Central Line Research Articles

The benefits of touched vertebra concept for the selection of the lowest instrumented vertebra in thoracic curves of adolescent idiopathic scoliosis.

To assess the benefits of using the touched vertebra (TV) rule in Lenke classification for thoracic curves of adolescent idiopathic scoliosis (AIS). A total of 141 AIS patients with thoracic curves determined by Suk classification were divided based on whether the lowest instrumented vertebra (LIV) matched the TV into groups of mTV (n = 84, LIV = TV), TV- (n = 21, LIV above TV), and TV+ (n = 36, LIV below TV) for 5-year follow-up. The radiological parameters were the central sacral vertical line (CSVL)-LIV distance, distal end vertebra rotation, coronal, and sagittal parameters. Complications included adding-on phenomenon, coronal imbalance, and distal junctional kyphosis. Adding-on phenomenon and coronal imbalance were significantly higher in the TV- group (P = 0.006) and TV + group (P = 0.006), respectively. The distal motion segments were significantly saved in the mTV group (P < 0.001). The CSVL-LIV distance was significantly improved in the mTV group compared to the others during the 5-year follow-up (P = 0.007). The 5-year follow-up CSVL-LIV distance correlated with LIV tilt angle (r = 0.442, P = 0.021) and coronal balance (r = 0.437, P = 0.023). Selecting the TV as LIV minimizes the loss of the distal mobile segment and reduces the complications in the thoracic curves of AIS, which produces a more stable LIV on the CSVL. Therefore, TV is an ideal landmark for determining the distal fusion level using the Lenke classification or Suk classification.

Development of image extraction using the centerline method in the identification of appendicitis in ultrasonography

Appendicitis is a disease that refers to inflammation of the appendix caused by obstruction, or blockage, in the lumen of the appendix. We investigated that this disease can be detected early through medical imaging such as ultrasonography (USG). However, the role of ultrasound in these cases is still limited due to the low visualization rate of the visible appendix. Based on this, this research aims to develop an image extraction process using the Centerline method in the process of identifying appendicitis in ultrasound images. The development of the extraction process is presented in the performance of the centerline and boundary extraction (CBE) algorithm which can represent image objects as boundaries that limit and separate one area from other areas. The research dataset used was 2097 ultrasound images sourced from 90 patients at the West Sumatra Lung Hospital. Based on the tests that have been carried out, it has been proven that it can reduce the width of the image object iteratively until the object is represented as a center line or the thinnest representation. The performance of the CBE algorithm in the identification process is sufficient to provide accuracy results of 92%. These results can be a new extraction concept that can provide accuracy in the identification process.

Preventive effect of probiotics on infections following colorectal cancer surgery: An umbrella meta-analysis

BACKGROUND Postoperative infections remain a significant source of morbidity among patients undergoing colorectal cancer (CRC) surgery. While probiotics have been proposed as a potential strategy to mitigate the risk of these infections, contemporary meta-analyses have produced conflicting findings. AIM To synthesize the available evidence regarding the prophylactic efficacy of probiotics in preventing infections following CRC surgery. METHODS A comprehensive search of PubMed and Scopus was conducted to identify relevant meta-analyses published up to February 2024. To assess the efficacy of probiotics on outcomes, relative risks (RR) and their corresponding 95%CI were pooled using a random effects model. RESULTS This comprehensive umbrella meta-analysis integrated eleven meta-analyses encompassing 11518 participants who fulfilled the inclusion criteria. Probiotics administration resulted in a statistically significant reduction in the incidence of total infections (RR: 0.40, 95%CI: 0.31-0.51; moderate certainty), surgical site infections (RR: 0.56, 95%CI: 0.49-0.63; high certainty), pneumonia (RR: 0.38, 95%CI: 0.30-0.48; high certainty), urinary tract infections (RR: 0.44, 95%CI: 0.31-0.61; moderate certainty), bacteremia (RR: 0.41, 95%CI: 0.30-0.56; high certainty), and sepsis (RR: 0.35, 95%CI: 0.25-0.44; high certainty). However, probiotics did not significantly affect intra-abdominal, central line, or peritoneal infections. CONCLUSION Probiotics have demonstrated potential in mitigating postoperative infectious complications among patients undergoing CRC surgery.

