Sources of specialist physician fee variation: Evidence from Australian health insurance claims data.

This study explores the variation in specialist physician fees and examines whether the variation can be attributed to patient risk factors, variation between physicians, medical specialties, or other factors. We use health insurance claims data from a large private health insurer in Australia. Although Australia has a publicly funded health system that provides universal health coverage, about 44 % of the population holds private health insurance. Specialist physician fees in the private sector are unregulated; physicians can charge any price they want, subject to market forces. We examine the variation in fees using two price measures: total fees charged and out-of- pocket payments. We follow a two-stage method of removing the influence of patient risk factors by computing risk-adjusted prices at patient-level, and aggregating the adjusted prices over all claims made by each physician to arrive at physician-level average prices. In the second stage, we use variance-component models to analyse the variation in the physician-level average prices. We find that patient risk factors account for a small portion of the variance in fees and out-of-pocket payments. Physician-specific variation accounts for the bulk of the vari- ance. The results underscore the importance of understanding physician characteristics in formulating policy efforts to reduce fee variation.

Risk factors for ventilator-associated lower respiratory tract infection in COVID-19, a retrospective multicenter cohort study in Sweden.

BACKGROUND: Ventilator-associated lower respiratory tract infections (VA-LRTI) increase morbidity and mortality in intensive care unit (ICU) patients. Higher incidences of VA-LRTI have been reported among COVID-19 patients requiring invasive mechanical ventilation (IMV). The primary objectives of this study were to describe clinical characteristics, incidence, and risk factors comparing patients who developed VA-LRTI to patients who did not, in a cohort of Swedish ICU patients with acute hypoxemic respiratory failure due to COVID-19. Secondary objectives were to decipher changes over the three initial pandemic waves, common microbiology and the effect of VA-LTRI on morbidity and mortality. METHODS: We conducted a multicenter, retrospective cohort study of all patients admitted to 10 ICUs in southeast Sweden between March 1, 2020 and May 31, 2021 because of acute hypoxemic respiratory failure due to COVID-19 and were mechanically ventilated for at least 48 h. The primary outcome was culture verified VA-LRTI. Patient characteristics, ICU management, clinical course, treatments, microbiological findings, and mortality were registered. Logistic regression analysis was conducted to determine risk factors for first VA-LRTI. RESULTS: Of a total of 536 included patients, 153 (28.5%) developed VA-LRTI. Incidence rate of first VA-LRTI was 20.8 per 1000 days of IMV. Comparing patients with VA-LRTI to those without, no differences in mortality, age, sex, or number of comorbidities were found. Patients with VA-LRTI had fewer ventilator-free days, longer ICU stay, were more frequently ventilated in prone position, received corticosteroids more often and were more frequently on antibiotics at intubation. Regression analysis revealed increased adjusted odds-ratio (aOR) for first VA-LRTI in patients treated with corticosteroids (aOR 2.64 [95% confidence interval [CI]] [1.31-5.74]), antibiotics at intubation (aOR 2.01 95% CI [1.14-3.66]), and days of IMV (aOR 1.05 per day of IMV, 95% CI [1.03-1.07]). Few multidrug-resistant pathogens were identified. Incidence of VA-LRTI increased from 14.5 per 1000 days of IMV during the first wave to 24.8 per 1000 days of IMV during the subsequent waves. CONCLUSION: We report a high incidence of culture-verified VA-LRTI in a cohort of critically ill COVID-19 patients from the first three pandemic waves. VA-LRTI was associated with increased morbidity but not 30-, 60-, or 90-day mortality. Corticosteroid treatment, antibiotics at intubation and time on IMV were associated with increased aOR of first VA-LRTI.

Study of some morphometric and meristic characteristics of Alepes vari (Cuvier, 1833) collected from the Arabian coast

Abstract The present study examines the correlations between fifteen morphometric and ten meristic characters and total length (TL) of males, females, and combined sexes of Alepes vari (Cuvier, 1833) collected from Karachi fish harbor, West Wharf of Karachi Coast. Statistical analyses of linear regression relationships show mostly strong correlations (r0.70; p 0.05) between total length (TL) and most morphometric characters in males, females, and combined sexes, except the height of pectoral-fin (PFH), and pelvic-fin base length (PelFL); whereas, meristic characters were found to be constant and indicate weak or negative type correlations (r0.50; p>0.05) with total length (TL). Hence, according to our present results, there is a direct relationship between the total length of fish and all morphometric characters, which were found to be the best indicators of positive allometric pattern growth in fish. Moreover, analysis of the 2-sample t-test revealed (t-test; p>0.05) that no sexual dimorphism was reported in Alepes vari. Thus, our present study could be valuable in systematic classification, sexual dimorphism, and management of this species on the Karachi coast.

