Mandatory Indication Research Articles

Impact of mandatory indications for outpatient antibiotic orders on accurate tracking of antibiotic indications.

We sought to evaluate whether implementing mandatory indications for outpatient electronic antibiotic orders or using encounter International Classification of Diseases, Tenth Revision (ICD10) codes more accurately reflected clinicians' charted diagnosis in encounter notes. Secondarily, we examined the appropriateness of antibiotic prescriptions. Cross-sectional study. Mandatory indications were added to all outpatient electronic antibiotic orders on May 18, 2022. A randomly selected convenience sample of 1300 outpatient encounters with antibiotics from walk-in clinics was reviewed. Adjusted logistic regression was used to compare the congruence between encounter ICD10 code and charted diagnosis for encounters from July 15 to September 15, 2021 (pre-implementation period) to the congruence between encounter ICD10 code, charted diagnosis, and mandatory indication for encounters from July 15 to September 15, 2022 (post-implementation period). Antibiotic appropriateness based on charted diagnosis was also evaluated. Among 1300 outpatient encounters, congruence between charted diagnosis and ICD10 code significantly increased in the post-implementation period (87.7% (565/644)) versus pre-implementation (83.3% (540/648), adjusted odds ratio (aOR) 1.52; 95% CI 1.03-2.25). Congruence between charted diagnosis and mandatory indication during post-implementation was 95.2% (613/644) and >5 times more likely to be congruent than charted diagnosis and ICD10 code during pre-implementation (aOR 5.45; 95% CI 3.26-9.11). Antibiotic prescribing based on charted diagnosis was twice as likely to be appropriate in the post-implementation period (aOR1.99; 95% CI 1.32-2.98). Mandatory indications within antibiotic orders show better congruence with charted diagnosis than ICD10 codes and may increase antibiotic appropriateness and congruence between ICD10 code and charted diagnosis.

On the issue of formal assimilation of anglicism nouns in the genus category of the german language system and its national variants

In the conditions of general globalisation, there is a massive consolidation of Anglicisms in all languages, including the German language with its national variants. The study of this process is topical and corresponds to modern priority scientific directions. Formal assimilation is an aspect of loaning foreign language material by a receptor language. It is this that allows foreign language material to gain a foothold in the system of the borrowing language. However, the German language we consider to be a receptor language, is not a monosystem formation due to its including of national variants. The German literary language is a potential abstract archsystem realised in three directions, sovereign systems of the German language (the German language of Germany, the Austrian and the Swiss varieties of the German literary language). The nature of the German language greatly influences the results of formal assimilation of borrowed material, since they will vary depending on the usage. Fluctuations in national variants arise both at the phonetic, lexical, grammatical, word-formation level, and can manifest themselves in relation to the processes of borrowing and Germanisation of foreign language material. This article studies and describes deviations and variations in the results of the formal assimilation of Anglicisms-nouns in the genus category, functioning in the national varieties of the German language of Austria and Switzerland in comparison with the German language of Germany. The acquisition of generic categorical meaning by borrowed units plays an important role in the German language system, since belonging to a certain grammatical gender is a mandatory and constant indicator of the part of speech “noun” and predetermines the further assimilation of the borrowed unit in the receptor language.

