Experimental and Theoretical Study of the Electronic Structures of Lanthanide Indium Perovskites LnInO3.

Ternary lanthanide indium oxides LnInO3 (Ln = La, Pr, Nd, Sm) were synthesized by high-temperature solid-state reaction and characterized by X-ray powder diffraction. Rietveld refinement of the powder patterns showed the LnInO3 materials to be orthorhombic perovskites belonging to the space group Pnma, based on almost-regular InO6 octahedra and highly distorted LnO12 polyhedra. Experimental structural data were compared with results from density functional theory (DFT) calculations employing a hybrid Hamiltonian. Valence region X-ray photoelectron and K-shell X-ray emission and absorption spectra of the LnInO3 compounds were simulated with the aid of the DFT calculations. Photoionization of lanthanide 4f orbitals gives rise to a complex final-state multiplet structure in the valence region for the 4f n compounds PrInO3, NdInO3, and SmInO3, and the overall photoemission spectral profiles were shown to be a superposition of final-state 4f n-1 terms onto the cross-section weighted partial densities of states from the other orbitals. The occupied 4f states are stabilized in moving across the series Pr-Nd-Sm. Band gaps were measured using diffuse reflectance spectroscopy. These results demonstrated that the band gap of LaInO3 is 4.32 eV, in agreement with DFT calculations. This is significantly larger than a band gap of 2.2 eV first proposed in 1967 and based on the idea that In 4d states lie above the top of the O 2p valence band. However, both DFT and X-ray spectroscopy show that In 4d is a shallow core level located well below the bottom of the valence band. Band gaps greater than 4 eV were observed for NdInO3 and SmInO3, but a lower gap of 3.6 eV for PrInO3 was shown to arise from the occupied Pr 4f states lying above the main O 2p valence band.

Risk factors for transmission of carbapenem-resistant Enterobacterales to healthcare personnel gloves and gowns in the USA.

BACKGROUND: Hospitals are sources for acquisition of carbapenem-resistant Entero-bacterales (CRE), and it is believed that the contamination of healthcare personnel (HCP) hands and clothing play a major role in patient-to-patient transmission of antibiotic-resistant bacteria. AIM: The aim of this study was to determine which HCP types, HCP-patient interactions, and patient characteristics are associated with greater transmission of CRE to HCP gloves and gowns in the hospital. METHODS: This was a prospective observational cohort study that enrolled patients with recent surveillance or clinical cultures positive for CRE at five hospitals in four states in the USA. HCP gloves and gown were cultured after patient care. Samples were also obtained from patients' stool, perianal area, and skin of the chest and arm to assess bacterial burden. FINDINGS: Among 313 CRE-colonized patients and 3070 glove and gown cultures obtained after patient care, HCP gloves and gowns were found to be contaminated with CRE 7.9% and 4.3% of the time, respectively. Contamination of either gloves or gowns occurred in 10.0% of interactions. Contamination was highest (15.3%) among respiratory therapists (odds ratio: 3.79; 95% confidence interval: 1.61-8.94) and when any HCP touched the patient (1.52; 1.10-2.12). Associations were also found between CRE transmission to HCP gloves or gown and: being in the intensive care unit, having a positive clinical culture, and increasing bacterial burden on the patient. CONCLUSION: CRE transmission to HCP gloves and gown occurred frequently. These findings may inform evidence-based policies about what situations and for which patients contact precautions are most important.

Adverse outcomes after planned surgery with anticipated intensive care admission in out-of-office-hours time periods: a multicentre cohort study.

BACKGROUND: Increasing mortality for patients admitted to hospitals during the weekend is a contentious but well described phenomenon. However, it remains uncertain whether adverse outcomes, including prolonged hospital length-of-stay (LOS), may also occur after patients undergoing major planned surgery are admitted to an intensive care unit (ICU) out-of-office-hours, either during weeknights (after 18:00) or on weekends. METHODS: All planned surgical admissions requiring admission to one of 183 ICUs across Australia and New Zealand between 2006 and 2016 were included in this retrospective population-based cohort study. Primary outcomes were hospital LOS and hospital mortality. RESULTS: Of the total 504 713 planned postoperative ICU admissions, 33.6% occurred during out-of-office-hours. After adjusting for available risk factors, out-of-office-hours ICU admissions were associated with a significant increase in hospital LOS [+2.6 days, 95% confidence interval (CI) 2.5-2.6], mortality [odd ratio (OR) 1.5, 95%CI 1.4-1.6], and a reduced chance of being directly discharged home (OR 0.8, 95%CI 0.8-0.8). The strongest association for adverse outcomes occurred with weekend ICU admissions (hospital LOS: +3.0 days, 95%CI 3.2-3.6; hospital mortality: OR 1.7, 95%CI 1.6-1.8). Clustering of adverse outcomes by hospitals was not observed in the generalised estimating equation analyses. CONCLUSIONS: Despite a greater clinical staff availability and higher monitoring levels, planned surgery requiring anticipated out-of-office-hours ICU admission was associated with a prolonged hospital LOS, reduced discharge directly home, and increased mortality compared with in-office-hours admissions. Our findings have potential clinical, economic and health policy implications on how complex planned surgery should be planned and managed.