Resumo O presente estudo examina as correlações entre 15 caracteres morfométricos e 10 caracteres merísticos e comprimento total (CT) de machos, fêmeas e sexos combinados de Alepes vari (Cuvier, 1833), coletados do porto de Karachi, West Wharf, na costa de Karachi. As análises estatísticas das relações de regressão linear mostraram, principalmente, correlações fortes (r 0,70; p 0,05) entre o CT e a maioria dos caracteres morfométricos em machos, fêmeas e sexos combinados, exceto a altura da nadadeira peitoral e o comprimento da base da nadadeira pélvica, enquanto os caracteres merísticos foram constantes, indicando correlações fracas ou negativas (r 0,50; p > 0,05) com o CT. Portanto, de acordo com nossos resultados, existe uma relação direta entre o CT dos peixes e todos os caracteres morfométricos, que foram considerados os melhores indicadores de crescimento do padrão alométrico positivo em peixes. Além disso, a análise do teste t de duas amostras revelou (teste t; p > 0,05) que nenhum dimorfismo sexual foi relatado em A. vari. Assim, o presente estudo pode ser valioso na classificação sistemática, dimorfismo sexual e manejo dessa espécie na costa de Karachi.

Study of some morphometric and meristic characteristics of Alepes vari (Cuvier, 1833) collected from the Arabian coast / Estudo de características morfométricas e merísticas de Alepes vari (Cuvier, 1833) coletados na costa da Arábia

The present study examines the correlations between fifteen morphometric and ten meristic characters and total length (TL) of males, females, and combined sexes of Alepes vari (Cuvier, 1833) collected from Karachi fish harbor, West Wharf of Karachi Coast. Statistical analyses of linear regression relationships show mostly strong correlations (r≥0.70; p<0.05) between total length (TL) and most morphometric characters in males, females, and combined sexes, except the height of pectoral-fin (PFH), and pelvic-fin base length (PelFL); whereas, meristic characters were found to be constant and indicate weak or negative type correlations (r≤0.50; p>0.05) with total length (TL). Hence, according to our present results, there is a direct relationship between the total length of fish and all morphometric characters, which were found to be the best indicators of positive allometric pattern growth in fish. Moreover, analysis of the 2-sample t-test revealed (t-test; p>0.05) that no sexual dimorphism was reported in Alepes vari. Thus, our present study could be valuable in systematic classification, sexual dimorphism, and management of this species on the Karachi coast.

O presente estudo examina as correlações entre 15 caracteres morfométricos e 10 caracteres merísticos e comprimento total (CT) de machos, fêmeas e sexos combinados de Alepes vari (Cuvier, 1833), coletados do porto de Karachi, West Wharf, na costa de Karachi. As análises estatísticas das relações de regressão linear mostraram, principalmente, correlações fortes (r ≥ 0,70; p < 0,05) entre o CT e a maioria dos caracteres morfométricos em machos, fêmeas e sexos combinados, exceto a altura da nadadeira peitoral e o comprimento da base da nadadeira pélvica, enquanto os caracteres merísticos foram constantes, indicando correlações fracas ou negativas (r ≤ 0,50; p > 0,05) com o CT. Portanto, de acordo com nossos resultados, existe uma relação direta entre o CT dos peixes e todos os caracteres morfométricos, que foram considerados os melhores indicadores de crescimento do padrão alométrico positivo em peixes. Além disso, a análise do teste t de duas amostras revelou (teste t; p > 0,05) que nenhum dimorfismo sexual foi relatado em A. vari.

The Interconnection of Carbon Active Addition on Mechanical Properties of Hybrid Agel/Glass Fiber-Reinforced Green Composite.