Impact of Molybdenum Foliar Application on Black Bean Development and Seed Production

Bean is a crop of great importance to Brazilian agriculture, due to their relevance for population diet and also as it is one of the countries that produces and consumes more beans. However, their production remains low and one of the reasons may be the failure in absorbing the most of the fertilization applied. Therefore, research is needed to find ways to ensure maximum efficiency and absorption of nutrients by plants, such as the use of Molybdenum application via foliar. The objective of the work was to evaluate the development and yield of beans with foliar application of Molybdenum. The experiment was conducted in randomized blocks in a 2 x 4 x 3 factorial scheme (sowing season x doses x application time), with treatments consisting of two sowing season: autumn/winter (sowing in February - dry season) and spring/summer (sowing in October – rainy season), four Mo doses (0, 50, 150 and 300 ml ha-1 of commercial Mo based product) and three application times, starting the count after 50% plant emergence (10 days after emergence – DAE, 20 DAE and 30 DAE). The experiment was performed at the Experimental Farm of the Grand Dourados Federal University, at the municipality of Dourados, MS, Brazil. The Mo source was a commercial product with a concentration of 216 g l-1 Mo. Black beans were sown using a conventional procedure, with soil preparation by subsoiling, harrowing and leveling. A pneumatic seeder was used with a spacing of 0.45 m, 12 seeds per meter of furrow, in plots of 5 x 5 m, totaling 10 plants per meter, a population of 222,222 plants ha-1 and depth of 0.02 m. For the agronomic evaluations, five plants per plot were collected at the end, when the crop reached physiological maturity, in the central line, for the following determinations: number of pods per plant; number of seeds per plant; number of seeds per pod; mass of a thousand seeds and yield. Positive Results in yield components and effective yield of black-beans were found when 50 ml ha-1 of molybdenum was applied via foliar application. Although it was not one of the objectives of the study, it was concluded that the amount of rainfall in the crop cycle affects the action of molybdenum on bean plants.

UMetals in the Gut: Microbial Strategies to Overcome Nutritional Immunity in the Intestinal Tract.

Trace metals are indispensable nutritional factors for all living organisms. During host-pathogen interactions, they serve as crucial resources that dictate infection outcomes. Accordingly, the host uses a defense strategy known as nutritional immunity, which relies on coordinated metal chelation to mitigate bacterial advances. In response, pathogens employ complex strategies to secure these resources at sites of infection. In the gastrointestinal (GI) tract, the microbiota must also acquire metals for survival, making metals a central line of competition in this complex ecosystem. In this minireview, we outline how bacteria secure iron, zinc, and manganese from the host with a focus on the GI tract. We also reflect on how host dietary changes impact disease outcomes and discuss therapeutic opportunities to target bacterial metal uptake systems. Ultimately, we find that recent discoveries on the dynamics of transition metals at the host-pathogen-microbiota interface have reshaped our understanding of enteric infections and provide insights into virulence strategies, microbial cooperation, and antibacterial strategies.

The generation method of orthophoto expansion map of arched dome mural based on three-dimensional fine color model

Murals carry cultural significance and historical information, and are an important channel for understanding ancient social norms, artistic styles, and religious beliefs. At present, the digitization of murals is an important technical means for the protection of cultural heritage. Orthogonal images of murals play a vital role in high-precision recording, preservation, academic research, educational expansion, mural protection, digital exhibition and dissemination. At present, orthogonal images of murals are mostly realized by plane projection, but this method is not suitable for making orthogonal images of arched and dome-shaped murals. To address this problem, this paper proposes a method for generating orthogonal expansion images of arched and dome-shaped murals. This method combines a three-dimensional virtual space simulation model with an RTT virtual camera and adopts a spatial reference orthogonal ray scanning model. First, the detailed three-dimensional color model is fitted to the geometric reference of cylindrical and spherical objects to determine its parameters. Next, for the cylindrical murals on the arch, the orientation of the model is initialized using quaternions, and the viewport matrix is adjusted to obtain the required resolution. Then, the RTT camera is used to perform line orthogonal projection in the viewport, and the fringe projection image is generated by rotating around the cylinder axis according to the inversely calculated rotation angle. For the murals on the dome ceiling, this method is used to segment them according to a certain longitude, and the circumscribed cylinder of the fitted sphere is rotated to perform cylindrical orthogonal line scanning in the segmented area. These individual orthogonal line scan images are carefully spliced together to form a complete orthogonal unfolded image. Finally, a fringe projection image is generated with the central meridian of the unfolded part as the center line, and the fringe projection images are spliced together to obtain the final orthogonal unfolded image. Experiments show that compared with existing methods, this method can generate two-dimensional orthogonal unfolded images with high texture fidelity, minimal texture deformation, and uniform deformation distribution. This study provides a novel perspective on the orthogonal unfolding of quasi-cylindrical and quasi-spherical painted objects, and provides an accurate and diverse data basis for the digitization of murals.