The deposition of metal nanoparticles on carbon surfaces: the role of specific functional groups.

The enormous complexity of a typical heterogeneous catalyst makes understanding the development and properties of any active nanoparticles present extremely challenging. In the case of carbon based catalysts that difficulty is compounded by the variability of the carbon powders used. We have previously developed a strategy that addresses these problems by mimicking the catalyst preparation conditions very closely but using highly ordered pyrolytic graphite crystals (HOPG) as a model surface. This enables us to examine the effects of specific functional groups on nanoparticle formation. We report here an extension of our work characterising functional groups on the HOPG surface, using XPS and AFM to explore the deposition of gold from aqueous solution onto HOPG surfaces treated in a variety of ways to alter the surface functionality. The structure and oxidation state of the resulting nanoparticles depend critically on the nature of the functional groups present and offers some insight into the development of catalysts based on these materials. Hydroxyls are identified as key functional species, reducing gold ions to their metallic state whilst being oxidised themselves to carbonyls. Carbonyls meanwhile promote the nucleation of Au3+, creating a network of islands at the HOPG surface. The results have relevance not only to catalysts using activated carbons but also the new generation of materials based on graphene and carbon nanotubes.

Deconstructing the relative benefits of a universal glove and gown intervention on MRSA acquisition.

BACKGROUND: The 20-site Benefits of Universal Glove and Gown (BUGG) study found that wearing gloves and gowns for all patient contacts in the intensive care unit (ICU) reduced acquisition rates of meticillin-resistant Staphylococcus aureus (MRSA). The relative importance of gloves and gowns as a barrier, improved hand hygiene, and reduced healthcare worker (HCW)-patient contact rates is unknown. AIM: To determine what proportion of the reduction in acquisition rates observed in the BUGG study was due to improved hand hygiene, reduced contact rates, and universal glove and gown use using agent-based simulation modelling. METHODS: An existing agent-based model to simulate MRSA transmission dynamics in an ICU was modified, and the model was calibrated using site-specific data. Model validation was completed using data collected in the BUGG study. A full 2k factorial design was conducted to quantify the relative benefits of improving each of the aforementioned factors with respect to MRSA acquisition rates. FINDINGS: Across 40 simulated replications for each factorial design point and intervention site, approximately 44% of the decrease in MRSA acquisition rates was due to universal glove and gown use, 38.1% of the decrease was due to improvement in hand hygiene compliance on exiting patient rooms, and 14.5% of the decrease was due to the reduction in HCW-patient contact rates. CONCLUSION: Using mathematical modelling, the decrease in MRSA acquisition in the BUGG study was found to be due primarily to the barrier effects of gowns and gloves, followed by improved hand hygiene and lower HCW-patient contact rates.

PdZn catalysts for CO2 hydrogenation to methanol using chemical vapour impregnation (CVI).

The formation of PdZn bimetallic alloys on ZnO, TiO2 and Al2O3 supports was investigated, together with the effect of alloy formation on the CO2 hydrogenation reaction. The chemical vapour impregnation (CVI) method produced PdZn nanoparticles with diameters of 3-6 nm. X-ray photoelectron spectroscopy and X-ray diffraction revealed the changes in the structure of the PdZn alloy that help stabilise formate intermediates during methanol synthesis. PdZn supported on TiO2 exhibits high methanol productivity of 1730 mmol kgcat-1 h-1 that is associated with the high dispersion of the supported PdZn alloy.

The anaesthetic assessment, management and risk factors of bariatric surgical patients requiring postoperative intensive care support: a state-wide, five-year cohort study.