Nowadays, the hybridization of natural and glass fiber has promised several advantages as a green composite. Nevertheless, their different characteristics lead to poor mechanical bonding. In this work, agel fiber and glass fiber was used as reinforcements, and activated carbon filler was added to the polymer matrix of a hybrid composite to modify its characteristics and mechanical properties. A tensile and bending test was conducted to evaluate the effect of three different weight percentages of activated carbon filler (1, 2, and 4 wt%). Vacuum-assisted resin infusion was used to manufacture the hybrid composite to obtain the high-quality composite. The results have revealed that adding 1 wt% filler yielded the most optimum result with the highest tensile strength, flexural strength, and elastic modulus, respectively: 112.90 MPa, 85.26 MPa, and 1.80 GPa. A higher weight percentage of activated carbon filler on the composite reduced its mechanical properties. The lowest test value was shown by the composite with 4 wt%. The micrograph observations have proven that the 4 wt% composite formed agglomeration filler that can induce stress concentration and reduce its mechanical performance. Adding 1 wt% filler offered the best dispersion in the matrix, which can enhance better load transfer capability.

Effect of Flame Treatment on Bonding Performance of GF/EP Pultrusion Sheets Used for VARI Process.

This paper presents an easy and low-cost flame treatment method to improve the bonding performance of GF/EP (Glass Fiber-Reinforced Epoxy) pultrusion plates, which are using widely for large size wind blades. In order to explore the effect of flame treatment on the bonding performance of the precast GF/EP pultruded sheet vs. the infusion plate, the GF/EP pultruded sheets were treated with different flame treatment cycles and were embedded in the fiber fabrics during the vacuum-assisted resin infusion process (VARI). The bonding shear strengths were measured by tensile shear tests. It is found that after 1, 3, 5, and 7 flame treatments, the tensile shear strength between the GF/EP pultrusion plate and infusion plate increased by 8.0%, 13.3%, 22.44%, and -2.1%, respectively. This indicates that the maximum tensile shear strength can be obtained after five times of flame treatment. In addition, DCB and ENF tests were also adopted to characterize the fracture toughness of the bonding interface with the optimal flame treatment. It is found that the optimal treatment gives increments of 21.84% and 78.36% for G I C and G II C, respectively. Finally, the surficial topography of the flame-treated GF/EP pultruded sheets were characterized by optical microscopy, SEM, contact angle test, FTIR, and XPS. The results show that flame treatment plays an impact on the interfacial performance through the combination of physical meshing locking and chemical bonding mechanism. Proper flame treatment would remove the weak boundary layer and mold release agent on the surface of the GF/EP pultruded sheet, etch the bonding surface and improve the oxygen-containing polar groups, such as C-O and O-C=O, to improve the surface roughness and surface tension coefficient of pultruded sheet to enhance the bonding performance. Excessive flame treatment destroys the integrity of epoxy matrix on bonding surface which results into the exposure of the glass fiber, and the carbonization of release agent and resin on the surface loosen the surficial structure, which reduces the bonding properties.

On the Mode I and Mode II Delamination Characteristics and Surface Morphological Aspects of Composites with Carbon-Thermoplastic Hybrid Fabrics and Innovative Liquid Thermoplastic Resin.

In the current research, the delamination behavior under Mode I and Mode II loading for the hybrid carbon-thermoplastic fabrics in conjunction with novel liquid thermoplastic acrylic Elium® resin processable at ambient conditions was studied. The experimentation by incorporating doublers methodology, studying the performance under Mode I and Mode II loading, and understanding failure mechanisms using surface morphological fractography is deliberated. Hybrid Carbon-Ultra-high molecular weight polyethylene (UHMWPP)/Elium® composite has shown a 22.81% higher GIC and a 22.2% higher GIIC than Carbon-UHMWPP/Epoxy composite. On the contrary, the Carbon_Ultra-high molecular weight polypropylene (UHMWPE)/Elium® has shown an 11.11% higher Mode I critical energy release rate (GIC) and a 7.58% higher Mode II critical energy release rate (GIIC) than Carbon_UHMWPE/Epoxy composite. Hybrid fiber reinforced thermoplastic composites have shown severe plastic deformation of the matrix, rough fracture surface, and micro-cracks on the de-bonding surface, extensive fiber bridging, and crack branching which contributed to the improvement in the delamination behavior. Hybrid fiber architecture is also found to be detrimental by inducing crack arresting mechanisms including the tortuous crack path and the resin-rich pockets path due to the mismatch of the size of the fiber yarns.

