Etude de la variabilité saisonnière des précipitations sur le plateau de Mbé au Pool-Nord (Congo-Brazzaville) : impacts sur les eaux de surface et souterraines

Cette étude porte sur l'impact de la variabilité saisonnière des précipitations sur les eaux du Plateau de Mbé. 120 échantillons d'eau ont été prélevés dans huit (08) points d'eau (1 puits, 4 forages et 3 rivières) entre novembre 2017 et août 2018. L'analysés au laboratoire de ces échantillons, permettent de caractériser les éléments physico-chimiques des eaux. Ces résultats sont traités à partir d'une méthode hydrochimie, en utilisant les diagrammes : de Piper, de Schoeller Berkaloff, de Stiff, et de Wilcox. Les données traitées montrent que les valeurs obtenues après les analyses des eaux des saisons ne présentent pas une variation considérable et sont toutes conformes aux normes prescrites par l'OMS pour l'eau de boisson, en dehors de la température qui est légèrement supérieure à la normale avec une moyenne de 27 ∘C. Le pH a une moyenne de 5.0; ce qui confirme le caractère acide des eaux dans toute cette zone d'étude. Abstract. This study examines the impact of seasonal rainfall variability on the Mbé Plateau waters. 120 water samples were taken from eight (08) water points (1 well, 4 boreholes and 3 rivers) between November 2017 and August 2018, analyzed in the laboratory, to characterize the physicochemical elements of the water. These results are processed from a hydrochemical method, using the diagrams : of Piper, Schoeller Berkaloff, Stiff, Wilcox. They show that the water values analyzed between the 4 seasons do not vary considerably and all comply with the standards prescribed by the WHO for drinking water, except for the abnormal temperature with an average of 27 ∘C and average pH of 5.0 which confirms the acidity of the waters throughout this study area.

Risk events during intrahospital transport of patients from the emergency department: a prospective observational study

BackgroundWe aimed to determine the incidence, nature of and predisposing factors for risk events (REs) that occur during the intrahospital transport of patients from the ED.MethodsWe undertook a prospective, observational study of intrahospital patient transports from a single ED between 30 January and 20 March 2020. An investigator attended each transport and recorded any RE on a specifically designed data collection document. An RE was any mishap, even if not foreseen, that had the potential to cause the patient harm. A patient equipment number was assigned based on the number of pieces of equipment required during the transport. Poisson regression generated incidence rate ratios (IRRs) and determined risk factors for REs.ResultsOf 738 transports, 289 (39.1%, 95% CI 35.6% to 42.8%) had at least one RE. The total of 521 REs comprised 125 patient-related, 279 device-related and 117 line/catheter-related REs. The most common included trolley collisions (n=142), intravenous fluid line catching/tangling (n=93), agitation/aggression events (n=31) and cardiac monitoring issues (n=31). Thirty-four (6.5%) REs resulted in an undesirable patient outcome, most commonly distress and pain. Predisposing factors for REs included an equipment number ≥3 (IRR 5.68, 95% CI 3.95 to 8.17), transport to a general ward (IRR 2.68, 95% CI 2.12 to 3.39), hypertension (IRR 1.93, 95% CI 1.07 to 3.50), an abnormal temperature and a GCS<14.ConclusionsREs are common in transport of patients from the ED and can result in undesirable patient outcomes. Adequate pre-transfer preparation, especially securing equipment and lines, would result in a reduced risk.

An Experimental and Numerical Study of Quenching-Induced Residual Stresses under the Effect of DSA in an IN718 Superalloy Disc

The effects of Dynamic Strain Ageing (DSA) on residual stresses generated in Ni-base superalloys during heat treatments are not well understood. In this work, the residual stress field induced by water quenching an IN718 disc while undergoing DSA is studied using coupled thermo-mechanical finite element analyses in conjunction with neutron diffraction (ND) measurements. A visco-plastic constitutive model which incorporates the effect of DSA is proposed to describe the experimentally observed negative strain rate sensitivity and abnormal temperature dependence phenomena in the stress-strain response of solid solution treated IN718. The predicted quenching residual stresses in the disc agree well with the ND measurements. Due to the DSA, a propagating high plastic strain rate region can be identified in the disc during the early stages of the quenching process. Due to the negative strain rate sensitivity and abnormal temperature dependence effects caused by DSA, the predicted residual stresses are approximately 10% greater than when those two effects are not accounted for. The effects of different convection heat transfer conditions in the FE model are examined and discussed. It is found that the convection heat transfer coefficients have a great influence both on the disc residual stresses and DSA-related plastic strain rate field predictions.

Evaluation of antibiotic escalation in response to nurse-driven inpatient sepsis screen

Objective: To determine the frequency and predictors of antibiotic escalation in response to the inpatient sepsis screen at our institution. Design: Retrospective cohort study. Setting: Two affiliated academic medical centers in Los Angeles, California. Patients: Hospitalized patients aged 18 years and older who had their first positive sepsis screen between January 1, 2019, and December 31, 2019, on acute-care wards. Methods: We described the rate and etiology of antibiotic escalation, and we conducted multivariable regression analyses of predictors of antibiotic escalation. Results: Of the 576 cases with a positive sepsis screen, antibiotic escalation occurred in 131 cases (22.7%). New infection was the most documented etiology of escalation, with 76 cases (13.2%), followed by known pre-existing infection, with 26 cases (4.5%). Antibiotics were continued past 3 days in 17 cases (3.0%) in which new or existing infection was not apparent. Abnormal temperature (adjusted odds ratio [aOR], 3.00; 95% confidence interval [CI], 1.91–4.70) and abnormal lactate (aOR, 2.04; 95% CI, 1.28–3.27) were significant predictors of antibiotic escalation. The patient already being on antibiotics (aOR, 0.54; 95% CI, 0.34–0.89) and the positive screen occurred during a nursing shift change (aOR, 0.36; 95% CI, 0.22–0.57) were negative predictors. Pneumonia was the most documented new infection, but only 19 (50%) of 38 pneumonia cases met full clinical diagnostic criteria. Conclusions: Inpatient sepsis screening led to a new infectious diagnosis in 13.2% of all positive sepsis screens, and the risk of prolonged antibiotic exposure without a clear infectious source was low. Pneumonia diagnostics and lactate testing are potential targets for future stewardship efforts.