Implementing a 4% EDTA Central Catheter Locking Solution as a Quality Improvement Project in a Large Canadian Hospital.

Oncology and critical care patients often require central vascular access devices (CVADs), which can make them prone to central line-associated bloodstream infections (CLABSIs) and thrombotic occlusions. According to the literature, CLABSIs are rampant and increased by 63% during the COVID-19 pandemic, highlighting the need for innovative interventions. Four percent ethylenediaminetetraacetic acid (4% EDTA) is an antimicrobial locking solution that reduces CLABSIs, thrombotic occlusions, and biofilm. This retrospective pre-post quality improvement project determined if 4% EDTA could improve patient safety by decreasing CLABSIs and central catheter occlusions. This was implemented in all adult cancer and critical care units at a regional cancer hospital and center. Before implementing 4% EDTA, there were 36 CLABSI cases in 16 months (27 annualized). After implementation, there were 6 cases in 6 months (12 annualized), showing a statistically significant decrease of 59% in CLABSIs per 1000 catheter days. However, there was no significant difference in occlusions (alteplase use). Eighty-eight percent of patients had either a positive or neutral outlook, while most nurses reported needing 4% EDTA to be available in prefilled syringes. The pandemic and nursing shortages may have influenced the results; hence, randomized controlled trials are needed to establish a causal relationship between 4% EDTA and CLABSIs and occlusions.

An updated nuclear-physics and multi-messenger astrophysics framework for binary neutron star mergers.

The multi-messenger detection of the gravitational-wave signal GW170817, the corresponding kilonova AT2017gfo and the short gamma-ray burst GRB170817A, as well as the observed afterglow has delivered a scientific breakthrough. For an accurate interpretation of all these different messengers, one requires robust theoretical models that describe the emitted gravitational-wave, the electromagnetic emission, and dense matter reliably. In addition, one needs efficient and accurate computational tools to ensure a correct cross-correlation between the models and the observational data. For this purpose, we have developed the Nuclear-physics and Multi-Messenger Astrophysics framework NMMA. The code allows incorporation of nuclear-physics constraints at low densities as well as X-ray and radio observations of isolated neutron stars. In previous works, the NMMA code has allowed us to constrain the equation of state of supranuclear dense matter, to measure the Hubble constant, and to compare dense-matter physics probed in neutron-star mergers and in heavy-ion collisions, and to classify electromagnetic observations and perform model selection. Here, we show an extension of the NMMA code as a first attempt of analyzing the gravitational-wave signal, the kilonova, and the gamma-ray burst afterglow simultaneously. Incorporating all available information, we estimate the radius of a 1.4M⊙ neutron star to be [Formula: see text] km.

Constraining neutron-star matter with microscopic and macroscopic collisions.

Interpreting high-energy, astrophysical phenomena, such as supernova explosions or neutron-star collisions, requires a robust understanding of matter at supranuclear densities. However, our knowledge about dense matter explored in the cores of neutron stars remains limited. Fortunately, dense matter is not probed only in astrophysical observations, but also in terrestrial heavy-ion collision experiments. Here we use Bayesian inference to combine data from astrophysical multi-messenger observations of neutron stars1-9 and from heavy-ion collisions of gold nuclei at relativistic energies10,11 with microscopic nuclear theory calculations12-17 to improve our understanding of dense matter. We find that the inclusion of heavy-ion collision data indicates an increase in the pressure in dense matter relative to previous analyses, shifting neutron-star radii towards larger values, consistent with recent observations by the Neutron Star Interior Composition Explorer mission5-8,18. Our findings show that constraints from heavy-ion collision experiments show a remarkable consistency with multi-messenger observations and provide complementary information on nuclear matter at intermediate densities. This work combines nuclear theory, nuclear experiment and astrophysical observations, and shows how joint analyses can shed light on the properties of neutron-rich supranuclear matter over the density range probed in neutron stars.

Implementing the Synergy Model: A Qualitative Descriptive Study.

Hospitals across our nation are seeking to implement models of care that meet the primary goals of Quadruple Aim: Improved population health, cost-effective care delivery, and patient and provider satisfaction. In an effort to address the Quadruple Aim and our patients' care needs, Hamilton Health Sciences (HHS) embarked on a model of care delivery redesign, beginning with nursing care delivery. From 2013 to 2018, 12 clinical programs at HHS implemented the Synergy Model with its accompanying synergy patient needs assessment tool for nurses to objectively assess patients' acuity and dependency needs. Data on patients' priority care needs were used to inform a nursing model of care redesign at HHS, including skill mix and staffing levels. This five-year project was an organization-wide quality improvement initiative. As part of the evaluation, HHS leaders partnered with health services nurse researchers to conduct a mixed methods study. This paper describes the evaluation outcomes from the qualitative component of the study, which included interviews with clinical nurse leaders and direct care nurses. Data were analyzed using descriptive thematic analysis. Some key findings were increased nurse awareness of patients' holistic care needs and leaders' capacity to plan staffing assignments based on patients' priority care needs. Themes helped inform recommendations for key stakeholders, including nurse leaders and direct care nurses.