Enhanced green view index.

Quantifying street-level greenery has been the subject of interest for researchers as it has several implications for community residents. Green View Index (GVI) is a widely used parameter to compute the greenery along the streets. However, it does not account for the health of the greenery. The new Enhanced Green View Index (EGVI) that we propose computes the amount of greenery along the streets along with the health of the greenery. • The new indicator computes street-level greenery; • Considers the health of vegetation while calculating greenery; and • Helps to study the impact of street-level greenery on community residents precisely.

Resin Flow Analysis for the Foam Core Sandwich Spoiler by Vacuum-Assisted Resin Injection Process.

This article presents the numerical analysis and experimental investigation for the manufacturing of a foam core sandwich spoiler by vacuum-assisted resin injection (VARI) process. To find an injection scheme that guarantees both a good impregnation of the preform and a filling time compatible with the process window, the finite element model (FEM) was applied to analyze the effect of different injection schemes on the resin flow front patterns. Based on the obtained results, two optimal injection schemes are selected to form the spoiler structure. The experimental results show that the best molding quality can be achieved from the thick-end injection with a thin-end exit scheme. The comparison between simulation and experimental results shows that the overall deviation of the numerical analysis on resin flow time is 15.9%.

Vari-Focal Light Field Camera for Extended Depth of Field.

The light field camera provides a robust way to capture both spatial and angular information within a single shot. One of its important applications is in 3D depth sensing, which can extract depth information from the acquired scene. However, conventional light field cameras suffer from shallow depth of field (DoF). Here, a vari-focal light field camera (VF-LFC) with an extended DoF is newly proposed for mid-range 3D depth sensing applications. As a main lens of the system, a vari-focal lens with four different focal lengths is adopted to extend the DoF up to ~15 m. The focal length of the micro-lens array (MLA) is optimized by considering the DoF both in the image plane and in the object plane for each focal length. By dividing measurement regions with each focal length, depth estimation with high reliability is available within the entire DoF. The proposed VF-LFC is evaluated by the disparity data extracted from images with different distances. Moreover, the depth measurement in an outdoor environment demonstrates that our VF-LFC could be applied in various fields such as delivery robots, autonomous vehicles, and remote sensing drones.

[Responses of radial growth of Pinus sylvestris var. mongolica and Larix gmelinii to climate change]. / 樟子松和落叶松径向生长对气候变化的响应.

In the context of global warming, the increases of temperature may affect tree growth and thus disturb ecosystem balance. In this study, we explored the main limiting factors for radial growth of Pinus sylvestris var. mongolica and Larix gmelinii in the Mohe area of Greater Khingan Mountains by using growth-climate response function analysis and moving correlation analysis, as well as the interspecific difference of the responses of radial growth to rapid warming. The results showed that the radial growth of P. sylvestris var. mongolica and L. gmelinii was affected by both temperature and precipitation. P. sylvestris var. mongolica was more sensitive to climate change than L. gmelinii, and its sensitivity to climate factors was more stable than L. gmelinii. The radial growth of P. sylvestris var. mongolica was significantly positively correlated with the monthly mean temperature and the monthly mean minimum temperature of the growing season, while that of L. gmelinii was significantly positively correlated with the monthly mean temperature and the monthly mean maximum temperature of winter. Precipitation in winter promoted the growth of P. sylvestris var. mongolica, whereas precipitation in the late growing season of the previous year inhibited the radial growth of L. gmelinii. After the rapid warming in 1990, the limiting effect of precipitation on P. sylvestris var. mongolica changed from negative to significantly positive, with the inhibition effect of high temperature being greater than the promotion effect. The inhibitory effect of high temperature on L. gmelinii was enhanced, and the limiting effect of precipitation on L. gmelinii was also enhanced after heating up. The growth rate decreased significantly, with obvious difference being observed in the correlations between the growth rate of two species with temperature and precipitation. Our results could provide scientific basis for forest ecosystem management and protection in Greater Khingan Mountains.