Comprehensive assessment of the quality of Ukrainian-made sour-milk cheese

Comprehensive research of food products, as well as compliance with the rules and regulations in the food industry, are necessary to provide consumers with quality and safe products. The purpose of this article is to provide a comprehensive analysis of the quality and safety of sour-milk cheese, including the evaluation of organoleptic characteristics, physicochemical properties, and microbiological indicators. The study was conducted with one of the largest producers of milk powder and fermented milk products on the Ukrainian market, BIAGR LLC as its basis. To achieve the set goal, the following methods were used: organoleptic, physicochemical, microbiological, and measurement of the content of toxic elements (cadmium, arsenic, lead). At the beginning of the measurement of quality indicators, packaging and labelling were evaluated, which complied with the requirements of the national standard. During the study of the organoleptic quality indicators of sour-milk cheese with a fat content of 5%, it was found that its consistency is soft, without whey separation; distinctive fermented milk smell and taste are without extraneous odour and favour; the colour of the sample is uniformly white. At the second stage of the research, the mandatory physicochemical quality indicators were measured and evaluated, namely: mass fraction of fat – 5.0%; mass fraction of protein – 14.6%; mass fraction of moisture – 68.0%; titratable acidity – 176°T; phosphatase was absent. Since food safety is now an urgent issue in Ukraine, the following safety indicators were measured during the research: the number of lactic acid bacteria, which was 2×106 CFU per 1 g; Escherichia coli bacteria were not detected; the number of mould fungi was 1×101 CFU per 1 g; the amount of yeast was 1×101 CFU per 1 g; pathogenic microorganisms, including Salmonella, Staphylococcus aureus, Listeria monocytogenes were not detected. Thus, in terms of organoleptic, physicochemical and safety indicators, sour-milk cheese with a fat content of 5%, produced by BIAGR LLC, meets the requirements of regulatory documents. The results of the research can be used for quality control of dairy products and improvement of production processes

The wastewater treatment plant operation estimation through the use of the water quality index – the case study of WWTP-Montana, Bulgaria

Wastewater treatment plants (WWTPs) are designed to treat the used water by improving its quality, so it is no longer harmful to the environment when discharged. The long-term mandatory monitoring of wastewater produces large amounts of data. It can be converted to a unitless number – the Water Quality Index (WQI) and used to assess the wastewater quality by checking compliance with the set regulations. It has gained increasing popularity among decision-makers, wastewater professionals, and environmental agencies. Operation assessment of the WWTP-Montana for a period of 12 years (2011-2022) was performed using the Canadian Council of Ministers Water Quality Index (CCME WQI) calculation for the raw water (influent) and the treated water (effluent) of the WWTP and applying time series analysis of CCME WQI and water quality indicators – chemical oxygen demand (COD), biochemical oxygen demand after 5 days (BOD5), total nitrogen (TN), total phosphorus (TP) and total suspended solids (TSS) in the influent. For the entire period, the calculated CCME WQI for the treated waters shows the perfect score of 100 (excellent water quality). The calculated CCME WQI at the inlet, on the other hand, classifies the raw water’s quality as “poor” (64% of the CCME WQI values), “marginal” (32%) and “fair” (4%). The time series analysis reveal that higher water quality of the inlet wastewater is detected in summer (August) due to the lower concentrations of the five mandatory physicochemical indicators.

Oncological and functional outcomes of patients who underwent open partial nephrectomy for kidney tumor.

To report long-term functional and oncological outcomes of OPN Methods: We enrolled 182 patients who underwent consecutive OPN with a diagnosis of kidney tumor in our clinic between April 2002 and February 2020 and were selected from our prospective OPN database. Preoperative demographic and clinical characteristics, intraoperative and pathological results, and patients' postoperative functional and oncological follow-up data were retrospectively analyzed. Overall survival (OS) and disease- free survival (DFS) were evaluated using Kaplan-Meier survival analysis. The time-dependent variation between preoperative and postoperative functional results was statistically analyzed and presented in a graph. The mean age was 54.4 ± 10.8 yr, and the median age-adjusted Charlson comorbidity index (ACCI) was 1 (interquartile range [IQR] 0-1). The mean tumor size was 3.1 ± 1.2 cm, and the median RENAL score was 6 (IQR 5-8). The most common malign histopathological subtype was clear cell carcinoma with 76.6%, and five cases (3.4%) had positive surgical margins (PSMs). The most common surgical techniques were the retroperitoneal approach (98.9%) and cold ischemia (88.5%). Estimated glomerular filtration rate (eGFR) preservation was 92% (80.8-99.3, IQR), which translates to 32% chronic kidney disease (CKD) upstaging. Acute kidney injury (AKI) was detected in 27 (14.8%) patients according to RIFLE criteria. The intraoperative complication rate was 5.5%, and the postoperative overall complication rate (Clavien-Dindo 1-5) was 30.2%. Major complications (Clavien-Dindo 3-5) were observed in 13 (7.1%) patients. The median oncological follow-up was 42 mo (21.3- 84.6, IQR), and the 5- and 10-yr OS were 90.1% and 78.6%, 5 and 10-yr DFS were 99.4% and 92.1%, respectively. No local recurrence was observed in 5 (3.4%) patients with PSMs; only one had distant metastasis in the 8th postoperative month. The retrospective design, the small number of patients who underwent PN based on mandatory indication, and one type of surgical approach may limit the generalizability of our findings. This study confirms excellent long-term oncologic and functional outcomes after OPN in a cohort of patients selected from a single institution. In light of the information provided by the literature and our study, our recommendation is to push the limits of PN under every technically feasible condition in the treatment of kidney tumors to protect the kidney reserve and achieve near-perfect oncological results.

