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The mechanism through which developmental programming of offspring overweight/obesity following in utero exposure to maternal overweight/obesity operates is unknown but may operate through biologic pathways involving offspring anthropometry at birth. Thus, we sought to examine to what extent the association between in utero exposure to maternal overweight/obesity and childhood overweight/obesity is mediated by birth anthropometry. Analyses were conducted on a retrospective cohort with data obtained from one hospital system. A natural effects model framework was used to estimate the natural direct effect and natural indirect effect of birth anthropometry (weight, length, head circumference, ponderal index, and small-for-gestational age [SGA] or large-for-gestational age [LGA]) for the association between pre-pregnancy maternal body mass index (BMI) category (overweight/obese vs normal weight) and offspring overweight/obesity in childhood. Models were adjusted for maternal and child socio-demographics. Three thousand nine hundred and fifty mother–child dyads were included in analyses (1467 [57.8%] of mothers and 913 [34.4%] of children were overweight/obese). Results suggest that a small percentage of the effect of maternal pre-pregnancy BMI overweight/obesity on offspring overweight/obesity operated through offspring anthropometry at birth (weight: 15.5%, length: 5.2%, head circumference: 8.5%, ponderal index: 2.2%, SGA: 2.9%, and LGA: 4.2%). There was a small increase in the percentage mediated when gestational diabetes or hypertensive disorders were added to the models. Our study suggests that some measures of birth anthropometry mediate the association between maternal pre-pregnancy overweight/obesity and offspring overweight/obesity in childhood and that the size of this mediated effect is small.
This chapter considers the financial management of the English convents in Catholic Europe. It places the convents’ economic dealings in the context of their overall history, underlining just how vital this aspect of convent life was to their very survival and function. This chapter starts by briefly considering the nuns’ devotion to poverty, before exploring some of the necessary expenses accrued by the foundations. The different economic income strands exploited by the English convents is then outlined, before some of the problems they experienced in their finances are explored. The chapter finishes with a consideration of whether the convents were ever able to separate completely from their English roots as far as finances were concerned. Though the English convents adopted similar approaches to financial management as their continental equivalents and were frequently the model of Tridentine economic behaviour, they did face additional problems as a result of their nationality. Ultimately, the English convents existed in a precarious economic zone that could easily fall prey to both domestic and international fluctuations in more than just the economic environment.
The introduction opens by detailing the development of the conventual movement, giving an overview of the two-hundred-year lifespan of this exile initiative. The chapter then discusses archival survival rates, as well as recent historiographical trends that have seen the English convents in exile become a major area of interest. This literature is explored with the intention of contextualising the English convents in Catholic Europe, opening up wider themes relating to religious and national identity in the convents. As well as providing the context for the chapters of the monograph, the nuns’ adherence to the edicts of Trent are also placed in the broader context of the Catholic Reformation and Catholic Europe. Each chapter is then summarised, with an explanation that, rather than a linear, chronological approach to the convents, the book explores the English convents in exile thematically. The chapters have been ordered to take the reader through the experience of a nun, from entry into the convent to life in enclosure, from what the nuns’ surroundings looked like to how the whole enterprise was funded, from what nuns did all day to their wider place within the Catholic world.
The second chapter considers the exile English convents’ commitment to a core tenet of the Council of Trent’s teaching on female religious life: the implementation and maintenance of full enclosure. It opens by detailing the convents’ initiation rites, through the ceremonies of clothing and profession of vows. This chapter considers the relationship between English women religious and enclosure as a touchstone indicator of commitment to the initiatives of the Catholic Reformation. In their dedication to such a major Catholic identifier, it is argued that the English convents did not just match their continental equivalents but even outstripped them, gaining a reputation for their full commitment to this aspect of religious identity. In short, English nuns were committed to the tenets of the Council of Trent, especially those surrounding enclosure. This dedication allowed the nuns to place themselves in the vanguard of new Catholic Reformation initiatives, though this in itself reveals a paradox: for all that they embraced enclosure, the communities were not cut off from the wider world or its perceptions but remained involved with it.
Chapter 3 explores the material world of the nuns as part of the intense rebuilding and architectural remodelling programmes embarked upon in mainland Europe after the Council of Trent. Again, the English convents sought to engage with the wider secular world, in this instance using the decoration of their public churches, as well as the vessels and fabrics used in the celebration of the liturgy, to convey how they wished to be viewed by the surrounding populace. Though they used their outward liturgical faces to support their national identity, far more stress was placed on their strong identification with their Order, emphasising their role as part of the universal Church. Material culture in each institution was aimed at developing the nuns’ spiritual lives in adherence with Tridentine rules on behaviour and management. The second half of the chapter focuses on the more private spaces in which the enclosed inhabitants lived their daily lives, yet, as was the case in other early modern European convents, the secular permeated enclosure through various material reminders. It is argued that exile did not mean poverty of material culture.
