Cost and Quality: How Do Surgical Site Infection Bundles Measure Up?

Introduction: Enhanced recovery after operation and surgical site infection (SSI) bundles have been implemented in hospital systems nationwide to mitigate complications after colorectal operation. These quality improvement bundles (QIB) aim to improve patient safety and should decrease healthcare costs. This study identifies the impact of QIB on SSI rate and hospital costs. Method(s): Vizient and SSI reporting data was queried from 2016- 2021, for all colorectal resections tracked by the National Healthcare Safety Network across the enterprise. The operations were linked to a financial database. Data was analyzed quarterly to identify a relationship between SSI rate, hospital cost, and implementation of SSI mitigation elements. Result(s): 4,163 patients were identified during the study period. SSIs peaked in quarter 2 of 2018 at 5.3%, after which SSI mitigation efforts were announced. A steady decrease is seen in SSI rates, until quarter 3 of 2020, when our hospital system experienced its first COVID wave. With adjustment for procedure type, hospital costs increased by 15.8% per case from 2018-Q3 forward on average with the sharpest elevation observed in quarter 3 of 2019, due to medication startup costs for our SSI bundle. Conclusion(s): We successfully reduced colon SSIs with implementation of an ERAS bundle but incurred 16% greater costs compared with pre implementation, especially during the early implementation period.

Web-based training intervention to increase physical activity level and improve health for adults with intellectual disability.

BACKGROUND: Individuals with intellectual disability (ID) are less physically active, have a higher body mass index (BMI) and are at greater risk for cardiovascular diseases (CVDs) than people without ID. The purpose of the study was to explore the effectiveness of a web-based training programme, consisting of 150 min of activity per week, on the health of people with ID. METHOD: Participants with ID living in supported accommodation (n = 28, 48% female, age = 36.4 ± 9.56 years) participated in a web-based training programme, consisting of a combination of exercises (endurance, strength balance and flexibility) of moderate intensity, 50 min, three times per week for 12 weeks. The body composition and waist circumference (WC) were measured, and questionnaires were used to assess enjoyment, quality of life (QoL) and physical activity (PA) level. Descriptive statistics and pairwise comparison pre and post intervention were carried out. RESULTS: A total of 22 out of 28 participants completed the 12-week training intervention with 83% mean attendance of training sessions. The intensity of the PA level increased and a decrease in fat mass of 1.9 ± 2.4 kg, P < 0.001 and WC of 3 ± 5 cm, P = 0.009 were observed. Enjoyment of training sessions was 3.9 out of 5, and no differences in QoL were found. CONCLUSION: A web-based training programme is an effective tool for improving health parameters of people with ID and offers a new way for caregivers to enhance the PA for the target group.

Classroom Exchanges: Big Data and the Commodification of Educational Communication

We contrast the centrality of free and full communication, especially as it occurs in classrooms, for John Dewey’s democratic vision of the Great Community with the technologically mediated classroom communication characteristic of the COVID-19 pandemic. We focus on Google’s dominance of educational communication in particular. Drawing on Shoshana Zuboff’s concept of rendition, we argue that Google’s interest in and influence over educational communication is rooted in behavioral data analytics that captures and exploits classroom language (spoken, written, and bodily) for capitalist accumulation and social control. We conclude that Dewey’s theories of language and communication are descriptively powerful regarding the commodification of communication, but his theory of power itself fails to provide a politics capable of countering Big Data’s hegemony in classrooms or the broader society. © 2021, Purdue University Press. All rights reserved.

Global CLT industry survey: The 2020 updates

Building on the first of its kind review of the global CLT industry published in 2017, this paper aims to provide insight into the global CLT industry. Based on two global CLT industry surveys, 46 plant tours, and supplemented with information obtained from other sources, we observed an increasing production trend of a complimentary cross-laminated panel products that use nails, wooden dowels and other alternative panel integration systems. In most countries outside the Alpine Region, the growth of the CLT industry has been encouraged by the governments motivated by the desire to find a stable, economically viable outlet for substantial volumes of domestic lumber of lesser quality. At the beginning of 2020, we estimated that, considering the number of high-capacity plants ready to go in line or reach full capacity in 2020, the global annual output might reach 2.0-2.5 million m3 by the end of the year. However, this number does not reflect the impact of the COVID-19 pandemic, something we will investigate in a third survey. © WCTE 2021. All rights reserved.