A new functionality for the digital building logbook: Assessing the progress of decarbonisation of national building sectors

The EU has set itself demanding objectives to achieve complete decarbonisation by 2050. The building sector plays an important role for this purpose, hence monitoring its progress towards decarbonisation is essential to identify measures that work and to readjust policies when necessary. However, collecting information to monitor the building sector is a complex task due to the scarcity and low quality of available data. The European digital building logbook (DBL) has great potential in this regard because it allows the collection of data at the building scale, which could be combined at a national level. Thus, this paper proposes a new functionality for the DBL -as an enabler for the collection of data for the assessment of the progress of the main EU policy objectives related to the building sector decarbonisation-, and it evaluates the potential of the DBL for it. To do so, the main policy objectives were associated to a set of progress indicators –mandatory and optional- and matched to DBL indicators. Mandatory indicators are for all Member States and they have been included in the 2023 amended version of the proposal for the Energy Performance of Buildings Directive recast. Optional indicators are considered country-specific in this paper and are sourced from various literature references. Here we have studied the optional progress indicators for the case of Spain. Results show that the DBL has great potential to contribute to the collection of more than half of the mandatory indicators and a very high share of the optional ones for Spain.

Issues of using modern organic reagents in the practice of drinking water supply (literature review)

The article contains a literature review devoted to the safe use of modern organic reagents in drinking water supply practice. When conducting a literature search, the following databases were used as follows: Pubmed, Scopus, Web of Science, MedLine, Global Health, RSCI, as well as a search method based on keywords and citations. The purpose of the review is that despite the large number of developed technologies and various reagents, the problem of removing anthropogenic and anthropogenic pollutants from natural water purification cannot be considered to be solved. Water purification technologies are being improved; their effectiveness largely depends on the intensification of reagent treatment.
 In addition to generally accepted laboratory studies of the reagents used in water treatment, it is necessary to conduct production tests to clarify the parameters of the health risk and toxicity of the transformation products formed during the water treatment process, as well as to study the effectiveness and safety of a set of reagents that together enter the water treatment process. The hygienic assessment of reagents should take into account the actual conditions of their use in drinking water supply practice, including further stages of water treatment. This concerns the assessment of the possible destruction of polymers during the production of composite reagents, the assessment of modifying additives included in their composition, the transformation of polymers in water during chlorination, chloramination, ozonation, under the influence of ultraviolet irradiation, and adjustment of a set of mandatory controlled indicators. To conduct these studies, laboratories must have publicly available analytical methods that allow accurately determining the presence of monomers, polymers, as well as various additives and transformation products in concentrations actually present in drinking water.