Real-time intervention to increase daily chlorhexidine bathing and reduce central line-associated bloodstream infections.

After an increase of central line-associated bloodstream infections (CLABSIs) at our community hospital in 2021, a case-control study suggested that patients with CLABSIs were 3.0 times more likely to have missed daily chlorhexidine gluconate (CHG) bathing than patients without CLABSIs. To increase the rate of daily CHG bathing in hospitalized patients with central lines and subsequently reduce the number of CLABSIs. Our pre-post intervention was launched on September 2022 and consisted of enhancements to the electronic health record (EHR) to simplify the identification of overdue CHG bathing instances to increase compliance, and therefore decrease the CLABSI rate at our hospital. A workflow was implemented Monday-Friday utilizing these EHR enhancements for active surveillance to engage frontline nursing staff and address gaps in care in real time. After the initiative was implemented, adherence to daily CHG bathing increased from 94.9% to 95.3%, with a considerable disparity between weekdays (97.6%) and weekends (89.3%). After weekend data were excluded, the post-intervention increase in the adherence rate was statistically significant (p = .003). This initiative underscored the importance of involving health care informatics partners and showed how technology can bridge gaps in health care quality. Outreach and reminders effectively improved CHG bathing adherence by emphasizing the importance of consistent communication and follow-up.

Diagnostic study of atmospheric pressure inductively coupled plasma temperature field based on image and relative spectral line method

Atmospheric pressure inductively coupled plasma (ICP) is widely applied in the production of high-purity coatings and powders. This paper innovatively presents a dual-band imaging ICP temperature diagnostic system that integrates visible light image processing technology and relative spectral line method. The system utilizes a dual-band imaging unit to simultaneously acquire monochromatic grayscale images of ICP at two different wavelengths using a single CCD camera. By establishing the correspondence between the emission intensity received by the emission spectrometer and the grayscale images recorded by the CCD camera, the two-dimensional (2D) electron excitation temperature (EET) field distribution of ICP is obtained by the relative spectral line method. The experimental results demonstrate that the maximum EET is located near to the center line of the RF-driven coil. Additionally, the EET in ICP decreases gradually from the center of the induction coil to the periphery. As the radio frequency (RF) power increases, the maximum EET also increases, and the high-temperature region expands. The accuracy of this method is validated by comparing it with the results obtained from the Boltzmann plot method. Therefore, this method can quickly obtain the transient EET field distribution of ICP, which is significant for optimizing the application of ICP in material processing.

T-Bar Angular Offset: A Novel Angle for Predicting Postoperative Coronal Balance Using Intraoperative Stitched Radiographs

BACKGROUND AND OBJECTIVES: Accurate intraoperative assessment of coronal alignment is critical to achieving favorable clinical outcomes in adult spinal deformity surgery. However, surgical positioning creates challenges in predicting standing coronal alignment. Gravity-based plumblines require an upright posture and are not possible intraoperatively. Intraoperative stitched radiography (ISR) is increasingly being used to evaluate coronal balance as an alternative to 36-inch films, which can be cumbersome. However, ISR does not allow for the measurement of absolute distances, which limits the intraoperative assessment of the coronal plane. We propose a novel angle to assess coronal balance on ISR: the T-bar angular offset (TAO). We evaluate TAO as a measure of coronal balance and assess the degree to which TAO measured on ISR can predict postoperative coronal balance. METHODS: Patients undergoing spinal fusion surgery with ISR were identified retrospectively. A virtual T-bar was created by drawing a line bisecting the S1 endplate perpendicular to a line connecting the acetabula. A second line was drawn from the origin of the first to the midpoint of the superior endplate of the upper instrumented vertebra (UIV) or C7. The angles subtended by these lines were defined as the UIV TAO and C7 TAO, respectively. RESULTS: Sixty-eight patients were identified, with a median (range) of 8 (3-21) levels fused. Intraoperative UIV TAO correlated with both postoperative UIV TAO (R = 0.695, P &lt; .001) and postoperative UIV central sacral vertical line (R = 0.435, P = .002). Intraoperative C7 TAO did not correlate with either postoperative C7 TAO (R = 0.213, P = .22) or C7 central sacral vertical line (R = 0.063, P = .72). CONCLUSION: TAO is a useful angular measure that can be used on noncalibrated ISR to predict the positioning of the UIV relative to the sacrum during spinal fusion surgery. However, it does not appear to be predictive of the coronal alignment of C7.