Multimessenger constraints on the neutron-star equation of state and the Hubble constant.

Observations of neutron-star mergers with distinct messengers, including gravitational waves and electromagnetic signals, can be used to study the behavior of matter denser than an atomic nucleus and to measure the expansion rate of the Universe as quantified by the Hubble constant. We performed a joint analysis of the gravitational-wave event GW170817 with its electromagnetic counterparts AT2017gfo and GRB170817A, and the gravitational-wave event GW190425, both originating from neutron-star mergers. We combined these with previous measurements of pulsars using x-ray and radio observations, and nuclear-theory computations using chiral effective field theory, to constrain the neutron-star equation of state. We found that the radius of a 1.4-solar mass neutron star is [Formula: see text] km at 90% confidence and the Hubble constant is [Formula: see text] at 1σ uncertainty.

Measuring the Hubble constant with a sample of kilonovae.

Kilonovae produced by the coalescence of compact binaries with at least one neutron star are promising standard sirens for an independent measurement of the Hubble constant (H0). Through their detection via follow-up of gravitational-wave (GW), short gamma-ray bursts (sGRBs) or optical surveys, a large sample of kilonovae (even without GW data) can be used for H0 contraints. Here, we show measurement of H0 using light curves associated with four sGRBs, assuming these are attributable to kilonovae, combined with GW170817. Including a systematic uncertainty on the models that is as large as the statistical ones, we find [Formula: see text] and [Formula: see text] for two different kilonova models that are consistent with the local and inverse-distance ladder measurements. For a given model, this measurement is about a factor of 2-3 more precise than the standard-siren measurement for GW170817 using only GWs.

Gravitational-Wave Luminosity of Binary Neutron Stars Mergers.

We study the gravitational-wave peak luminosity and radiated energy of quasicircular neutron star mergers using a large sample of numerical relativity simulations with different binary parameters and input physics. The peak luminosity for all the binaries can be described in terms of the mass ratio and of the leading-order post-Newtonian tidal parameter solely. The mergers resulting in a prompt collapse to black hole have the largest peak luminosities. However, the largest amount of energy per unit mass is radiated by mergers that produce a hypermassive neutron star or a massive neutron star remnant. We quantify the gravitational-wave luminosity of binary neutron star merger events, and set upper limits on the radiated energy and the remnant angular momentum from these events. We find that there is an empirical universal relation connecting the total gravitational radiation and the angular momentum of the remnant. Our results constrain the final spin of the remnant black hole and also indicate that stable neutron star remnant forms with super-Keplerian angular momentum.

Modeling the Complete Gravitational Wave Spectrum of Neutron Star Mergers.

In the context of neutron star mergers, we study the gravitational wave spectrum of the merger remnant using numerical relativity simulations. Postmerger spectra are characterized by a main peak frequency f2 related to the particular structure and dynamics of the remnant hot hypermassive neutron star. We show that f(2) is correlated with the tidal coupling constant κ(2)^T that characterizes the binary tidal interactions during the late-inspiral merger. The relation f(2)(κ(2)^T) depends very weakly on the binary total mass, mass ratio, equation of state, and thermal effects. This observation opens up the possibility of developing a model of the gravitational spectrum of every merger unifying the late-inspiral and postmerger descriptions.

Modeling the Dynamics of Tidally Interacting Binary Neutron Stars up to the Merger.

The data analysis of the gravitational wave signals emitted by coalescing neutron star binaries requires the availability of an accurate analytical representation of the dynamics and waveforms of these systems. We propose an effective-one-body model that describes the general relativistic dynamics of neutron star binaries from the early inspiral up to the merger. Our effective-one-body model incorporates an enhanced attractive tidal potential motivated by recent analytical advances in the post-Newtonian and gravitational self-force description of relativistic tidal interactions. No fitting parameters are introduced for the description of tidal interaction in the late, strong-field dynamics. We compare the model energetics and the gravitational wave phasing with new high-resolution multiorbit numerical relativity simulations of equal-mass configurations with different equations of state. We find agreement within the uncertainty of the numerical data for all configurations. Our model is the first semianalytical model that captures the tidal amplification effects close to merger. It thereby provides the most accurate analytical representation of binary neutron star dynamics and waveforms currently available.