[Response differences of radial growth of Larix gmelinii and Pinus sylvestris var. mongolica to climate change in Daxing'an Mountains, Northeast China]. / å¤§å ´å®‰å²­å ´å®‰è½å¶æ¾å’Œæ¨Ÿå­æ¾å¾„å‘ç”Ÿé•¿å¯¹æ°”å€™å˜åŒ–çš„å“åº”å·®å¼‚.

Daxing'an Mountains is one of regions in China with the most significant climate change. Larix gmelinii and Pinus sylvestris var. mongolica are the most important species in this area. The study of their radial growth response to climate change would provide a scientific basis for predicting the dynamics of boreal forests under climate change. A total of 451 tree-ring cores of L. gmelinii and P. sylvestris var. mongolica were collected from six sites in the Daxing'an region, and 12 standard chronologies were established. We compared the tree growth trend since 1900, and analyzed their response to the climate factor in each site using Pearson correlation analysis. Effects of temperature and precipitation on the annual radial growth of L. gmelinii and P. sylvestris var. mongolica were investigated by linear mixed models. The time stability of the relationship between two species growth-climate was compared by moving correlation. The results showed that the radial growth of L. gmelinii was negatively correlated with mean temperature in March and positively correlated with precipitation in the previous winter and July of current year. The radial growth of P. sylvestris var. mongolica was positively correlated with temperature in August and precipitation in the growing season (from May to September) of current year. Snow in winter played an important role in promoting the radial growth of L. gmelinii, whereas precipitation in summer limited the radial growth of P. sylvestris var. mongolica. The responses of L. gmelinii and P. sylvestris var. mongolica to climate change were significantly different, which affected tree growth, species composition, and spatial distribution in the boreal forests.

Salmonellosis outbreak with novel Salmonella enterica subspecies enterica serotype (11:z41:e,n,z15) attributable to sesame products in five European countries, 2016 to 2017.

In spring 2016, Greece reported an outbreak caused by a previously undescribed Salmonella enterica subsp. enterica serotype (antigenic formula 11:z41:e,n,z15) via the Epidemic Intelligence Information System for Food- and Waterborne Diseases and Zoonoses (EPIS-FWD), with epidemiological evidence for sesame products as presumptive vehicle. Subsequently, Germany, Czech Republic, Luxembourg and the United Kingdom (UK) reported infections with this novel serotype via EPIS-FWD. Concerned countries in collaboration with the European Centre for Disease Prevention and Control (ECDC) and European Food Safety Authority (EFSA) adopted a common outbreak case definition. An outbreak case was defined as a laboratory-confirmed notification of the novel Salmonella serotype. Between March 2016 and April 2017, 47 outbreak cases were notified (Greece: n = 22; Germany: n = 13; Czech Republic: n = 5; Luxembourg: n = 4; UK: n = 3). Whole genome sequencing revealed the very close genetic relatedness of isolates from all affected countries. Interviews focusing on sesame product consumption, suspicious food item testing and trace-back analysis following Salmonella spp. detection in food products identified a company in Greece where sesame seeds from different countries were processed. Through European collaboration, it was possible to identify and recall sesame spread as one contaminated food item serving as vehicle of infection and trace it back to its origin.

Ventilator-associated events versus ventilator-associated respiratory infections-moving into a new paradigm or merging both concepts, instead?

Despite ventilator-associated respiratory infections (VARI) are reported as the most common and fatal complications related to mechanical ventilation (MV), they are not the unique occurrences. The new classification of ventilator-associated events (VAE) proposed by the centers for disease control and prevention (CDC) enhance the spectra of complications due to MV including both infection-related and non-infectious events. Both VAEs and VARIs are associated with prolonged duration of MV, longer stay in hospital and in the intensive care unit (ICU) and more antibiotic consumption, nonetheless patients with VAEs have worst outcomes. The VARI and VAE algorithms are focused on different targets and the correlation between both classifications is shown to be poor. The diagnostic criteria of the traditional classification have limited accuracy and the non-infectious complications may be misinterpreted as VARI. While the VAE surveillance enhances the spectra of MV complications but excludes less severe VARIs. Noninfective events explain up to 30% of VAEs, the main causes being atelectasis, acute respiratory distress syndrome, pulmonary edema and pulmonary embolism. The bundles assessing VAE are associated with less incidence of VAP and improved outcomes but they fail to reduce the rates of VAE. Automated VAE surveillance is efficient and useful as a quality indicator in the ICU while the differences in the interpretation of VARI criteria limit its role in the design of global protocols and preventive strategies. We suggest that a more comprehensive strategy should combine both algorithms with emphasis on clinical outcomes.