Incidence of and Risk Factors for Central Venous Catheter Thrombosis: Results from a Single-Center Pediatric Intensive Care Unit.

Central Venous Catheter (CVC) is a necessary and important tool in managing acutely ill children and those needing complex care. CVC enables infusing venous medication, fluids, blood products, chemotherapy, total parental nutrition, and painless withdrawal of blood for laboratory testing when needed. To identify the incidence and risk factors for Central Venous Catheter-Related Thrombosis (CVC-RT) among patients admitted to the Pediatric Intensive Unit. This was a prospective, observational, single-center study that was conducted over 17 months from September 2019 to January 2021 at King Abdulaziz Medical City, Jeddah. Prospective observational study. King Abdulaziz Medical City, a tertiary care center in the western region of Saudi Arabia. Pediatric patients aged 1 to 168 months who were admitted to the PICU and required central line insertion (whether inserted centrally or peripherally) for more than 48 hours were included. Screening for thrombosis was performed within day 4-7 post-line insertion and again on the 14th day. A total of 255 patients were enrolled over 17 months. The incidence rate of CVC-RT was 5.4%. The type of CVC was significantly different between the two groups; in the no thrombosis group, 59.2% had a central line while in the CVC-RT groups, 51.9% had a PIC line (p = 0.027). In a multivariate regression analysis including patients' clinical profile, high D-dimer as baseline and low platelets were both significant risk factors for CVC-RT [adjusted OR = 3.22, CI (1.25-8.28), p = 0.015 and adjusted OR = 7.38, CI (2.18-25.02), p = 0.001], respectively. The current study found that PIC line was associated with an increased risk of CVC-RT, which is congruent with the literature. As children with CVC can have multiple risk factors for developing CVC-RT, it is important to conduct further large prospective studies to identify such factors and decrease the incidence of CVC-RT.

Ordering Effect of Charge-Charge Repulsion in Doped Antiferromagnetic Lattices: A Coupled Cluster Study.

In quantum chemistry, single-reference Coupled Cluster theory, and its refinements introduced by Bartlett, has become a "gold-standard" predictive method for taking into account electronic correlations in molecules. In this article, we introduce a new formalism based on a Coupled Cluster expansion of the wave function that is suited to describe model periodic systems and apply this methodology to the case of hole-doped antiferromagnetic two-dimensional (2D)-square spin-lattices as a proof of concept. More precisely, we focus our study on 1/5 and 1/7 doping ratios and discuss the possible ordering effect due to large hole-hole repulsion. Starting from one of the equivalent single determinants exhibiting a full spin alternation and the most remote location of the holes as a single reference, the method incorporates some corrections to the traditional Coupled Cluster formalism to take into account the nonadditivity of excitation energies to multiply excited determinants. The amplitudes of the excitations, which are possible on the excited determinants but impossible on the reference, are evaluated perturbatively, while their effect is treated as a dressing in the basic equations. The expansion does not show any sign of divergence of the wave operator. Finally, the probabilities of holes moving toward the first- and second-neighboring sites are reported, which confirms the importance of the hole-hole repulsion and offers a picture of how stripes expand around its central line in the "stripe phases" observed in cuprates.

Perceptions of distinctions between patient and healthcare zones among intensive care unit nurses at a Korean tertiary hospital: A cross-sectional study.

