Economic burden attributable to healthcare-associated infections at western China hospitals: 6 Year, prospective cohort study.

OBJECTIVES: Healthcare-associated infections (HAIs) represent a major threat to patient safety and are associated with significant economic burden. Calculating the costs attributable to HAIs is challenging given the various sources of bias. Although HAIs as a reasonably preventable medical harm should have been closely linked to medical insurance incentives, there was little linkage between HAIs and medicare in western China owing to the lack of economic evaluation data. The present study aimed to generate estimates of the attributable costs associated with HAIs and the magnitude of costs growth. METHODS: In this cohort study designed horizontally and vertically from 2016 to 2022, we compared outcomes of randomly sampling patients with HAIs and individually matched patients without HAIs in two cohorts at a 6-year interval at 34 hospitals in western China. The primary outcome was the direct medical cost for the entire hospital stay, converted to US dollars ($ for the benchmark year), discounted at 3% annually, and estimated separately in the full analysis set (FAS) and the per protocol set (PPS). We used multiple linear regression to adjust the discounted costs and to assess subgroups effects within each cohort. We nested a dynamic vertical comparison of costs attributable to HAIs between the front and rear cohorts. RESULTS: A total of 230 patients with HAIs in 2016 and 204 patients with HAIs in 2022 were enrolled. After a 1:1 match, all 431 pairs were recruited as FAS, of which 332 pairs as PPS met all matching restrictions. Compared to the 2016 cohort in FAS, the patients with HAIs in 2022 had a significantly older age (64.40 ± 16.45 years), higher repeat hospitalization rate (65 [32.02%] of 203), and lower immune function (69 [33.99%] of 203). The discounted costs and adjusted-discounted costs for patients with HAIs in the 2022 cohort were found to be significantly higher than those of patients without HAIs (discounted costs: $5484.60 [IQR 8426.03] vs $2554.04(4530.82), P < 0.001; adjusted-discounted costs: $5235.90 [3772.12] vs $3040.21(1823.36), P < 0.001, respectively), and also higher than those of patients with HAIs in the 2016 cohort (discounted costs: $5484.60 [8426.03] vs $3553.00 [6127.79], P < 0.001; adjusted-discounted costs: $5235.90 [3772.12] vs $3703.82 [3159.14], P < 0.001, respectively). In vertical comparison of PPS, the incremental costs of the 2022 cohort are 1.48 times higher than those of the 2016 cohort ($964.63(4076.15) vs $652.43 [2533.44], P = 0.084). CONCLUSIONS: This meticulously designed study in western China has successfully and accurately examined the economic burden attributable to HAIs. Their rapidly increasing tendency poses a serious challenge to patients, hospitals, and the medical insurance. A closer linkage between HAIs and ongoing motivating system changes is urgently needed in western China.

Insights into the Biocontrol Function of a Burkholderia gladioli Strain against Botrytis cinerea.

