Association of dementia diagnosis with urinary tract infection in the emergency department.

OBJECTIVES: Overdiagnosis of urinary tract infections (UTI) among people living with dementia is a nationally recognized problem associated with morbidity from antibiotics as well as multidrug-resistant bacteria. However, whether this problem also exists in the emergency department (ED) is currently unknown. METHODS: To examine the association between dementia and UTI diagnosis in the ED we performed a retrospective analysis of Medicare beneficiaries older than 65 years old who presented to an ED in 2016. A diagnosis of UTI was present in 58,580 beneficiaries, and 321,479 beneficiaries without a diagnosis of UTI served as the comparison group. Our logistic regression model controlled for dementia, older age, female sex, Medicaid status, skilled nursing facility residence, history of prostate cancer, recent urinary catheter use, recurrent UTI, and multiple comorbidities. RESULTS: In our model, people living with dementia had over twice the odds (odds ratio = 2.27, 95% confidence interval = 2.21, 2.33) of being diagnosed with a UTI in the ED compared to those without dementia despite their lower prevalence of symptoms and signs localizing to the genitourinary tract (3.8% vs 8.9%, respectively). CONCLUSION: This is the first study from a national database that examines the association of dementia with UTI diagnosis among older adults who visit the ED. Our study could not establish whether the UTI diagnoses in the ED were accurate but does imply a disproportionate burden of UTI diagnoses in people living with dementia despite their lower prevalence of clinical criterion. Antimicrobial stewardship in the ED should address the complexity of UTI diagnosis in dementia.

Dual passivation of GaAs (110) surfaces using O2/H2O and trimethylaluminum.

The nucleation and passivation of oxide deposition was studied on defect-free GaAs (110) surfaces to understand passivation of surfaces containing only III-V heterobonds. The passivation process on GaAs (110) was studied at the atomic level using scanning tunneling microscopy while the electronic structure was determined by scanning tunneling spectroscopy (STS). The bonding of the oxidant and reductant were modeled with density functional theory. To avoid Fermi level pinning during gate oxide atomic layer deposition, a dual passivation procedure was required using both a reductant, trimethylaluminum (TMA), and an oxidant, O2 or H2O. Dosing GaAs (110) with TMA resulted in the formation of an ordered complete monolayer of dimethylaluminum which passivates the group V dangling bonds but also forms metal-metal bonds with conduction band edge states. These edge states were suppressed by dosing the surface with oxidants O2 or H2O which selectively react with group III-aluminum bonds. The presence of an ordered Al monolayer with a high nucleation density was indirectly confirmed by XPS and STS.