Intensive care unit (ICU) patients face higher infection risks from invasive procedures, highlighting the critical role of ICU nurses in infection prevention. Clear differentiation between the patient and healthcare zones is essential for effective hand hygiene and disinfection, yet research on this topic is limited. To assess ICU nurses' perception of the concept of patient and healthcare zones and evaluate their similarity and accuracy in identifying the zones. A descriptive survey was conducted at a 2,732-bed tertiary hospital in Korea from 28 July to 27 August 2022. Participants were recruited from various ICUs through flyers. 225 questionnaires-with illustrations 27 item locations for three ICU scenarios-were made available at nursing stations for voluntary completion. Participants were asked to classify items into the patient zone or the healthcare zone. Similarity scores reflected participant agreement, while accuracy scores measured the proportion of correct answers. Participants' free-text opinions regarding zone classification were analysed thematically. 104 nurses participated voluntarily. Average similarity and accuracy were 84.7% and 82.7%, respectively. The top 8 items, with over 97% similarity and accuracy, were all frequently in contact with ICU patients (e.g., pulse oximeter, Levin tube, central line, urine bag, and patient bed). The bottom 7 items, with less than 80%, included the glucometer, flashlight, trolley, and sink. Participants with higher education levels had significantly higher similarity (p = .044) and accuracy (p = .033), whereas those already familiar with the patient-zone concept had significantly higher accuracy (p = .009). From the free-text analysis, participants considered factors beyond proximity to the patient, such as patient contact, room type, and distance. To address zone classification challenges, clear criteria for patient and healthcare zones, space redesign, and educational programs are recommended. Further research is necessary to improve greater clarity and consensus regarding patient and healthcare zones to enhance infection control practices.

Design of a CPW-based SSPP band-pass filter with reflectionless notch

Abstract This work proposes a band-pass filter (BPF) with a reflectionless notch based on spoof surface plasmon polaritons (SSPPs), utilizing interdigital coupling structures and novel transmission line unit cells. This filter efficiently transmits signals within the 0.67 GHz −4.06 GHz frequency range. By analyzing the equivalent LC circuit of the novel transmission line unit cell, its dispersion relation is derived using microwave network theory, with a cutoff frequency of 4.11 GHz. By comparing its dispersion relation with that of the conventional transmission line unit cell, the miniaturization capability of the proposed unit cell can be verified. In the BPF, loading a zigzag groove onto the central transmission line can be equivalently represented as an interdigital coupling structure, generating a stopband in the low-frequency range near 0 GHz. By deriving and analyzing its S-parameters, it is shown that the bandwidth of the low-frequency stopband can be flexibly adjusted by modifying the geometric dimensions of the zigzag groove. Additionally, loading another set of interdigital coupling structures onto the transmission line generates a notch at its resonant frequency of 3.4 GHz. It is noteworthy that in this configuration, the interdigital coupling structures along with the central transmission line can be represented equivalently as a set of CPW antennas. At the resonant frequency, the atructure radiates signals into free space, forming a reflectionless notch. Based on the simulations, a physical filter was fabricated and tested, showing excellent agreement between simulations and measurements.

Virtual Chest Radiographs Developed From Computed Tomography Images for Differentiating Central Venous Versus Misplaced Arterial Lines and for Training Radiologists

Objective Radiographic findings to identify central venous catheter misplacement in the arteries, which can cause lethal complications, have not been fully evaluated, and its training is difficult because it is rare. The purpose of this study is to clarify radiographic findings for differentiating central venous and misplaced arterial lines using virtual chest radiographs and elucidate their usefulness in training radiologists. Methods This retrospective study included 150 patients (mean age, 67 [SD, ±12] years; 97 men) who underwent colon cancer surgery between January 2018 and December 2020. Virtual chest radiographs, including 6 oblique projections at 5° intervals, were developed from the computed tomography images using ray-sum reconstruction. Virtual venous and arterial lines were drawn from the right neck to the superior vena cava and aorta, respectively. Diagnostic abilities, including area under the curve (AUC) analysis of the 7 proposed radiographic findings for differentiating these lines in 100 patients, were evaluated. The diagnostic performance, including AUC analysis by 5 radiologists in the other 50 patients, was compared before and after disclosing these results to the radiologists. Results The findings of crossing over the right paratracheal stripe and running along the paracaval line showed the highest AUC for indicating arterial and venous lines in the frontal, right anterior oblique 15°, and left anterior oblique 15° projections (AUC = 0.992, 0.991, and 0.979, and 1.000, 0.994, and 0.998, respectively). The diagnostic performance of the radiologists improved after informing them of these results (AUC, 0.982–0.999 to 0.993–1.000 [P = 0.145–1.000] for the frontal projections and 0.932–0.970 to 0.967–0.995 [P = 0.075–0.150] for the oblique projections). Conclusions Virtual chest radiographs created from computed tomography images were useful for clarifying radiographic findings for differentiating central venous and misplaced arterial lines and for training radiologists.