Value of heart rate variability and sympathetic skin response in differential diagnosis of Parkinson's disease / 西安交通大学学报(医学版)

Objective To evaluate the value of heart rate variability (HRV ) and sympathetic skin response (SSR) in differential diagnosis of Parkinson's disease (PD) .Methods We selected 36 PD ,17 essential tremor (ET) and 59 Parkinsonism-Plus (PD-plus) patients diagnosed in our department .We recorded HRV during the period of quiet breath ,deep breath and Vasaval as well as SSR incubation period of the upper limbs and lower limbs . Results ① During the period of quiet breath ,HRV decreased significantly in PD group compared with that in ET group (P< 0 .05) ,and abnormality rate of HRV in PD group was higher than that in ET group .HRV did not significantly differ between PD and PD-plus .HRV did not significantly differ among the three groups during the period of deep breath and Vasaval .② SSR incubation period showed no significant difference among PD ,PD-plus and ET groups .③ The specificity and sensibility of HRV in PD and PD-plus differential diagnosis were 22 .8% and 82 .6% , while for PD and ET differential diagnosis the values were 66 .9% and 82 .6% . The specificity and sensibility of SSR in PD and PD-plus differential diagnosis were 39 .0% and 52 .6% , 29 .4% and 52 .6% , respectively ,for PD and ET differential diagnosis .Conclusion Compared with those in ET patients ,HRV in PD patients decreases and HRV abnormality rate increases .HRV is of great value in differential diagnosis of PD and ET but not in differential diagnosis of PD and PD-plus .Determining SSR incubation period does not have much value in differential diagnosis of PD ,PD-plus and ET .

Preface: How far has Neotropical Ichthyology progressed in twenty years?

Studies on the diversity, taxonomy, phylogeny, and biogeography of Neotropical Fishes have thrived over the twenty years that have elapsed since the first symposium on their phylogeny and classification in Porto Alegre, Brazil. Here, we review recent advances in the study of Neotropical fishes and assess the known diversity of freshwater species in that region. 6,255 valid freshwater species have been discovered in the Neotropics so far, and we estimate that over 9,000 species will be known when the inventory is complete. We also summarize the events of the second Symposium on Phylogeny and Classification of Neotropical Fishes that took place last year in Londrina, Brazil. Along with invited talks on the biodiversity of all major groups of Neotropical fishes, a series of presentations on the development of fish collections, and numerous contributed talks, the meeting included a special session to honor Dr. Richard Vari, who was one of the most prolific and beloved members of our community.(AU)

Estudos sobre diversidade, taxonomia, filogenia e biogeografia de peixes neotropicais prosperaram nos últimos vinte anos, desde o primeiro simpósio sobre filogenia e classificação em Porto Alegre, Brasil. Aqui, os novos avanços nos estudos de peixes neotropicais são discutidos e a diversidade conhecida reavaliada para espécies de água doce. Foram descobertas 6.255 espécies de peixes de água doce para na região Neotropical até o momento, e estimamos que haja mais de 9.000 espécies quando o inventário estiver completo. Nós resumimos as informações do segundo Simpósio sobre Filogenia e Classificação de Peixes Neotropicais ocorrido no ano passado em Londrina, Brasil. Além de apresentações de convidados sobre Biodiversidade dos grandes grupos de peixes Neotropicais, de uma série de apresentações sobre o estado da arte das coleções científicas, e de diversas outras apresentações, o simpósio incluíu uma sessão especial em homenagem ao Dr. Richard Vari, um dos membros mais prolíficos e amados da nossa comunidade.(AU)

Ventilator-associated respiratory infection in a resource-restricted setting: impact and etiology.

