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Burn patients are particularly vulnerable to infection, and an estimated half of all burn deaths are due to infections. This study explored risk factors for healthcare-associated infections (HAIs) in adult burn patients.
Retrospective cohort study.
Tertiary-care burn center.
Adults (≥18 years old) admitted with burn injury for at least 2 days between 2004 and 2013.
HAIs were determined in real-time by infection preventionists using Centers for Disease Control and Prevention criteria. Multivariable Cox proportional hazards regression was used to estimate the direct effect of each risk factor on time to HAI, with inverse probability of censor weights to address potentially informative censoring. Effect measure modification by burn size was also assessed.
Overall, 4,426 patients met inclusion criteria, and 349 (7.9%) patients had at least 1 HAI within 60 days of admission. Compared to <5% total body surface area (TBSA), patients with 5%–10% TBSA were almost 3 times as likely to acquire an HAI (hazard ratio [HR], 2.92; 95% CI, 1.63–5.23); patients with 10%–20% TBSA were >6 times as likely to acquire an HAI (HR, 6.38; 95% CI, 3.64–11.17); and patients with >20% TBSA were >10 times as likely to acquire an HAI (HR, 10.33; 95% CI, 5.74–18.60). Patients with inhalational injury were 1.5 times as likely to acquire an HAI (HR, 1.61; 95% CI, 1.17–2.22). The effect of inhalational injury (P=.09) appeared to be larger among patients with ≤20% TBSA.
Larger burns and inhalational injury were associated with increased incidence of HAIs. Future research should use these risk factors to identify potential interventions.
The dynamic model Nitrogen Dynamics in Crop rotations in Ecological Agriculture (NDICEA) was used to assess the nitrogen (N), phosphorus (P) and potassium (K) balance of long-term organic cropping trials and typical organic crop rotations on a range of soil types and rainfall zones in the UK. The measurements of soil N taken at each of the organic trial sites were also used to assess the performance of NDICEA. The modeled outputs compared well to recorded soil N levels, with relatively small error margins. NDICEA therefore seems to be a useful tool for UK organic farmers. The modeling of typical organic rotations has shown that positive N balances can be achieved, although negative N balances can occur under high rainfall conditions and on lighter soil types as a result of leaching. The analysis and modeling also showed that some organic cropping systems rely on imported sources of P and K to maintain an adequate balance and large deficits of both nutrients are apparent in stockless systems. Although the K deficits could be addressed through the buffering capacity of minerals, the amount available for crop uptake will depend on the type and amount of minerals present, current cropping and fertilization practices and the climatic environment. A P deficit represents a more fundamental problem for the maintenance of crop yields and the organic sector currently relies on mined sources of P which represents a fundamental conflict with the International Federation of Organic Agriculture Movements organic principles.
Cooperating for Peace and Security attempts to understand - more than fifteen years after the end of the Cold War, seven years after 9/11, and in the aftermath of the failure of the United Nations (UN) reform initiative - the relationship between US security interests and the factors that drove the evolution of multilateral security arrangements from 1989 to the present. Chapters cover a range of topics - including the UN, US multilateral cooperation, the North Atlantic Treaty Organization (NATO), nuclear nonproliferation, European and African security institutions, conflict mediation, counterterrorism initiatives, international justice and humanitarian cooperation - examining why certain changes have taken place and the factors that have driven them and evaluating whether they have led to a more effective international system and what this means for facing future challenges.
On March 29, 2005, to the delight of the assembled diplomats, UN Secretary-General Kofi Annan walked into the Security Council chamber and bested the United States.
It was fifteen years after the end of the Cold War, and ten years after France's President Chirac had termed the United States a “hyperpower.” In the previous two years, the United States had invaded Afghanistan and ousted the Taliban from its former safe haven and put on an extraordinary display of military might in the first phase of the Iraq war. The U.S. economy was operating with a massive surplus, and the U.S. military was not just unrivaled in contemporary terms but was realistically being described as the most powerful military force in history. In book after book, international relations scholars and historians eschewed the debate about whether there was an American Empire and turned their minds to such questions as: was the Empire good for American values and interests; was it liberal; was it stronger than the British Empire at its height; and how long it would last.
Five years earlier, a confident American public, basking in eight years of prosperity and relative peace overseen by the Clinton administration, elected to office George W. Bush and the neoconservative wing of the Republican party, waving the flags of American dominance and contempt for multilateralism.
In 1979, the evolutionary biologists Stephen Jay Gould and Richard Lewontin gave a conference paper that was soon recognized as a classic in their field. At first, it seemed to have nothing to do with evolution at all. “The Spandrels of San Marco and the Panglossian Paradigm: A Critique of the Adaptionist Programme” opens by observing that “the great central dome of St. Mark's Cathedral in Venice presents in its mosaic design a detailed iconography expressing the mainstays of the Christian faith.”
Three circles of figures radiate out from a central image of Christ: angels, disciples and virtues. Each circle is divided into quadrants, even though the dome itself is radially symmetrical in structure. Each quadrant meets one of the four spandrels in the arches below the dome. Spandrels – the tapering triangular spaces formed by the intersection of two rounded arches at right-angles – are necessary architectural by-products of mounting a dome on rounded arches. Each spandrel contains a design fitted into its tapering space. An evangelist sits in the upper part flanked by the heavenly cities. Below, a man representing one of the four Biblical rivers (Tigris, Euphrates, Indus and Nile) pours water into the narrow space below his feet.
This is noteworthy not only because the artistry in the spandrels is beautiful but also because its beauty can fool a tourist or art historian “to view it as the starting point of any analysis, as the cause in some sense of the surrounding architecture.