Cesarean sections in the Thiadiaye health district 2015 2016

Objective: To evaluate the follow-up of pregnancy in patients with caesarean deliveries, the time taken to perform the procedure and the postoperative prognosis. Material and methods: This was a retrospective, descriptive and analytical study conducted over a period of two years at the Maternity Hospital of the health district. Data were collected from clinical records, delivery room and operating theatre registers. The variables studied were the epidemiological characteristics of the patients, the follow-up of the pregnancy, the indications for caesarean section and the maternal and neonatal outcome. The data were entered and analysed using SPHINX software. Results: During this period we performed 274 caesarean sections out of a total number of 7025 deliveries, i.e. a caesarean section rate of 3.9%. The epidemiological profile of the patients was that of a young woman, with an average age of 27.4 years. The majority were married (98.1%). The socio-economic level was low (97.8%) and they were primiparous (33.2%). As regards pregnancy follow-up, 34.3%) had had 3 antenatal consultations and 31.7% had had 4 antenatal consultations. Hypertension was observed in 25.9% of pregnancies. The standard blood test was performed in 25.2% of patients. For obstetrical ultrasound, 52.2% of patients had undergone at least one ultrasound examination. The majority of patients (80%) had their first caesarean section and 14% had their second. These were emergency caesareans in 82.1%. They were mandatory indications in 49%, of prudence in 30% and of necessity in 21%. The extraction time was less than 30 minutes in 41 cases and between 30 and 60 minutes in 132 cases. Post-operative complications were dominated by vasculo-renal syndromes. Perinatal mortality was 28.6‰. The contraceptive rate after caesarean section was 98.1% during this period. Conclusion: The management of deliveries in rural areas is often difficult, prenatal consultations are often of poor quality, the management of caesarean sections performed with rather long delays.

Carbon intensity constraint, economic growth pressure and China's low-carbon development

Within the context of promotion tournaments among local governments, the management of economic growth goals plays a crucial role in China's economic development. Despite China's rise as the second-largest economy globally, it has also emerged as the largest emitter of carbon emissions. Since the implementation of the 12th Five-Year Plan in 2011, the Chinese central government has made carbon intensity targets mandatory indicators for national economic development. This has prompted local governments to pursue low-carbon growth and adjust their economic growth targets (EGT) to comply with carbon intensity constraints. In this study, a sample of 282 prefecture-level cities in China is used to empirically examine the impact of carbon intensity constraints on total factor carbon emission efficiency (TCE) using the intensity difference-in-differences (DID) framework. The study also emphasizes the role of the transmission channel for economic growth pressure (EGP). The findings of the study reveal several key results. Firstly, the implementation of carbon intensity constraints leads to an average increase of 8.24% in total factor carbon emission efficiency (TCE), which is supported by robustness tests, parallel trend analysis, and placebo tests. Secondly, these constraints result in an average decrease of 0.1828 in local governments' economic growth targets (EGT) and a reduction of 0.1269 in economic growth pressure (EGP). Thirdly, cities with a higher proportion of secondary industry experience a more significant mitigation effect, although the promotion of provincial EGT hinders this effect. Fourthly, synergistic policies can effectively promote low-carbon development, and government expenditure on technology and marketization can facilitate a positive relationship between carbon intensity constraints and TCE. Lastly, the effects of carbon intensity constraints vary across the east, middle, and west regions, suggesting the presence of heterogeneity. The article proposes a shift in the assessment of lower governments by superior governments, from growth assessment to low-carbon growth assessment.

Quality improvement review of O positive blood in emergency transfusion.

We recently introduced a policy to use O positive red cells in emergency transfusions for males >16 years of age and females >50 years of age. Here, we investigate changes in emergency transfusion practice and rates of red cell alloimmunization with the use of O positive blood for emergency transfusion. State-wide retrospective review of emergency transfusions between June 2020 and June 2021. The laboratory information system and patient medical records were used to collect demographic details, indications for transfusion, usage of O positive and O negative blood and rates of alloimmunization. There were 2354 red cell units transfused to 1013 patients (male = 59%, average age = 53 years) during the 12-month period. O positive units accounted for 46.9% (1103 units) of emergency transfusions. However, 726 (30.8%) O negative units were transfused to patients without a mandatory indication for O negative blood. Twenty-eight patients (2.9%) had a red cell alloantibody prior to transfusion including anti-E (n = 10), anti-D (n = 4), and anti-K (n = 4). One patient with prior anti-D had mild delayed hemolysis. There were 19 patients (4.3%, median follow-up 22 days) who developed a red cell alloantibody after emergency transfusion and include anti-E (n = 10), anti-D (n = 7), and anti-C (n = 5). The use of O positive blood for emergency transfusion has saved 1103 O negative red cell units with no detriment to patient outcome. There remains potential to optimize use of O positive blood in emergency transfusion and to understand red cell alloimmunization rates in a prospective fashion.

