Accuracy of electronic surveillance of catheter-associated urinary tract infection at an academic medical center.

OBJECTIVE: To develop and validate a methodology for electronic surveillance of catheter-associated urinary tract infections (CAUTIs). DESIGN: Diagnostic accuracy study. SETTING: A 425-bed university hospital. SUBJECTS: A total of 1,695 unique inpatient encounters from November 2009 through November 2010 with a high clinical suspicion of CAUTI. METHODS: An algorithm was developed to identify incident CAUTIs from electronic health records (EHRs) on the basis of the Centers for Disease Control and Prevention (CDC) surveillance definition. CAUTIs identified by electronic surveillance were compared with the reference standard of manual surveillance by infection preventionists. To determine diagnostic accuracy, we created 2 × 2 tables, one unadjusted and one adjusted for misclassification using chart review and case adjudication. Unadjusted and adjusted test statistics (percent agreement, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and κ) were calculated. RESULTS: Electronic surveillance identified 64 CAUTIs compared with manual surveillance, which identified 19 CAUTIs for 97% agreement, 79% sensitivity, 97% sensitivity, 23% PPV, 100% NPV, and κ of .33. Compared with the reference standard adjusted for misclassification, which identified 55 CAUTIs, electronic surveillance had 98% agreement, 80% sensitivity, 99% specificity, 69% PPV, 99% NPV, and κ of .71. CONCLUSION: The electronic surveillance methodology had a high NPV and a low PPV compared with the reference standard, indicating a role of the electronic algorithm in screening data sets to exclude cases. However, the PPV markedly improved compared with the reference standard adjusted for misclassification, suggesting a future role in surveillance with improvements in EHRs.

Cell seeding in porous transplantation devices.

Porous laminated discs of 1.35 cm diameter and thickness of 0.5 cm fashioned from biodegradable polymers were used as scaffolds for the transplantation of isolated cell populations. The distribution of cells seeded in these devices via injection was modelled with a system of dyed polymeric microparticles. Optimization of parameters related to device design and surgical injection conditions was carried out to maximize the device volume effectively employed in cell transplantation. The area of distribution on the top surface of each device was determined by image analysis techniques and used as a measure of the spatial distribution of injected particles. For poly(L-lactic acid) devices of porosity of 0.83 and median pore diameter of 166 microns seeded with 6 microns beads under standard injection conditions, the average surface area of distribution was 44.45% (+/- 3.36%). The device pore size was found to be a crucial determinant of particle distribution, whilst particle size in the range of 1-10 microns was not found to be important for the devices tested. Application of these results to the seeding of hepatocyte suspensions was made.

Growth and gas production for hyperthermophilic archaebacterium, Pyrococcus furiosus.

Pyrococcus furiosus represents one of the most important hyperthermophilic bacteria isolated thus far because of its relatively high cell yields and rapid growth rates. Pyrococcus furiosus exhibits several interesting growth characteristics, especially in terms of biotic gas production, which were examined in this study. In the presence of elemental sulfur, both carbon dioxide and hydrogen sulfide production appeared to be strongly growth associated, while no significant hydrogen production was observed. In the absence of sulfur, hydrogen and carbon dioxide were produced by the organism and hydrogen inhibition was observed. The addition of elemental sulfur to the medium apparently eliminated, hydrogen inhibition as growth proceeded normally even when hydrogen was added to the gas phase. Also, no apparent substrate limitation or toxic product could be attributed to the cessation of growth as cell growth in spent media was at least as good as in fresh media. An unstructured growth model was used to correlate growth and gas production for P. furiosus in complex seawater-based media at 98 degrees C both in the absence and presence of elemental sulfur. The model was shown to be useful for examining some of the observations made in this study.