BACKGROUND: Ventilator-associated respiratory infection (VARI) is a significant problem in resource-restricted intensive care units (ICUs), but differences in casemix and etiology means VARI in resource-restricted ICUs may be different from that found in resource-rich units. Data from these settings are vital to plan preventative interventions and assess their cost-effectiveness, but few are available. METHODS: We conducted a prospective observational study in four Vietnamese ICUs to assess the incidence and impact of VARI. Patients ≥ 16 years old and expected to be mechanically ventilated > 48 h were enrolled in the study and followed daily for 28 days following ICU admission. RESULTS: Four hundred fifty eligible patients were enrolled over 24 months, and after exclusions, 374 patients' data were analyzed. A total of 92/374 cases of VARI (21.7/1000 ventilator days) were diagnosed; 37 (9.9%) of these met ventilator-associated pneumonia (VAP) criteria (8.7/1000 ventilator days). Patients with any VARI, VAP, or VARI without VAP experienced increased hospital and ICU stay, ICU cost, and antibiotic use (p < 0.01 for all). This was also true for all VARI (p < 0.01 for all) with/without tetanus. There was no increased risk of in-hospital death in patients with VARI compared to those without (VAP HR 1.58, 95% CI 0.75-3.33, p = 0.23; VARI without VAP HR 0.40, 95% CI 0.14-1.17, p = 0.09). In patients with positive endotracheal aspirate cultures, most VARI was caused by Gram-negative organisms; the most frequent were Acinetobacter baumannii (32/73, 43.8%) Klebsiella pneumoniae (26/73, 35.6%), and Pseudomonas aeruginosa (24/73, 32.9%). 40/68 (58.8%) patients with positive cultures for these had carbapenem-resistant isolates. Patients with carbapenem-resistant VARI had significantly greater ICU costs than patients with carbapenem-susceptible isolates (6053 USD (IQR 3806-7824) vs 3131 USD (IQR 2108-7551), p = 0.04) and after correction for adequacy of initial antibiotics and APACHE II score, showed a trend towards increased risk of in-hospital death (HR 2.82, 95% CI 0.75-6.75, p = 0.15). CONCLUSIONS: VARI in a resource-restricted setting has limited impact on mortality, but shows significant association with increased patient costs, length of stay, and antibiotic use, particularly when caused by carbapenem-resistant bacteria. Evidence-based interventions to reduce VARI in these settings are urgently needed.

Optimizing Polymer Infusion Process for Thin Ply Textile Composites with Novel Matrix System.

For mass production of structural composites, use of different textile patterns, custom preforming, room temperature cure high performance polymers and simplistic manufacturing approaches are desired. Woven fabrics are widely used for infusion processes owing to their high permeability but their localised mechanical performance is affected due to inherent associated crimps. The current investigation deals with manufacturing low-weight textile carbon non-crimp fabrics (NCFs) composites with a room temperature cure epoxy and a novel liquid Methyl methacrylate (MMA) thermoplastic matrix, Elium®. Vacuum assisted resin infusion (VARI) process is chosen as a cost effective manufacturing technique. Process parameters optimisation is required for thin NCFs due to intrinsic resistance it offers to the polymer flow. Cycles of repetitive manufacturing studies were carried out to optimise the NCF-thermoset (TS) and NCF with novel reactive thermoplastic (TP) resin. It was noticed that the controlled and optimised usage of flow mesh, vacuum level and flow speed during the resin infusion plays a significant part in deciding the final quality of the fabricated composites. The material selections, the challenges met during the manufacturing and the methods to overcome these are deliberated in this paper. An optimal three stage vacuum technique developed to manufacture the TP and TS composites with high fibre volume and lower void content is established and presented.

Pre-emptive antibiotic therapy to reduce ventilator-associated pneumonia: "thinking outside the box".

Mechanically ventilated, intubated patients are at increased risk for tracheal colonization with bacterial pathogens that may progress to heavy bacterial colonization, ventilator-associated tracheobronchitis (VAT), and/or ventilator-associated pneumonia (VAP). Previous studies report that 10 to 30 % of patients with VAT progress to VAP, resulting in increased morbidity and significant acute and chronic healthcare costs. Several natural history studies, randomized, controlled trials, and a meta-analysis have reported antibiotic treatment for VAT can reduce VAP, ventilator days, length of intensive care unit (ICU) stay, and patient morbidity and mortality. We discuss early diagnostic criteria, etiologic agents, and benefits of initiating, early, appropriate intravenous or aerosolized antibiotic(s) to treat VAT and reduce VAP, to improve patient outcomes by reducing lung damage, length of ICU stay, and healthcare costs.