming many of the limitations previously faced. The SSI performs high-accuracy automated measurements of spheres, flats, and mild aspheres up to 200 mm in diameter by stitching subaperture data. The system combines a six-axis precision workstation, a commercial Fizeau interferometer of 4" or 6" aperture, and dedicated software. QED's software automates the measurement design, data acquisition, and mathematical reconstruction of the full-aperture phase map. The stitching algorithm incorporates a general framework for compensating several types of errors introduced by the interferometer and stage mechanics. These include positioning errors, viewing system distortion, the system reference wave error, etc. The SSI has been proven to deliver the accurate and flexible metrology that is vital to precision optics fabrication. This paper will briefly review the capabilities of the SSI as a production-ready, metrology system that enables costeffective manufacturing of precision optical surfaces.

Students' Experience of Working with Socioscientific Issues - a Quantitative Study in Secondary School

NASA Astrophysics Data System (ADS)

Ottander, Christina; Ekborg, Margareta

2012-12-01

This research project aims to investigate how students in lower secondary school experience work with socioscientific issues (SSI). The six socioscientific cases developed and used in this project are relevant according to characteristics of SSI and to the national curriculum. Approximately 1,500 students in Sweden have worked with one SSI case chosen by the teachers. A questionnaire-based instrument was used to measure the affective domain of students' attitudes towards and interest in science before starting to work with the case and a second questionnaire after finishing a case. The second student questionnaire, measured the situational characteristics of the SSI work and perceived cognitive and affective outcomes. According to the students' self-reported experience, all cases were interesting and related to a current issue. Most cases were equally interesting to boys and girls, the only exception was You are what you eat, which girls found more interesting than boys did. Almost all students claim that they learnt new facts, learnt to argue for their standpoint and to search and evaluate information during the work with the cases. The girls' average scores were higher on several aspects of learning outcomes. Furthermore the students, especially the girls, perceived that the outcome of working with SSI had relevance for their future, with some cases more relevant than others. The more interesting the student found the case, the more they claimed they learnt. The students do not, however, claim that they learnt more science than during ordinary lessons.

Snowmelt and Infiltration Deficiencies of SSiB and Their Resolution with a New Snow-Physics Scheme

NASA Technical Reports Server (NTRS)

Sud, Y. C.; Mocko, David M.

1999-01-01

A two-year 1987-1988 integration of SSiB forced with ISLSCP Initiative I surface data (as part of the Global Soil Wetness Project, GSWP, evaluation and intercomparison) produced generally realistic land surface fluxes and hydrology. Nevertheless, the evaluation also helped to identify some of the deficiencies of the current version of the Simplified Simple Biosphere (SSiB) model. The simulated snowmelt was delayed in most regions, along with excessive runoff and lack of an spring soil moisture recharge. The SSIB model had previously been noted to have a problem producing accurate soil moisture as compared to observations in the Russian snowmelt region. Similarly, various GSWP implementations of SSIB found deficiencies in this region of the simulated soil moisture and runoff as compared to other non-SSiB land-surface models (LSMs). The origin of these deficiencies was: 1) excessive cooling of the snow and ground, and 2) deep frozen soil disallowing snowmelt infiltration. The problem was most severe in regions that experience very cold winters. In SSiB, snow was treated as a unified layer with the first soil layer, causing soil and snow to cool together in the winter months, as opposed to snow cover acting as an insulator. In the spring season, a large amount of heat was required to thaw a hard frozen snow plus deep soil layers, delaying snowmelt and causing meltwater to become runoff over the frozen soil rather than infiltrate into it.

Collaboration with an infection control team for patients with infection after spine surgery.

PubMed

Kobayashi, Kazuyoshi; Imagama, Shiro; Kato, Daizo; Ando, Kei; Hida, Tetsuro; Ito, Kenyu; Tsushima, Mikito; Matsumoto, Akiyuki; Morozumi, Masayoshi; Tanaka, Satoshi; Yagi, Tetsuya; Nishida, Yoshihiro; Ishiguro, Naoki

2017-07-01

The risk of infection, including surgical site infection (SSI), after spine surgery has increased due to aging and more immunocompromised hosts. An infection control team (ICT) is responsible for management of health care-associated infections at our institution. The study subjects were 40 patients (18 men and 22 women with an average age of 54 years) referred to the ICT after spine surgery since 2010. Pathogenic bacteria and treatment in these cases were reviewed. Collaboration with the ICT involved guidance on use of antibiotics for infection in 30 patients (16 SSI and 14 non-SSI) and a search for the infection focus for fever of unknown origin in 10 patients (7 patients were found to have urinary tract infections and 2 patients were found to have pneumonia). The detection rate of causative bacteria in ICT consultation was 88% (35 out of 40 patients). SSI patients with instrumentation involved had a significantly higher rate of methicillin-resistant Staphylococcus aureus infection compared with those without instrumentation (42% vs 13%; P < .05). All cases of SSI with instrumentation involved were cured by ICT support without removal of instrumentation. Early assistance from the ICT was important for prevention of worsening of methicillin-resistant S aureus infection. Collaboration with the ICT was helpful for detection of pathogenic bacteria and allowed appropriate use of antibiotics at an early stage. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.