Amniotic fluid content in children with kidney and urinary tract anomalies determines pre- and postnatal development

BackgroundRenal oligohydramnios (ROH) describes an abnormally low volume of amniotic fluid (AF) during pregnancy. ROH is mostly caused by congenital fetal kidney anomalies. The ROH diagnosis frequently implies an increased risk of peri- and postnatal fetal mortality and morbidity. The present study aimed to evaluate the impact of ROH on pre-and postnatal development in children with congenital kidney anomalies.MethodsThis retrospective study included 168 fetuses with anomalies in the kidney and urinary tract. Based on the amount of AF measured by ultrasound, patients were divided into three groups: normal amniotic fluid (NAF), amniotic fluid in the lower normal range (LAF), and ROH. These groups were compared with respect to prenatal sonographic parameters, perinatal outcomes, and postnatal outcomes.ResultsAmong the 168 patients with congenital kidney anomalies, 26 (15%) had ROH, 132 (79%) had NAF, and 10 (6%) had LAF. Of the 26 families affected by ROH, 14 (54%) decided to terminate pregnancy. Of 10 live-born children in the ROH group, 6 (60%) survived the observation time; of these, 5/6 presented with chronic kidney disease, stages I–III, at their last examination. The main differences in postnatal development between the ROH group and the NAF and LAF groups were: restricted height and weight gain, respiratory issues, complicated feeding, and the presence of extrarenal malformations.ConclusionsROH is not a mandatory indicator of severe postnatal kidney function impairment. However, children with ROH have complicated peri-and postnatal periods, due to the presence of concomitant malformations, which must be considered in prenatal care.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

Reducing 25-Hydroxyvitamin D Testing in a Large, Urban Safety Net System.

25-Hydroxyvitamin D testing is increasing despite national guidelines and Choosing Wisely recommendations against routine screening. Overuse can lead to misdiagnosis and unnecessary downstream testing and treatment. Repeat testing within 3months is a unique area of overuse. To reduce 25-hydroxyvitamin D testing in a large safety net system comprising 11 hospitals and 70 ambulatory centers. This was a quality improvement initiative with a quasi-experimental interrupted time series design with segmented regression. All patients in the inpatient and outpatient settings with at least one order for 25-hydroxyvitamin D were included in the analysis. An electronic health record clinical decision support tool was designed for inpatient and outpatient orders and involved two components: a mandatory prompt requiring appropriate indications and a best practice advisory (BPA) focused on repeat testing within 3months. The pre-intervention period (6/17/2020-6/13/2021) was compared to the post-intervention period (6/14/2021-8/28/2022) for total 25-hydroxyvitamin D testing, as well as 3-month repeat testing. Hospital and clinic variation in testing was assessed. Additionally, best practice advisory action rates were analyzed, separated by clinician type and specialty. There were 44% and 46% reductions in inpatient and outpatient orders, respectively (p < 0.001). Inpatient and outpatient 3-month repeat testing decreased by 61% and 48%, respectively (p < 0.001). The best practice advisory true accept rate was 13%. This initiative successfully reduced 25-hydroxyvitamin D testing through the use of mandatory appropriate indications and a best practice advisory focusing on a unique area of overuse: the repeat testing within a 3-month interval. There was wide variation among hospitals and clinics and variation among clinician types and specialties regarding actions to the best practice advisory.

Quality and safety in residential aged care: an evaluation of a national quality indicator programme.