Pathogenic fungi are the main cause of yield loss and postharvest loss of crops. In recent years, some antifungal microorganisms have been exploited and applied to prevent and control pathogenic fungi. In this study, an antagonistic bacteria KRS027 isolated from the soil rhizosphere of a healthy cotton plant from an infected field was identified as Burkholderia gladioli by morphological identification, multilocus sequence analysis, and typing (MLSA-MLST) and physiobiochemical examinations. KRS027 showed broad spectrum antifungal activity against various phytopathogenic fungi by secreting soluble and volatile compounds. KRS027 also has the characteristics of plant growth promotion (PGP) including nitrogen fixation, phosphate, and potassium solubilization, production of siderophores, and various enzymes. KRS027 is not only proven safe by inoculation of tobacco leaves and hemolysis test but also could effectively protect tobacco and table grapes against gray mold disease caused by Botrytis cinerea. Furthermore, KRS027 can trigger plant immunity by inducing systemic resistance (ISR) activated by salicylic acid- (SA), jasmonic acid- (JA), and ethylene (ET)-dependent signaling pathways. The extracellular metabolites and volatile organic compounds (VOCs) of KRS027 affected the colony extension and hyphal development by downregulation of melanin biosynthesis and upregulation of vesicle transport, G protein subunit 1, mitochondrial oxidative phosphorylation, disturbance of autophagy process, and degrading the cell wall of B. cinerea. These results demonstrated that B. gladioli KRS027 would likely become a promising biocontrol and biofertilizer agent against fungal diseases, including B. cinerea, and would promote plant growth. IMPORTANCE Searching the economical, eco-friendly and efficient biological control measures is the key to protecting crops from pathogenic fungi. The species of Burkholderia genus are widespread in the natural environment, of which nonpathogenic members have been reported to have great potential for biological control agents and biofertilizers for agricultural application. Burkholderia gladioli strains, however, need more study and application in the control of pathogenic fungi, plant growth promotion, and induced systemic resistance (ISR). In this study, we found that a B. gladioli strain KRS027 has broad spectrum antifungal activity, especially in suppressing the incidence of gray mold disease caused by Botrytis cinerea, and can stimulate plant immunity response via ISR activated by salicylic acid- (SA), jasmonic acid- (JA), and ethylene (ET)-dependent signaling pathways. These results indicate that B. gladioli KRS027 may be a promising biocontrol and biofertilizer microorganism resource in agricultural applications.

Leaf photosynthetic plasticity does not predict biomass responses to growth irradiance in rice.

Phenotypic plasticity, the capacity of an organism to generate alternative phenotypes in response to different environments, is a particularly important characteristic to enable sessile plants to adapt to rapid changes in their surroundings. Leaf anatomical and physiological traits exhibit plasticity in response to growth irradiances, but it is relatively unclear if the plasticity varies among genotypes for a species. Equally importantly, empirical results on how leaf-level plasticity influences whole-plant growth are largely absent. We conducted an integrated investigation into the light-introduced plasticity by measuring 48 traits involving plant growth, leaf anatomy, leaf biochemistry, and leaf physiology of five rice genotypes grown under two irradiances. More than half of the estimated traits were significantly affected by growth light intensities, and the sizes of the cumulative effect of growth light ranged from -25.04% (stomatal conductance at high measurement light) to 135.2% (tiller number). Growth irradiance levels dramatically shifted the relationship between photosynthetic rate and stomatal conductance. However, the relationship between photosynthetic rate and mesophyll conductance was rarely influenced by growth light levels. Importantly, the present study highlights the significant variation in trait plasticity across rice genotypes and that the light-introduced biomass changes were rarely predicted by leaf photosynthetic plasticity. Our findings imply that the genotypes with high productivity at the low growth light conditions do not necessarily have high productivity under high light conditions.

Experimental-numerical analysis of added resistance to container ships under presence of wind-wave loads.

Experimental and numerical analyses performed on a scaled-down model of a 1900TEU container-ship are reported herein. Wind-tunnel and towing-tank experiments along with computational-fluid-dynamic simulations were performed to obtain (1) wind-load coefficients for superstructure of container ship at different wind angles under full-load operating conditions; (2) wave resistance of the model sans the superstructure under different wave conditions; and (3) combined wind-wave resistance of the model in the head waves coupled with a fluctuating wind. Wind-tunnel experiments were first performed to determine wind-load coefficients concerning of the superstructure at different wind angles. Subsequently, the obtained wind-load coefficients from the wind tunnel test were compared against numerical and empirically obtained results to validate the applicability of the applied numerical methods. Next, the wave-induced resistance to ship motion was investigated via a series of towing-tank experiments and numerical simulations to analyze the resistance and motion of ship under wavy conditions. Finally, characteristics of the added resistance to ship motion under conditions of combined wind-wave load were analyzed, and the coupling between ship motion and combined wind-wave load was used to investigate the changes in added resistance under different load scenarios. The results reveal that combined wind-wave load causes the resistance to ship motion to exceed the algebraic sum of the corresponding resistances under standalone wind- and wave-load conditions. The additional resistance was observed to be a combined manifestation of resistances induced by ship motion and wave-parameter alterations.