Cost-effectiveness of a central venous catheter care bundle

Background: A bundled approach to central venous catheter care is currently being promoted as an effective way of preventing catheter-related bloodstream infection (CR-BSI). Consumables used in the bundled approach are relatively inexpensive which may lead to the conclusion that the bundle is cost-effective. However, this fails to consider the nontrivial costs of the monitoring and education activities required to implement the bundle, or that alternative strategies are available to prevent CR-BSI. We evaluated the cost-effectiveness of a bundle to prevent CR-BSI in Australian intensive care patients. ---------- Methods and Findings: A Markov decision model was used to evaluate the cost-effectiveness of the bundle relative to remaining with current practice (a non-bundled approach to catheter care and uncoated catheters), or use of antimicrobial catheters. We assumed the bundle reduced relative risk of CR-BSI to 0.34. Given uncertainty about the cost of the bundle, threshold analyses were used to determine the maximum cost at which the bundle remained cost-effective relative to the other approaches to infection control. Sensitivity analyses explored how this threshold alters under different assumptions about the economic value placed on bed-days and health benefits gained by preventing infection. If clinicians are prepared to use antimicrobial catheters, the bundle is cost-effective if national 18-month implementation costs are below $1.1 million. If antimicrobial catheters are not an option the bundle must cost less than $4.3 million. If decision makers are only interested in obtaining cash-savings for the unit, and place no economic value on either the bed-days or the health benefits gained through preventing infection, these cost thresholds are reduced by two-thirds.---------- Conclusions: A catheter care bundle has the potential to be cost-effective in the Australian intensive care setting. Rather than anticipating cash-savings from this intervention, decision makers must be prepared to invest resources in infection control to see efficiency improvements.

4-Carbamoylpiperidinium 5-nitrosalicylate

In the structure of the title compound, C6H13N2O+ C7H4NO5-, the isonipecotamide cations and the 5-nitrosalicylate anions form hydrogen-bonded chain substructures through head-to-tail piperidinium N---H...O(carboxyl) hydrogen bonds and through centrosymmetric cyclic head-to-head amide-amide hydrogen-bonding associations [graph set R2/2(8)]. These chains are cross linked by amide N---H...O~carboxyl~ and piperidinium N-H...O(nitro) associations to give a two-dimensional sheet structure.

Raman spectroscopy of hydrogene-arsenate group (AsO3OH) in solid-state compounds: cobalt mineral phase burgessite Co2(H2O)4[AsO3OH]2•H2O

Raman spectrum of burgessite, Co2(H2O)4[AsO3OH]2.H2O was studied, interpreted and compared with its infrared spectrum. The stretching and bending vibrations of (AsO3) and As-OH units together with the stretching, bending and libration modes of water molecules and hydroxyl ions were assigned. The range of O-H...O hydrogen bond lengths was inferred from the Raman and infrared spectra of burgessite. The presence of (AsO3OH)2- units in the crystal structure of burgessite was proved in agreement with its recently solved crystal structure. Raman and infrared spectra of erythrite inferred from the RRUFF database are used for comparison.

4-Carbamoylpiperidinium 2-carboxybenzoate-benzene-1,2-dicarboxylic acid (1/1)

In the structure of the title salt adduct, C6H13N2O+ C8H5O4- . C8H6O4, the asymmetric unit comprises one isonipecotamide cation, a hydrogen phthalate anion and a phthalic acid adduct molecule and form a two-dimensional hydrogen-bonded network through head-to-tail cation-anion-adduct molecule interactions which include a cyclic heteromolecular amide--carboxylate motif [graph set R2/2(8)], conjoint cyclic R2/2(6) and R3/3(10) piperidinium N-H...O(carboxyl) associations, as well as strong carboxylic acid O-H...O(carboxyl) hydrogen bonds.

Pseudo-merohedral twinning in the structure of the hydrated 1:1 proton-transfer compound of 5-sulfosalicylic acid with 4-aminopyridine

The structure of the pseudo-merohedrally twinned crystal of the 1:1 proton-transfer compound of 5-sulfosalicylic acid (3-carboxy-4-hydroxybenzenesulfonic acid) with 4-aminopyridine: 4-aminopyridinium 3-carboxy-4-hydroxybenzenesulfonate sesquihydrate has been determined at 180 K and the hydrogen-bonding pattern is described. Crystals of the compound are monoclinic with space group P21/c, with unit cell dimensions a = 35.2589(8), b = 7.1948(1), c = 24.5851(5) Å, β = 110.373(2)o, and Z = 16. The monoclinic asymmetric unit comprises four cation-anion pairs and six water molecules of solvation with only the pyridinium cations having pseudo-symmetry as a result of inter-cation aromatic ring π-π stacking effects. Extensive hydrogen bonding gives a three-dimensional framework structure.

Review of Dr. Richard Shapcott's International Ethics : A Critical Introduction. 2010. London: Polity Press. ISBN-13: 978-0-7456-3142-4.

This work by Richard Shapcott is, as the title provides, an introduction to international ethics. By taking a quick glance at the table of contents (see Figure 1) we see that he has systematically divided this particular discourse into its normative areas of concern (in other words its major areas of argument or research). When reading, we also see that a great deal of work has gone into the publication because the narrative is flowing, the arguments continuous, and because the tone of the work maintained its critical position throughout.