Bariatric surgery is a rapidly growing and dynamic discipline necessitating a specialised anaesthetic approach coordinating high-risk patients with appropriate post-operative intensive care (ICU) support. The relationship between the anaesthetic and ICU utilisation after bariatric surgery is poorly understood. All adult bariatric surgery patients admitted to any ICU over a five-year period between 2007 and 2011 in Western Australia were identified from hospital admission records and cross-referenced against the Western Australian Department of Health Data Linkage Unit database. During the study period 12,062 patients under went bariatric surgery with 581 (4.8%) patients admitted to ICU immediately following surgery. The mean pre-operative ASA score was 3.3 [standard deviation 1.1] with 76.9% of patients were assessed by their anaesthetist for the first time on the day-of-surgery. Blood pathology (75%) and ECG (46.3%) were the most common preoperative investigations. Intra-operatively, 2.1% of patients had a grade 4 intubation with only 3.4% of patients requiring a videoscopic assisted intubation. Despite being deemed at high risk, 23.6% of patients were managed with 20 gauge or smaller intravenous access. Anaesthetic complications were extremely uncommon (0.5% of all bariatric cases) but accounted for 9.7% of all postoperative ICU admissions. Smoking history, but not body-mass-index (P=0.46), was the only significant prognostic factor for respiratory or airway related anaesthetic complications (P=0.012). In summary, the anaesthesia management of bariatric surgery varied widely in Western Australia, with smoking as the only significant preoperative risk factor for respiratory or airway related anaesthesia complications.

Audit and Feedback Processes Among Antimicrobial Stewardship Programs: A Survey of the Society for Healthcare Epidemiology of America Research Network.

Optimal implementation of audit-and-feedback is an important part of advancing antimicrobial stewardship programs. Our survey demonstrated variability in how 61 programs approach audit-and-feedback. The median (interquartile range) number of recommendations per week was 9 (5-19) per 100 hospital-beds. A major perceived barrier to more comprehensive stewardship was lack of resources. Infect Control Hosp Epidemiol 2016;37:704-706.

Incidence and risk factors for intensive care unit admission after bariatric surgery: a multicentre population-based cohort study.

BACKGROUND: With increasing rates of bariatric surgery and the consequential involvement of increasingly complex patients, uncertainty remains regarding the use of intensive care unit (ICU) services after bariatric surgery. Our objective was to define the incidence, indications, and outcomes of patients requiring ICU admission after bariatric surgery and assess whether unplanned ICU admission could be predicted using preoperative factors. METHODS: All adult bariatric surgery patients between 2007 and 2011 in Western Australia were identified from the Department of Health Data Linkage Unit database and merged with a separate database encompassing all subsequent ICU admissions pertaining to bariatric surgery. The minimal and mean follow-up periods were 12 months and 3.4 yr, respectively. RESULTS: Of the 12 062 patients who underwent bariatric surgery during the study period, 590 patients (4.9%; 650 ICU admissions) were admitted to an ICU after their bariatric surgery. Patients admitted to the ICU were older (48 vs 43 yr, P<0.001), more likely to be male (49.7 vs 20.2%, P<0.001), and more likely to require revisional bariatric surgery (14.4 vs 7.1%, P<0.001). One hundred and seventy-six patients required an emergent unplanned ICU admission, with 51 requiring multiple ICU admissions. Revisional or open surgery, diabetes mellitus, chronic respiratory disease, and obstructive apnoea were the strongest preoperative factors associated with unplanned ICU admission. CONCLUSIONS: Intensive care unit admission after bariatric surgery was uncommon (4.9% of all patients), with 30.9% of all referrals being unplanned. A nomogram and smartphone application based on five important preoperative factors may assist anaesthetists to conduct preoperative planning for high-risk bariatric surgical patients.

Spectrum of hot methane in astronomical objects using a comprehensive computed line list.

Hot methane spectra are important in environments ranging from flames to the atmospheres of cool stars and exoplanets. A new spectroscopic line list, 10to10, for (12)CH4 containing almost 10 billion transitions is presented. This comprehensive line list covers a broad spectroscopic range and is applicable for temperatures up to 1,500 K. Previous methane data are incomplete, leading to underestimated opacities at short wavelengths and elevated temperatures. Use of 10to10 in models of the bright T4.5 brown dwarf 2MASS 0559-14 leads to significantly better agreement with observations and in studies of the hot Jupiter exoplanet HD 189733b leads to up to a 20-fold increase in methane abundance. It is demonstrated that proper inclusion of the huge increase in hot transitions which are important at elevated temperatures is crucial for accurate characterizations of atmospheres of brown dwarfs and exoplanets, especially when observed in the near-infrared.

Patient factors associated with frequent clotting of dialysers during haemodiafiltration in critically ill patients: a post hoc analysis of a randomised controlled study.

