Using the i-PARIHS theoretical framework to develop evidence implementation strategies for central venous catheter maintenance: a multi-site quality improvement project.

INTRODUCTION: Evidence-based nursing practice can reduce complications associated with central venous catheters (CVCs). In this project, the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework was considered an ideal theoretical instrument to identify facilitators and barriers to implementing evidence-based practice. METHODS: The project was conducted in pediatric intensive care units in six Chinese tertiary children's hospitals. Twenty-two audit criteria were obtained from best practice recommendations, and a baseline audit was conducted to assess current practice against best practice. Next, the i-PARIHS framework was used to identify facilitators and barriers to best practice and develop improvement strategies. A follow-up audit was then conducted to measure changes in compliance with best practices. RESULTS: Facilitators and barriers were identified at the innovation, recipient, and context levels. A comprehensive CVC maintenance strategy was then developed to apply the best evidence to nurses' clinical work. Of the 22 audit criteria, 17 showed significant improvement compared with the baseline audit. CONCLUSIONS: The i-PARIHS framework is an effective tool for developing targeted, evidence-based improvement strategies and applying these to the clinical setting. The quality of the nurses' clinical practice improved during CVC maintenance. However, there is no certainty that these positive results can be maintained, and long-term data are needed to verify this. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A185.

3-Hydroxythiophenol-Formaldehyde Resin Microspheres Modulated by Sulfhydryl Groups for Highly Efficient Photocatalytic Synthesis of H2 O2.

Resorcinol-formaldehyde (RF) resin represents a promising visible-light responding photocatalyst for oxygen reduction reaction (ORR) toward H2 O2 production. However, its photocatalytic ORR activity toward H2 O2 generation is still unsatisfied for practical application. Herein, 3-hydroxythiophenol-formaldehyde (3-HTPF) resin microspheres synthesized through polycondensation reaction between 3-HTP and formaldehyde at room temperature and subsequent hydrothermal treatment exhibit enhanced photocatalytic ORR activity is reported. The experimental results show that the partial substitution of hydroxy group (─OH) by sulfhydryl one (─SH) through using 3-HTP to replace resorcinol could slow the rates of nucleation and growth of the resin particles and lead to strongly π-stacked architecture in 3-HTPF. The introduction of ─SH group can also improve adsorption ability of 3-HTPF to O2 molecules and enhance ORR catalytic activity of the photocatalysts. Stronger built-in electric field, better adsorption ability to O2 molecules, and increased surface catalytic activity collectively boost photocatalytic activity of 3-HTPF microspheres. As a result, H2 O2 production rate of 2010 µm h-1 is achieved over 3-HTPF microspheres at 273 K, which is 3.4 times larger than that obtained using RF submicrospheres (591 µm h-1 ). The rational substituent group modulation provides a new strategy for designing polymeric photocatalysts at the molecular level toward high-efficiency artificial photosynthesis.

Comparison of pneumonia and nonpneumonia-related Acinetobacter baumannii complex bacteremia: A single-center retrospective study.

BACKGROUND: Acinetobacter baumannii complex (ABC) is a group of increasingly prevalent opportunistic pathogens that cause a variety of life-threatening nosocomial infections, especially in the intensive care unit (ICU). This study assessed the differences between pneumonia- and non-pneumonia-related ABC bacteremia and possible independent risk factors for 30-day mortality. METHODS: The clinical data of ICU patients diagnosed with ABC bacteremia at a tertiary care hospital from January 2009 to December 2020 were collected, and sorted into groups of ABC bacteremia with and without pneumonia. RESULTS: Significant changes in the incidence of ABC bacteremia and antibiotic resistance were observed over the 12-year study. Compared with nonpneumonia-related ABC bacteremia, pneumonia-related ABC bacteremia was associated with a higher rate of hypertension, less prior tigecycline use, more carbapenem-resistant (CR) strains, and a higher 30-day mortality rate. In multivariate analysis, immunosuppression, higher APACHE II score, and SOFA score were independent risk factors for 30-day mortality. Moreover, the risk of death was 1.919 times higher in the pneumonia-related group. CONCLUSIONS: Although pneumonia-related ABC bacteremia had worse outcomes, it was not an independent risk factor for death statistically. Immunosuppression and disease severity levels increased the risks of death in ICU patients with ABC bacteremia.

Short-term biodrying achieves compost maturity and significantly reduces antibiotic resistance genes during semi-continuous food waste composting inoculated with mature compost.

Food waste (FW) is important object of resource utilization and source of antibiotic resistance genes (ARGs). This study investigated the effects of biodrying combined with inoculating mature compost (B&M) on the composting efficiency, succession of bacterial communities and their links with metabolism functions as well as the fate of ARGs during FW composting. The results showed that B&M could rapidly raise and maintain high relative abundance of Bacillaceae (66.59-94.44%) as well as composting temperature (45.86-65.86 â„ƒ), so as to achieve the final maturity of FW composting in a short time by regulating microbial carbohydrate (14.02-15.31%) and amino acid metabolism (10.33-12.47%). Network analysis demonstrated that high temperature could effectively inhibit the proliferation and spread of potential bacterial hosts of ARGs and integrons including Lactobacillaceae, Enterobacteriaceae, Leuconostocaceae and Corynebacteriaceae during the first two days of composting. As a result, B&M significantly reduced the absolute (72.09-99.47%) and relative abundances (0.31-2.44 logs) of nearly all ARGs especially ermB, tetM, blaCTX-M and blaOXA. Present study deepened the knowledge of ARGs variation, succession and metabolism functions of bacterial communities when B&M processes were used for FW composting, suggesting a promising technology for reducing the transmission risk of ARGs and reaching maturity of FW composting.

