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To summarize risk factors for Clostridioides (formerly Clostridium) difficile infection (CDI) in hospitalized pediatric patients as determined by previous observational studies.
Meta-analysis and systematic review.
Studies evaluating risk factors for CDI in pediatric inpatients were eligible for inclusion.
We systematically searched MEDLINE, Web of Science, Scopus, and EMBASE for subject headings and text words related to CDI and pediatrics from 1975 to 2017. Two of the investigators independently screened studies, extracted and compiled data, assessed study quality, and performed the meta-analysis.
Of the 2,033 articles screened, 14 studies reporting 10,531,669 children met the inclusion criteria. Prior antibiotic exposure (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.31–3.52) and proton pump inhibitor (PPI) use (OR, 1.33; 95% CI, 1.07–1.64) were associated with an increased risk of CDI in children. Subgroup analyses using studies reporting only adjusted results suggested that prior antibiotic exposure is not a significant risk factor for CDI. H2 receptor antagonist (H2RA) use (OR, 1.36; 95% CI, 0.31–5.98) and that female gender (OR, 0.87; 95% CI, 0.74–1.03) did not play a significant role as a risk factor for developing CDI.
Prior antibiotic exposure appears to be an important risk factor for CDI based on the combined analysis but not significant using adjusted studies. PPI use was associated with an increased risk of CDI. Judicious and appropriate use of antibiotics and PPIs may help reduce the risk of CDI in this vulnerable population.
This paper describes the design and fabrication of a range of ‘gas cell’ microtargets produced by the Target Fabrication Group in the Central Laser Facility (CLF) for academic access experiments on the Orion laser facility at the Atomic Weapons Establishment (AWE). The experiments were carried out by an academic consortium led by Imperial College London. The underlying target methodology was an evolution of a range of targets used for experiments on radiative shocks and involved the fabrication of a precision machined cell containing a number of apertures for interaction foils or diagnostic windows. The interior of the cell was gas-filled before laser irradiation. This paper details the assembly processes, thin film requirements and micro-machining processes needed to produce the targets. Also described is the implementation of a gas-fill system to produce targets that are filled to a pressure of 0.1–1 bar. The paper discusses the challenges that are posed by such a target.
In this article, we present a short case study based on an incident that occurred in Israel several years ago. The incident did not reach the courts but was made public by the family members of the older woman at the center of it. The family argued that the actions taken by one of the parties involved should have been defined as elder abuse, but no criminal charges were ever brought. Yet the issues concern key legal and ethical questions about law, religion, and older persons. More specifically, the incident raises the issue of the moral commitment to one's past religious beliefs in reference to one's current choices and preferences once living with dementia. We contend in this article that an Aristotelean account of human dignity would have provided the most satisfactory way to resolve the tensions created by this incident.
Factors favoring blood stream infections associated with gastrointestinal mucosa versus skin organisms were explored. An observed difference was attributable to bacteremia from oral flora in patients with acute myelogenous leukemia or mucositis. Our data do not support the conclusion that isolation of enteric Gram-negatives is unrelated to the central catheter.
Property-based models of the ownership of body parts are common. They are inadequate. They fail to deal satisfactorily with many important problems, and even when they do work, they rely on ideas that have to be derived from deeper, usually unacknowledged principles. This article proposes that the parent principle is always human dignity, and that one will get more satisfactory answers if one interrogates the older, wiser parent instead of the younger, callow offspring. But human dignity has a credibility problem. It is often seen as hopelessly amorphous or incurably theological. These accusations are often just. But a more thorough exegesis exculpates dignity and gives it its proper place at the fountainhead of bioethics. Dignity is objective human thriving. Thriving considerations can and should be applied to dead people as well as live ones. To use dignity properly, the unit of bioethical analysis needs to be the whole transaction rather than (for instance) the doctor-patient relationship. The dignity interests of all the stakeholders are assessed in a sort of utilitarianism. Its use in relation to body part ownership is demonstrated. Article 8(1) of the European Convention of Human Rights endorses and mandates this approach.
This paper examines the nature of welfare and best interests as used in medical and family law. It argues that these are commonly presented in individualistic terms, requiring the court to promote the interests of a child or incompetent adult without reference to the interests of others. However, this paper argues that, properly understood, best interests and welfare should be taken as concepts which recognise the importance of relational interests, the performance of obligations, and the virtue of altruism.
Ogier Ghiselin de Busbecq (1522–92) was a Flemish herbalist, diplomat and writer. In 1554, Ferdinand I, soon to be Holy Roman Emperor, dispatched him to Suleiman the Magnificent's court as an ambassador to the Ottoman empire, where Busbecq spent years negotiating a border dispute between his employer and the sultan. While there, he also discovered important manuscripts and sent the first tulip bulbs to Europe. He returned to Vienna in 1562, where he acted as counsellor to Ferdinand, after whose death he continued to serve the Habsburgs. This two-volume work, first published in 1881, contains Busbecq's letters, edited and translated into English from Latin by two Cambridge scholars. Volume 2 contains letters written in France to the Holy Roman Emperors Maximilian II and Rudolph II, and an index and appendix to both volumes, the latter including Busbecq's itineraries and a helpful outline of Hungarian history.