Continuous haemodiafiltration (CVVHDF) is the main form of renal replacement therapy in critically ill patients with severe acute kidney injury. Clotting of the dialysers during CVVHDF is frequent, because most patients with acute kidney injury have an increased risk of bleeding and cannot be systemically anticoagulated. Using data from a randomised controlled trial comparing the efficiency of CVVHDF by placing the dialysis catheter tip at the right atrium or superior vena cava, this study assessed the patient factors associated with an increased risk of frequent clotting of the dialysers-defined by >1 dialysers clotted per day of CVVHDF. Of the 94 patients included in this study, a higher body mass index, a higher platelet count and a lower International Normalized Ratio were associated with an increased risk of frequent clotting of dialysers in the univariate analyses. Use of aspirin or clopidogrel, causes of acute kidney injury and daily dose of unfractionated heparin used were not significantly associated with the risk of frequent clotting of dialysers. In the multivariate parsimony model, only a high body mass index (odds ratio 1.06 per point increment, 95% confidence interval 1.01 to 1.13; P=0.036) and a high platelet count (odds ratio 1.84 per 100x10(9)/l increment, 95% confidence interval 1.17 to 2.91; P=0.009), both in a relatively linear fashion, were independently associated with an increased risk of frequent clotting of dialysers. Optimising the position of the tip of the dialysis catheter may be particularly important for patients with a high body mass index and platelet count in order to reduce frequent clotting of dialysers during CVVHDF.

Predictors of early treatment discontinuation in a cohort of patients treated with boceprevir-based therapy for hepatitis C infection.

In this real-world cohort, 49% of patients stopped boceprevir-based hepatitis C therapy early, with only 20% stopping due to treatment futility. Having more comorbidities was significantly associated with early discontinuation. Tolerability of boceprevir-based regimens may be substantially worse than reported in clinical trials, particularly for patients with comorbidities.

Encapsulation of Au Nanoparticles on a Silicon Wafer During Thermal Oxidation.

We report the behavior of Au nanoparticles anchored onto a Si(111) substrate and the evolution of the combined structure with annealing and oxidation. Au nanoparticles, formed by annealing a Au film, appear to "float" upon a growing layer of SiO2 during oxidation at high temperature, yet they also tend to become partially encapsulated by the growing silica layers. It is proposed that this occurs largely because of the differential growth rates of the silica layer on the silicon substrate between the particles and below the particles due to limited access of oxygen to the latter. This in turn is due to a combination of blockage of oxygen adsorption by the Au and limited oxygen diffusion under the gold. We think that such behavior is likely to be seen for other metal-semiconductor systems.

Characterization of a novel oral glucocorticoid system and its possible role in disease.

Synthetic corticosteroids are used widely for the treatment of a variety of diseases of the mouth. However, little is known as to whether the oral mucosa is able to modulate the local concentration of active corticosteroids or to produce steroids de novo. This has important clinical implications, because tissue-specific regulation of glucocorticoids is a key determinant of the clinical efficacy of these drugs. In the present study, we show that oral fibroblasts and keratinocytes expressed ACTH receptor (MC2R), glucocorticoid receptor (GR), and 11ß-hydroxysteroid dehydrogenases (11ß-HSDs). Unlike keratinocytes, fibroblasts lacked 11ß-HSD2 and could not effectively deactivate exogenously administered cortisol. However, both cell types were able not only to activate cortisone into the active form cortisol, but also to synthesize cortisol de novo following stimulation with ACTH. 11ß-HSD2, the enzyme controlling cortisol deactivation, exhibited different patterns of expression in normal (squamous epithelium and salivary glands) and diseased oral mucosa (squamous cell carcinoma and mucoepidermoid carcinoma). Blocking of endogenous cortisol catabolism in keratinocytes with the 11ß-HSD2 inhibitor 18ß-glycyrrhetinic acid mimicked the effect of exogenous administration of hydrocortisone and partially prevented the detrimental effects induced by pemphigus vulgaris sera. Analysis of the data demonstrates that a novel, non-adrenal glucocorticoid system is present in the oral mucosa that may play an important role in disease.

Combined effect of selected non-thermal technologies on Escherichia coli and Pichia fermentans inactivation in an apple and cranberry juice blend and on product shelf life.