Effects of persulfate treatment on the fates of antibiotic resistance genes in waste activated sludge fermentation process and the underlying mechanism.

The occurrence of antibiotic resistance genes (ARGs) in waste activated sludge (WAS) fermentation was investigated with persulfate (PS)-based treatment. ARGs affiliated with multidrug (mexP), macrolide (blaOXA-129), tetracycline (tetB), sulfonamide (sul1), and vancomycin (vanRG) types were significantly decreased by PS/Fe treatment. Mechanistic investigations revealed that PS/Fe possessed oxidating potential and exhibited devastating effects on WAS fermentation. First, PS/Fe promoted cell structure damage, which facilitated ARGs release from potential hosts. A co-occurrence network analysis indicated that Fe/PS suppressed the proliferation of potential host bacteria. In addition, the PS/Fe treatment induced the decreased abundance of certain functional genes involved in pathways associated with ARGs dissemination. Finally, variation partitioning analysis demonstrated that the microbial community structure exhibited more vital effects on ARGs fates than physicochemical factors (i.e., pH and ORP) and gene expression (i.e., two-component system). This work provided a deeper understanding of the critical factors used to determine ARGs fates during WAS fermentation.

Feasibility and effectiveness of prone position ventilation technique for postoperative acute lung injury in infants with congenital heart disease: study protocol for a prospective randomized study.

BACKGROUND: Prone position ventilation is a widely used lung protection ventilation strategy. The strategy is more convenient to implement in children compared to adults. Due to the precise mechanism of improving oxygenation function, development of pediatric prone ventilation technology has been largely focused on children with acute respiratory distress syndrome. There is a paucity of high-quality studies investigating the effects of prone position ventilation after pediatric cardiac surgery. The purpose of this study is to evaluate the feasibility and effectiveness of prone position ventilation in infants who develop postoperative acute lung injury after surgery for congenital heart disease. METHODS: A single-center, randomized controlled trial of pediatric patients with acute lung injury after surgery for congenital heart disease who will receive prone position ventilation or usual care (control group). A total of 68 children will be enrolled according to the inclusion criteria. The main outcome measures will be lung compliance and oxygenation index. The secondary outcomes will be duration of mechanical ventilation, length of stay in cardiac intensive care unit, reintubation rate, and complication rate. DISCUSSION: This study will investigate the feasibility and effectiveness of prone position ventilation techniques in children who develop postoperative acute lung injury after surgery for congenital heart disease. The results may help inform strategies to improve airway management after surgery for congenital heart disease. TRIAL REGISTRATION: ClinicalTrials.gov NCT04607993 . Initially registered on 29 October 2020.

[Improved methods of isolation and purification of rat islets and its viability research].

OBJECTIVE: The purity and activity of islets will greatly affect the outcome of xenotransplantation therapy of type 1 diabetes mellitus. To set up an improved method of the isolation and purification of rat islets, which can obtain high-purity, high-yield, and high-viability islets. METHODS: Ten healthy and adult male SD rats, weighing 250-300 g were used as organ donors. Collagenase V was perfused into pancreas via pancreatic duct. Pancreas was digested with collagenase in water bath at 38 degrees C about 15 minutes, islet purification was performed using two techniques: with Ficoll 400 density gradient (group A), and Ficoll-Paque PLUS (group B). Dithizone (DTZ) was utilized for identifying islets, counting islets equivalent quantity (IEQ) and islets' purity. Trypan blue staining was used to detect the viability of islets. Islets of group B was encapsulated with alginate/poly-L-lysine/alginate (APA). Islets function of microencapsulated and nonmicroencapsulated was evaluated by the insulin release test. RESULTS: DTZ staining showed that islets shape were round, ellipse and irregular with a clear edge and a diameter range of 50-300 microm. The IEQ values were 338.04 +/- 76.61 and 834.80 +/- 54.00 in groups A and B, respectively, showing significant difference (P < 0.05). The purities were 88.31% +/- 2.67% and 95.63% +/- 1.96% in groups A and B, respectively, showing no significant difference (P > 0.05). The activities of islets were 67.40% +/- 5.15% and 86.05% +/- 2.52% in groups A and B, showing significant difference (P < 0.05). Islet APA microcapsules had round shape, unified size, and its diameter was between 1.5 and 2.0 mm. Each microcapsule was encapsulated of 1 to 3 islets. The result of insulin release assay was that the concentrations of insulin secretion with islets of microencapsulated and nonmicroencapsulated were (5.53 +/- 1.64) ng/mL and (4.76 +/- 0.26) ng/mL in low glucose, and its concentrations of insulin secretion in high glucose were (11.95 +/- 2.07) ng/mL and (14.34 +/- 3.18) ng/mL. Stimulated insulin secretion in high glucose was 2 times more than that in low glucose (P < 0.05), but there was no significant difference (P > 0.05) in the stimulation index between group A (2.16 +/- 0.30) and group B (3.01 +/- 0.59). CONCLUSION: The method of islets isolation and purification using Ficoll-Paque PLUS own the virtues of more convenient, high islet yield, and high islet purity. Both microencapsulated and nonmicroencapsulated islets show high-viability while culture in vitro.