In Australia, 243 000 individuals live in approximately 2700 residential aged care facilities yearly. In 2019, a National Aged Care Mandatory Quality Indicator programme (QI programme) was implemented to monitor the quality and safety of care in facilities. To examine the validity of the QI programme indicators using explicit measure review criteria. The QI programme manual and reports were reviewed. A modified American College of Physicians Measure Review Criteria was employed to examine the QI programme's eight indicators. Five authors rated each indicator on importance, appropriateness, clinical evidence, specifications and feasibility using a nine-point scale. A median score of 1-3 was considered to not meet criteria, 4-6 to meet some criteria and 7-9 to meet criteria. All indicators, except polypharmacy, met criteria (median scores=7-9) for importance, appropriateness and clinical evidence. Polypharmacy met some criteria for importance (median=6, range 2-8), appropriateness (median=5, range 2-8) and clinical evidence (median=6, range 3-8). Pressure injury, physical restraints, significant unplanned weight loss, consecutive unplanned weight loss, falls and polypharmacy indicators met some criteria for specifications validity (all median scores=5) and feasibility and applicability (median scores=4 to 6). Antipsychotic use and falls resulting in major injury met some criteria for specifications (median=6-7, range 4-8) and met criteria for feasibility and applicability (median=7, range 4-8). Australia's National QI programme is a major stride towards a culture of quality promotion, improvement and transparency. Measures' specifications, feasibility and applicability could be improved to ensure the programme delivers on its intended purposes.

Biotesting for the objectivization of the hygienic evaluation of the surface and underground drinking water sources

Introduction. An algorithm for evaluating the hygienic safety of drinking water sources based on biotesting and studying sanitary and chemical indicators has been developed and tested. Materials and methods. The research methods included sanitary and chemical analysis of water samples, as well as biotesting methods using single-celled green alga Chlorella vulgaris Beijer and bull spermatozoa. Results. For experimental approbation of the developed algorithm for determining the hygienic safety of water based on a two-component system of express biotesting and measurement of sanitary and chemical indicators, 6 underground and 5 surface water sources were evaluated. The response of test objects indicating the presence of acute toxicity in water samples taken from surface and underground in many cases correlates with the excess of MPC for individual indicators identified by sanitary and chemical analysis. For two water samples, differences were found between the results of biotesting and sanitary-chemical analysis, and therefore it is necessary to conduct an extended toxicological and chemical assessment to identify the source of toxic effects. Limitations. The two-component test system cannot be used separately without sanitary and chemical analysis of water media. Conclusion. Biotesting can be an addition to sanitary and chemical analyses, showing the presence of toxic substances that are not in the list of mandatory indicators to be determined (according to MR 2.1.4.0176-20 (in Russian)).

Intergenerational live-in student programmes for meaningful engagement: Creating cohesive and supportive collectives in aged-care facilities.

Older adults in residential aged-care facilities (RACFs) experience segregation from society and face limited opportunities to meaningfully engage on a social and/or occupational level due to various structural and systemic challenges. An occupational therapy-coordinated intergenerational live-in student programme (ILiSP) with allied health students was successfully pioneered across Sydney (Australia) to facilitate ongoing intergenerational contact. We explored how ongoing intergenerational contact influenced meaningful engagement of older adults in RACFs by investigating routinely collected clinical data and exploring stakeholders' perspectives. We employed a concurrent nested mixed-methods design. Residents' attendance in weekly organisational activities and students' monthly volunteer hour reports were analysed to produce statistics for demonstrating the changes in residents' activity attendance alongside ongoing intergenerational contact. Qualitative data from discussions directed by the nominal group technique (NGT) with staff, management and students, individual interviews with relatives and residents, and narrative clinical documentation were thematically analysed. The Wilcoxon signed-rank test indicated that residents' activity attendance increased during intergenerational contact. Qualitative data yielded three main themes-interdependence, meaningful engagement, and kinship-all associated with intergenerational contact as part of established ongoing relationships. The NGT highlighted consensus on on-site living for maintaining a cohesive and supportive collective. Despite structural and systemic challenges within RACFs that dissuade community integration, ILiSP created opportunities for students to connect/reconnect residents to new/established networks and to support residents to maintain or re-engage with previous lifestyle preferences. Therefore, ongoing intergenerational contact fostered a cohesive collective in support of the social and occupational needs of residents, which should be capitalised on by policymakers (e.g., the National Aged Care Mandatory Quality Indicator Program) and interested organisations.