The combination of novel, non-thermal technologies for preservation purposes is a recent trend in food processing research. In the present study, non-thermal hurdles such as ultraviolet light (UV) (5.3 J/cm²), high intensity light pulses (HILP) (3.3 J/cm²), pulsed electric fields (PEF) (34 kV/cm, 18 Hz, 93 µs) or manothermosonication (MTS) (4bar, 43 °C, 750 W, 20 kHz) were examined. The objective was to establish the potential of these technologies, applied individually or in paired sequences, to inactivate Escherichia coli and Pichia fermentans inoculated in a fresh blend of apple and cranberry juice. The shelf-life evaluation of selected non-thermally treated samples was conducted over 35 days and compared to pasteurised samples and untreated juices. All treatments applied individually significantly reduced (1.8-6.0 log cfu/ml) microbial counts compared to the untreated sample (p<0.01). Furthermore, UV treatment produced significantly greater inactivation (p<0.05) for E. coli compared to P. fermentans. Combinations of non-thermal hurdles consisting of UV or HILP followed by either PEF or MTS resulted in comparable reductions for both microorganisms (p ≥ 0.05) to those observed in thermally pasteurised samples (approx. 6 log cfu/ml). Thermally pasteurised samples had a shelf life exceeding 35 days, while that of UV+PEF and HILP+PEF-treated samples was 14 and 21 days, respectively. These results indicate that combinations of these non-thermal technologies could successfully reduce levels of E. coli and P. fermentans in apple and cranberry juice, although optimisation is required in order to further extend shelf life.

Combinations of High Intensity Light Pulses and Thermosonication for the inactivation of Escherichia coli in orange juice.

The non-thermal technologies High Intensity Light Pulses (HILP) and Thermosonication (TS) were applied alone and in combination to study their effect on Escherichia coli inactivation in orange juice. Two different energy settings were chosen in the current study, 'Low' (L) and 'High' (H), being the combinations applied: HILP(L) (4.03 J/cm(2)), HILP(H) (5.1 J/cm(2)), TS(L) (2.8 min residence time at 40 °C) and TS(H) (5 min residence time at 50 °C). Both the individual technologies and their combinations (HILP&TS and TS&HILP) were studied. Results showed inactivation ranging from 1.10 (TS(H)) to 2.42 (HILP(H)) log cfu/ml for the hurdles when applied individually and from 2.5 (HILP(L)&TS(H)) to 3.93 (HILP(H)&TS(L)) log cfu/ml for the combined treatments. Similar reductions in E. coli populations were achieved in orange juice by all treatment combinations irrespective of the sequence in which they were applied.

Do contact precautions cause depression? A two-year study at a tertiary care medical centre.

Contact precautions, used to reduce the transmission of infectious diseases, include the wearing of gowns and gloves for room entry. Previous small studies have shown an association between contact precautions and increased symptoms of depression and anxiety. A retrospective cohort of all patients admitted to a tertiary care centre over two years was studied to assess the relationship between contact precautions and depression or anxiety. During the two-year period, there were 70,275 admissions including 28,564 unique non-intensive-care-unit (ICU), non-psychiatric admissions. After adjusting for potential confounders, contact precautions were associated with depression [odds ratio (OR) 1.4, 95% confidence interval (CI) 1.2-1.5] but not with anxiety (OR 0.8, 95% CI 0.7-1.1) in the non-ICU population. Depression was 40% more prevalent among general inpatients on contact precautions.

Efficacy of UV light treatment for the microbiological decontamination of chicken, associated packaging, and contact surfaces.

UV light was investigated for the decontamination of raw chicken, associated packaging, and contact surfaces. The UV susceptibilities of a number of Campylobacter isolates (seven Campylobacter jejuni isolates and three Campylobacter coli isolates), Escherichia coli ATCC 25922, and Salmonella enterica serovar Enteritidis ATCC 10376 in liquid media were also investigated. From an initial level of 7 log CFU/ml, no viable Campylobacter cells were detected following exposure to the most intense UV dose (0.192 J/cm(2)) in liquid media (skim milk subjected to ultrahigh-temperature treatment and diluted 1:4 with maximum recovery diluent). Maximum reductions of 4.8 and 6.2 log CFU/ml were achieved for E. coli and serovar Enteritidis, respectively, in liquid media. Considerable differences in susceptibilities were found between the Campylobacter isolates examined, with variations of up to 4 log CFU/ml being observed. UV treatment of raw chicken fillet (0.192 J/cm(2)) reduced C. jejuni, E. coli, serovar Enteritidis, total viable counts, and Enterobacteriaceae by 0.76, 0.98, 1.34, 1.76, and 1.29 log CFU/g, respectively. Following UV treatment of packaging and surface materials, reductions of up to 3.97, 4.50, and 4.20 log CFU/cm(2) were obtained for C. jejuni, E. coli, and serovar Enteritidis, respectively (P < 0.05). Overall, the color of UV-treated chicken was not significantly affected (P ≥ 0.05). The findings of this study indicate that Campylobacter is susceptible to UV technology and that differences in sensitivities exist between investigated isolates. Overall, UV could be used for improving the microbiological quality of raw chicken and for decontaminating associated packaging and surface materials.