An event-related potential study of P300 in preschool children with attention deficit hyperactivity disorder.

To study the characteristics of event related potential P300 in preschool children with attention deficit hyperactivity disorder (ADHD) aged 4-6 years (4≤ age <6), and to explore the differences in cognitive function compared with healthy children. To explore a new method for the study of cognitive function in preschool children with ADHD. A total of 73 preschool children aged 4-6 years were selected from the outpatient clinic of Neurology Department, the ADHD-specialized Clinic and Health Care Department of the Children's Hospital Affiliated to the Capital Institute of Pediatrics from March 2021 to May 2024. They were divided into the ADHD group (45 cases) and healthy children group (28 cases). Event related potential P300 was measured in all children and the amplitude and latency of the wave were compared between the two groups separately. The latency of P300 at all the recording electrodes (Fz, Cz, Pz, Oz, C3, C4) in the ADHD group was significantly longer than controls (p < 0.05). The wave amplitudes of children with ADHD were significantly higher than controls at Pz and Oz points. The differences between two groups in P300 test show that preschool children with ADHD present longer latency at central line of the brain and bilateral central lobes compared with healthy children, and higher amplitude at the central parietal lobe and central occipital lobe. It may suggest that attention cognition has already impaired in preschool children with ADHD.

Assessing the effect of implementing a central line care bundle on central line-associated bloodstream infections in a tertiary hospital in Saudi Arabia

Central line-associated bloodstream infections (CLABSIs) are severe bloodstream infections caused by catheter use and are often associated with a longer hospital stay, increased healthcare costs, and a higher mortality rate. However, catheter-related bloodstream infections can be successfully treated. It is essential that healthcare workers are aware of central line (CL) insertion and maintenance bundles to reduce and prevent the incidence of CLABSI. The objective of this study was to assess the impact of implementing CL care bundles on hospital-wide CLABSI incidence rates. This is a prospective study conducted at the King Faisal Specialist Hospital and Research Center in Saudi Arabia from January 2017 to December 2021. The research period was divided into two phases: the pre-intervention phase (January 1, 2017 to December 31, 2018) and the post-intervention phase (January, 2019 to December 31, 2020). During both phases, outcome variables, including CLABSI rate, were assessed. In the present study, the total number of CLABSIs is 439, of which 266 were in the pre-intervention phase and 173 were in the post-intervention phase. The overall CLABSI rate significantly decreased from 1.6±0.05 in the pre-intervention phase to 0.9±0.05 in the post-intervention phase. This decline in CLABSI was significant (p&lt;0.0001) across all hospital settings, including critical care and non-critical care units. The implementation of care bundles is essential and has been shown to significantly reduce CLABSI rates in nearly all participating units.

Abstract 4138350: Candidemia in Patients with Left Ventricular Assist Device-A Case Series

Introduction: Candidemia is rare but associated, have significant morbidity and mortality. Outcomes are not well-characterized in patients with left ventricular assist devices (LVADs). With an increasing number of patients living with LVADs, we sought to characterize risk factors to help optimize outcomes for this high-risk population. Methods: We retrospectively reviewed records of 97 patients who underwent LVAD implant between January 2012 to May 2024 at Indiana University Health, Indianapolis Indiana. Demographic and clinical data were extracted. Candidemia was defined as a positive blood culture with candida species. Result: We identified three patients with candidemia, with an overall attack rate of 3.09%. All patients had a HeartMate III (HM3) at the time of infection. The mean age of patients was 40.3 years (Range 29.0 – 58.0 years) and mean BMI was 35.7 kg/m 2 (Range, 30.0 – 42.0 kg/m 2 ). One patient grew Candida auris and Candida tropicana, the other patient grew Candida auris and the third patient grew Candida globrata. All patients had an automatic implantable cardiac defibrillation, a peripherally inserted central catheter line, and right heart failure. Two patients had driveline infections (one fungal, one bacterial) while one patient developed LVAD endocarditis with a right ventricular outflow tract vegetation. Two patients had persistently positive blood cultures despite treatment with a multi-drug anti-fungal regimen (Flucytosine, Amphotericin B and micafungin) and expired. The third patient initially cleared her blood cultures after treatment with IV micafungin only but was re-admitted with muti-organ failure and expired. Summarily, all patients with candidemia died with a mortality rate of 100%. None of the patients were candidates for heart transplantation. Average survival from the time of diagnosis of candidemia was 5 months (Range 1.0 – 11.0 months). RHF, chronic DL infection and high BMI were associated with candidemia in our series. Conclusion: Candidemia in LVAD patients, while less common than bacterial infections, carry high mortality without cardiac transplantation (100% mortality in our cohort). Its rare occurrence makes it challenging to identify reversible risk factors, leading to poor survival. Multicenter registries are needed to fully elucidate these risk factors and determine effective treatment strategies.