Evaluation of the accuracy of a mandatory indication field for outpatient antibiotic prescriptions.

Evaluation of the accuracy of a mandatory indication field for outpatient antibiotic prescriptions.

Tell-a provider about tele: Reducing overuse of telemetry across 10 hospitals in a safety net system.

Telemetry is often a scarce resource at hospitals and is important for arrhythmia and myocardial ischemia detection. Overuse of telemetry monitoring leads to alarm fatigue resulting in failure to respond to arrhythmias, patient harm, and possible unnecessary testing. This quality improvement initiative was implemented across NYC Health and Hospitals, an 11-hospital urban safety net system. The electronic health record intervention involved the addition of a mandatory indication in the telemetry order and a best practice advisory (BPA)that would fire after the recommended time period for reassessment had passed. The average telemetry hours per patient encounter went from 60.1 preintervention to 48.4 postintervention, a 19.5% reduction (p < .001). When stratified by the 11 hospitals, decreases ranged from 9% to 30%. The BPA had a 53% accept rate and fired 52,682 times, with 27,938 "discontinue telemetry" orders placed. The true accept rate was 50.4%, as there was a 2.6% 24-hreorder rate. There was variation based on clinician specialty and clinician type (attending, fellow, resident, physician associate, nurse practitioner). We successfully reduced telemetry monitoring across a multisite safety net system using solely an electronic health record (EHR) intervention. This expands on previous telemetry monitoring reduction initiatives using EHR interventions at single academic sites. Further study is needed to investigate variation across clinician type, specialty, and post-acute sites.

ANALYSIS OF THE MECHANICAL PROPERTIES OF LONG PRODUCT ROLLING MILL ROLLS

Rolls of longproduct rolling mills, as an expendable working tool of the rolling technological operation, make up a significant share of redistribution costs and significantly affect the economic efficiency of the manufacturing process. The importance of rolls is manifested in the organization of their production at specialized enterprises, the presence of rolling menage in the workshops of metallurgical enterprises, the development and introduction of new rolling rolls materials. Therefore, the tasks of analyzing the available roll materials and their properties, choosing the optimal set of properties for the conditions of a certain state become quite actual.&#x0D; The purpose of the work is to review rolled materials and analyze the properties of rolls used in modern long-product mills. Such an analysis was performed for steel and cast-iron rolls, the use of which is most common on mills for the production of simple profiles in the form of bars and rods.&#x0D; Based on the analysis of the latest research and publications, the stages of the development of rolled materials in retrospect, the main indicators of the mechanical, technological and operational properties of the rolls have been determined. The main types of cast iron and steel rolling materials offered by leading manufacturers of rolling rolls are also established. For these groups of roll materials, an analysis of their mechanical properties, such as hardness, tensile strength, and bending strength, was performed.&#x0D; Based on the results of the analysis, a significant improvement in the mechanical and operational properties of modern rolled materials was noted. This is achieved due to alloying, improvement of their manufacturing technologies, specialized types of heat treatment aimed at forming a certain structure and properties. Conditional blurring of boundaries between cast iron and steel rolls is also established. For example, iron rolls with a ferrite structure and spheroidal graphite and graphitized steel rolls are used, which provide approximately the same mechanical strength, gripping ability and wear resistance.&#x0D; Modern rolled materials are characterized by the expansion of controlled property indicators. This applies both to the components of the chemical composition and to indicators of mechanical properties. In particular, the leading manufacturers of rolled rolls include the bending strength limit, which is 1.5 to 2 times higher than the strength limit from tensile tests, among the mandatory indicators.&#x0D; In the calculations of the rolls, the fulfillment of their strength conditions should be checked by the allowable stresses determined beyond the bending strength limit, as an indicator of the properties, which to a greater extent corresponds to the load conditions of the rolls.&#x0D; An objective assessment of the performance of the rolls according to the strength conditions can be obtained only when determining the allowable stresses based on the actual values of the properties provided by the manufacturer of the rolls, and not according to the range of values recommended in the literature.&#x0D; The results of the conducted analysis can be used for the justified selection of rolling materials, improving the control of their properties, obtaining objective assessments of their performance, increasing the efficiency of the rolling farm and technical and economic indicators of production processes.