Circulating neutrophils from critically ill covid-19 patients have increased netosis via canonical and non-canonical pathways

Introduction. The pathophysiology of infection with SARS-CoV-2 involves the lower airways and host-launched aggressive inflammatory responses leading to exacerbated lung damage in these vital tissues. Early clinical studies found that COVID-19 patients have higher levels of neutrophils in the circulation. Neutrophils are the most abundant leukocyte in circulation and are known to be highly proinflammatory due to production of neutrophil extracellular traps (NETosis). NETs are web-like chromatin structures coated with histones and proteases that both capture and kill invading pathogens. However, while being an effective countermeasure towards foreign microbes, this process also causes undesirable damage in host tissues. Therefore, we sought to characterize NETosis in circulating neutrophils from COVID-19 patients to determine whether this immunological response might be exacerbating or driving the disease state in COVID-19, rather than mitigating the virus. Methods.Blood was drawn daily from critically ill COVID-19 patients (n=16) after consent was obtained. Healthy controls (n=13) were screened for COVID-19 and gave blood once a week. Blood was drawn into lithium heparin tubes (BD Vacutainer). Neutrophils were isolated using PolymorphprepTM(PROGEN) per manufacturer's instructions. Cells were resuspended at 2x106 cells/ml for functional assays. Neutrophils were stimulated with increasing concentrations of PMA (Phorbol 12-myristate 13-acetate) of 2.5nM, 25nM and 250nM to stimulate NETosis via the canonical pathway, and nigericin at 15uM for the non-canonical pathway. NETosis was quantified using the Quant-iT™ PicoGreen™ dsDNA Assay Kit (Invitrogen) and by NET visualization via myeloperoxidase and nuclear staining (using Polyclonal Rabbit Anti-Human Myeloperoxidase by Dako and Hoescht stain by Invitrogen). Results.Functional NETosis assays of circulating neutrophils from COVID-19 patients demonstrate overall increased NETosis determined by increased release of dsDNA. This enhanced NETosis occurred at baseline and after stimulation with PMA when compared to healthy controls (Figure 1A, p <0.0001). Fluorescent microscopy also demonstrated increased NETosis in neutrophils from COVID-19 patients (Figure 1B;MPO-green and nucleus-blue). NETosis via the non-canonical pathway (induction with nigericin) was also increased in COVID-19 patients versus controls (p=0.02). Conclusions.Circulating neutrophils from critically ill COVID-19 patients are more prone to produce NETs than circulating neutrophils from healthy individuals. This is likely to lead to NETmediated tissue injury once neutrophils enter inflamed tissue, where they can potentially drive acute lung injury and acute respiratory distress syndrome, common causes of mortality in COVID-19. The finding of increased production of NETs by both canonical and non-canonical pathways is consistent with an overall hyper-activated state in COVID-19.

[Diagnostic approach and evaluation of hospitalized patients with COVID-19]

COVID-19 is the infectious disease caused by coronavirus SARS-CoV-2. The most common symptoms of COVID-19 are dry cough, tiredness and fever. Most patients recover from COVID-19 within a few weeks, but some patients have symptoms lasting for weeks or even months after recovery from acute illness, such as fatigue, shortness of breath and cough. This is a review of what we currently know about the clinical disease and its severity as well as which diagnostic strategies are recommended during and after hospital admission.

[Clinical management of hospitalised patients with COVID-19]

COVID-19 is the infectious disease caused by SARS-CoV-2. This is a review of the current treatment strategies available for patients with COVID-19 during hospital admission. Patients requiring hospitalisation frequently suffer from respiratory failure and may require oxygen therapy. Insufficient response to oxygen may be an indication, that other modalities such as high-flow nasal cannula, continuous positive airway pressure or mechanical ventilation are needed. The only medical treatments currently being used are remdesivir and dexamethasone.

Inactivation of porcine epidemic diarrhea virus in contaminated swine feed through inclusion of a dry lactic acid-based product

Survivability and infectivity of porcine epidemic diarrhea virus within complete feed was tested in the presence or absence of a dry lactic acid-based feed acidifier product (Guardicate) at levels of 0.75%, 1.0%, or 1.5%. The virus was inactivated, and contaminated feed did not cause infection at all three inclusion rates.