Eliminating Error in Central Line Scheduling and Placement Using Quality Improvement Methods.

The Joint Commission defines a sentinel event as "surgery or other invasive procedure performed at the wrong site, on the wrong patient, or that is the wrong (unintended) procedure for a patient regardless of the type of procedure or the magnitude of the outcome." At our institution, we observed a low but consistent rate of incorrect surgical line placement for pediatric patients with cancer. Following quality improvement methodology and using the resources available on a large academic medical campus we designed and implemented a new multi-factorial process to schedule and place surgical central lines for pediatric patients with cancer. Changes included re-defining responsibilities, adding staff, and redesigning the process with workflows supported by modifications to the electronic medical record. Our primary outcome measures were incorrect central line placement or near miss event per quarter and days between these events. After implementation the rate of incorrect line placement and near miss events was reduced to zero with 1018 days since the last incorrect line placement. As a result of our multi-factorial quality improvement initiative in the scheduling and placement of central lines, we were able to eliminate surgical line placement sentinel events and improve care for pediatric patients with cancer.

102. Surgical Treatment of Brachial Artery Aneurysm Associated qith Arteriovenous Shunt for Hemodialysis: Case Report

Introduction: A brachial artery aneurysm is a rare complication of an arteriovenous fistula (AVF) created for hemodialysis access. This report details the case of a patient with a brachial artery aneurysm associated with an AVF for hemodialysis, who underwent successful surgical treatment. Case: A 64-year-old female with CKD undergoing regular hemodialysis presented with a painful lump in her right arm one-week AVF installation. Her medical history included a left nephrectomy in 2022, previous failed AV fistula placement, and central dialysis line (CDL) insertion. The patient had a medical history significant for CKD requiring routine HD twice a week. Local examination of the patient's right arm revealed a mobile, painful lump, diagnosed as a brachial artery aneurysm, limiting arm movement. A chest X-ray showed cardiomegaly, thoracic spondylosis, and proper CDL positioning. Laboratory results were normal. The patient underwent surgical repair of the aneurysm and was hospitalized for three days postoperatively. Post-surgery treatment included analgesics, antibiotics, anticoagulation therapy, and outpatient clopidogrel. Conclusions: A brachial artery aneurysm is a rare complication of an AVF, posing risks of peripheral embolism and hand ischemia, and therefore requires surgical correction.

Numerical determination of the threshold magnetic field in superconducting strips and coils triggering dynamic resistance

Abstract The threshold magnetic field is a key parameter for evaluating the current decay caused by dynamic resistance in superconducting windings and magnets. For a DC-carrying superconducting slab under an AC parallel magnetic field, the analytical theory clearly shows that there is only one electric central line (ECL) across the slab width at the onset of dynamic-resistance. However, threshold magnetic fields in superconducting strips and coils have not been fully investigated. Based onthe one-ECL criterion, this paper first presents a method for numerically determining the threshold magnetic field via the evolving internal magnetic field in superconducting strips and coils. By probing transient electromagnetic behaviours, interestingly, we found a distinctive feature of superconducting strips in which a wide region of zero electrical field is observed when dynamic resistance/loss initially occurs. With increasing magnetic fields, this region gradually shrinks and eventually become the ECL. More importantly, this numerical method can analyse the local threshold magnetic field in a targeted coil turn. The ability to quantify threshold magnetic field provides a clear guidance on the acceptable level of ripple and harmonic magnetic fields for coil windings in superconducting maglev trains and field windings of superconducting machines operating at persistent current mode.&amp;#xD;