Hand hygiene and HAI transmission in Piedmont, Italy: an observational study, 2017-2019

Abstract Background Hand hygiene (HH) is one of the most important measures to prevent healthcare-associated infections (HAIs). Several indicators have been proposed to measure HH practices, including alcohol-based handrub consumption (AHC). The objective of this study was to evaluate whether AHC is associated with HAI transmission. Methods All 25 public hospitals/trusts of Piedmont, in Northern Italy, are required to provide data each year concerning HAIs and infection prevention and control (IPC) activities, as part of a mandatory regional indicator system. Data on AHC and HAIs were extracted from reports provided concerning the years 2017-2019. The mean annual AHC for each facility was expressed as liters per patient-day. The rate of hospital-wide Methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacteriaceae (CRE) infections was calculated per 1000 patient-days (pd). Mean ventilation-associated infections (VAP) for 1000 days of ventilation (vd) and mean catheter-related bloodstream infections (CR-BSI) for 1000 days of catheterization (cd) were calculated for intensive care units (ICUs). Spearman's correlational analysis was conducted between AHC and HAIs: hospital-level, ICU-level. Results Hospital-level: mean AHC was 15.4 liters/pd; mean HAI rate was 39.6/1000 pd (MRSA) and 18.5/1000 pd (CRE). No significant correlation was found. ICU-level: mean AHC was 39.6 liters/pd; mean HAI rate was 1.7/1000 cd (CR-BSI) and 8.2/1000 vd (VAP). A moderate correlation was found between AHC and CR-BSI rate (Spearman's ρ -0.55, p 0.022). Concerning AHC and VAP, higher AHC was reported from facilities with lower VAP rates, however no significant correlation was found (Spearman's ρ -0.203, p 0.451). Conclusions Results of this study support the validity of AHC as an indicator of IPC practices in ICUs. The hospital-level analysis could have been affected by important differences in AHC among ward types. Key messages

Prospective Study of Clinical Outcomes From a Breast Implant Assessment Service.

Breast augmentation remains the commonest cosmetic surgical procedure worldwide, in spite of recent regulatory action. We established a breast implant assessment clinic to evaluate women with breast implants and sought to capture clinical and implant data in women presenting to the service. Patients were enrolled prospectively between January 2018 and December 2021. Clinical, implant, and practitioner data were recorded. Patients reported satisfaction on size, shape, and overall outcome as well as the presence or pain. Radiological evaluation, where indicated, was performed and data was included on these findings. A total of 603 patients were assessed. Mean age was 42.7 years and mean age of implantation was 29.1 years. The most common complications were capsular contracture followed by pain waterfall deformity and double bubble with rupture/contracture rates increasing after the 10-year mark. The risk of double bubble was significantly lower if patients were operated on by certified practitioners (OR = 0.49, p = 0.011). There was almost universally poor awareness of the risks of breast implants in patients presenting for evaluation. This study has shown benefit in a breast implant assessment clinic to gather information on adverse events and patient reported outcomes following breast implant surgery. For patients who underwent cosmetic augmentation by appropriately trained and certified practitioners, the risk of implant malposition and deformity is significantly lowered. Any adverse event occurring within 5 years of initial surgery should be flagged as a mandatory reportable clinical indicator and trigger further investigation.