Diiodidobis[4-(-nitrobenzyl)pyridine-kN']zinc

In the structure of title compound [ZnI2(C12H10N2O2)2] from the reaction of 4-(4-nitrobenzyl)pyridine with zinc(II) iodide, the asymmetric unit contains two independent discrete distorted tetrahedral complex units [Zn-I range, 2.5472(8)-2.5666(7)A; Zn-N range, 2.044(4)-2.052(4)A], which are essentially identical conformationally and exist in the crystal structure as a racemic twin.

A Near-infrared and Raman spectroscopic study of the mineral richelsdorfite Ca2Cu5Sb[Cl|(OH)6|(AsO4)4]•6H2O

Raman spectroscopy has enabled insights into the molecular structure of the richelsdorfite Ca2Cu5Sb[Cl|(OH)6|(AsO4)4]·6H2O. This mineral is based upon the incorporation of arsenate or phosphate with chloride anion into the structure and as a consequence the spectra reflect the bands attributable to these anions, namely arsenate or phosphate and chloride. The richelsdorfite Raman spectrum reflects the spectrum of the arsenate anion and consists of ν1 at 849, ν2 at 344 cm−1, ν3 at 835 and ν4 at 546 and 498 cm−1. A band at 268 cm−1 is attributed to CuO stretching vibration. Low wavenumber bands at 185 and 144 cm−1 may be assigned to CuCl TO/LO optic vibrations.

A Raman and infrared spectroscopic study of the mineral delvauxite CaFe3+4(PO4,SO4)2(OH)8•4-6H2O- a ‘colloidal’ mineral

The mineral delvauxite CaFe3+4(PO4,SO4)2(OH)8•4-6H2O has been characterised by Raman spectroscopy and infrared spectroscopy. The mineral is associated with the minerals diadochite and destinezite. Delvauxite appears to vary in crystallinity from amorphous to semi-crystalline. The mineral is often X-ray non-diffracting. The minerals are found in soils and may be described as ‘colloidal’ minerals. Vibrational spectroscopy enables determination of the molecular structure of delvauxite. Bands are assigned to phosphate and sulphate stretching and bending modes. Two symmetric stretching modes for both the phosphate and sulphate symmetric stretching modes support the concept of non-equivalent phosphate and sulphate units in the mineral structure. Multiple water bending and stretching modes imply that non-equivalent water molecules in the structure exist with different hydrogen bond strengths.

Electron paramagnetic resonance, NIR studies on zoisite, clinozoisite and chrom-zoisite minerals

A zoisite group of mineral samples from different localities are used in the present study. An EPR study on powdered samples confirms the presence of Mn(II), Fe(III) and Cr(III) in the minerals. NIR studies confirm the presence of these ions in the minerals.

Rapid displacement of dengue virus type 1 by type 4, Pacific region, 2007-2009

Since 2000-2001, dengue virus type 1 has circulated in the Pacific region. However, in 2007, type 4 reemerged and has almost completely displaced the strains of type 1. If only 1 serotype circulates at any time and is replaced approximately every 5 years, DENV-3 may reappear in 2012.

A subtropical urban community : medium to high density residential typologies - case study 4

On the case study site, using these strategies, the site density achieved was approximately 180 dwellings per hectare. According to ASK consulting engineers‟ acoustic report (in Ecolateral‟s report) the design gives solid consideration to the environmental noise issues associated with the site. The subject structure not only provides significant shielding of transport corridor noise to the suburb, it also minimises the potential for adverse impact on residential amenity within the building itself...

2-(4-Aminophenyl)-1-phenyldiazenium 2,4,6-trinitrophenolate

In the structure of the title salt, C12H12N3+ C6H2N3O7-, the diazenyl group of the 4-(phenyldiazenyl)aniline molecule is protonated and forms a hydrogen bond with the phenolate O acceptor of the picrate anion. Structure extension occurs through two symmetrical inter-ion three-centre amine N---H...O,O'(nitro) hydrogen-bonding associations [graph set R2/1(4)] giving a convoluted two-dimensional network structure.

2,4,6-Trinitro-N-[4-(phenyldiazenyl)phenyl)phenyl]aniline

The title compound, C18H12N6O6 was prepared from the reaction of 4-(phenyldiazenyl)aniline (aniline yellow) with picrylsulfonic acid. The dihedral angle formed by the two benzene rings of the diphenyldiazenyl ring system 6.55(13)deg. and that formed by the rings of the picrate-aniline ring system is 48.76(12)deg. The molecule contains an intramolecular aniline-nitro N-H...O hydrogen bond.

A Raman spectroscopic study of M2+M3+ sulfate minerals, römerite Fe2+Fe23+ (SO4)4· 14H2O and botryogen Mg2+Fe3+ (SO4)2(OH)·7H2O

The mixed valency (M2+M3+) sulphate minerals, römerite Fe2+Fe23+(SO4)4•14H2O and botryogen Mg2+Fe3+(SO4)2(OH).7H2O have been studied by Raman spectroscopy. The Raman spectra of the two types of crystals proved very similar but not identical. The observation of two symmetric stretching modes confirmed the presence of the two non-equivalent sulphate units in the römerite structure. The observation of multiple bands in the antisymmetric stretching region and in the bending regions proves the symmetry of the sulphate anion is significantly reduced in the römerite structure. The number of Raman bands related to the (SO4)2- symmetric and antisymmetric vibrations support the X-ray single crystal structure conclusion that two symmetrically distinct S6+ are present in the structure of botryogen. Römerite is a mineral of environmental significance as it is commonly found in tailings and dumps.