Chapter 1 examines recruitment, looking at questions surrounding a postulant’s choice of convent and how they managed to travel there. The very foundation of each exile convent was based on national identity: these were, after all, English convents. Yet this insistence on Englishness did not only emanate from the women religious themselves but was fundamental to their gaining permission to establish convents in the first place. Nevertheless, it is argued that particular religious identities affected the process of joining a convent. It takes as its case study convent recruitment from the county of Essex to argue that women chose particular convents based on an interplay between home and abroad, as well as clerical and familial patronage. It highlights the effect of one clerical movement – the Jesuits – on convent recruitment patterns, yet these issues of competing spiritualities were not, despite first appearances, solely products of particular national contexts but part of wider developments in Catholic Europe. They show the formation of the English convents as part of the European – and even global – Catholic Reformation rather than presenting them as isolated national enclaves.
This chapter examines the liturgical and spiritual life of the convents. It opens by outlining the daily routine within enclosure, exploring the devotional life of the women religious. This is followed by consideration of the spiritual ethos of different convents before focusing at greater length on the nuns’ attitudes towards relics and martyrdom, which was an especially strong devotional strain within the convents. The English convents considered themselves very much part of the English mission, and were committed to eventually replanting female religious life in their homeland, something very much central to the missionary impulse of early modern Catholicism. As such, though they had a natural interest in the fate of their persecuted fellow Catholics back home, the nuns in no way neglected the significance of martyrs from further afield, or relics more indicative of the wider Church, underlining their relationship with mainland European religious and spiritual trends.
The conclusion asks whether the exile women religious were English women who happened to be Catholic, or were they Catholic women who happened to be English? It argues that there is a far stronger case for the latter interpretation. Yes, they kept an English element of identity but this was as part of the transnational Church. It challenges a historiographical approach to the English convents and women religious that prioritises their position as communities of women or interprets them through a lens of nationality, considering them simply as communities of English. It stresses that there is a need to reorientate our understanding of the convents towards Catholic Europe and its centres, with Rome predominant but also acknowledging the importance of Spanish and French religious trends. The English convents were self-consciously Catholic communities, not isolated but fully committed parts of the universal Catholic Church and this is the core identifier that underlined their very existence.
The book’s sixth chapter focuses on the convents’ role within the wider English and Catholic Mission. It considers the convents’ contact with other exile institutions from the western peripheries of Catholic Europe. This chapter asks whether the exile convents and colleges were concentrated only on their own survival or were male and female expressions of the Catholic Reformation bound by national interest? It is argued that the English convents were fully part of the English Catholic endeavour, the nuns overcoming traditional gender boundaries to act as committed partners in the exile enterprise; they were not isolated institutions defined by insularity. The final part of this chapter examines whether Catholic identity trumped national interests. It asks whether archipelagic Catholic identities were formed in the Catholic diaspora through the relationship of the English convents with the continental Irish and Scottish colleges. It is evident that national allegiances won out. In this, the English convents were not behaving any differently to the rest of Catholic Europe: this national approach to mission and Catholic renewal was part of Catholic Reformation methodology.
In 1598, the first English convent to be founded since the dissolution of the monasteries was established in Brussels, followed by a further twenty-one foundations, which all self-identified as English institutions in Catholic Europe. Around four thousand women entered these religious houses over the following two centuries. This book highlights the significance of the English convents as part of, and contributors to, national and European Catholic culture. Covering the whole exile period and making extensive use of rarely consulted archive material, James E. Kelly situates the English Catholic experience within the wider context of the Catholic Reformation and Catholic Europe. He thus transforms our understanding of the convents, stressing that they were not isolated but were, in fact, an integral part of the transnational Church which transcended national boundaries. The original and immersive structure takes the reader through the experience of being a nun, from entry into the convent, to day-to-day life in enclosure, how the enterprise was funded, as well as their wider place within the Catholic world.
To assess variability in antimicrobial use and associations with infection testing in pediatric ventilator-associated events (VAEs).
Descriptive retrospective cohort with nested case-control study.
Pediatric intensive care units (PICUs), cardiac intensive care units (CICUs), and neonatal intensive care units (NICUs) in 6 US hospitals.
Children≤18 years ventilated for≥1 calendar day.
We identified patients with pediatric ventilator-associated conditions (VACs), pediatric VACs with antimicrobial use for≥4 days (AVACs), and possible ventilator-associated pneumonia (PVAP, defined as pediatric AVAC with a positive respiratory diagnostic test) according to previously proposed criteria.
Among 9,025 ventilated children, we identified 192 VAC cases, 43 in CICUs, 70 in PICUs, and 79 in NICUs. AVAC criteria were met in 79 VAC cases (41%) (58% CICU; 51% PICU; and 23% NICU), and varied by hospital (CICU, 20–67%; PICU, 0–70%; and NICU, 0–43%). Type and duration of AVAC antimicrobials varied by ICU type. AVAC cases in CICUs and PICUs received broad-spectrum antimicrobials more often than those in NICUs. Among AVAC cases, 39% had respiratory infection diagnostic testing performed; PVAP was identified in 15 VAC cases. Also, among AVAC cases, 73% had no associated positive respiratory or nonrespiratory diagnostic test.
Antimicrobial use is common in pediatric VAC, with variability in spectrum and duration of antimicrobials within hospitals and across ICU types, while PVAP is uncommon. Prolonged antimicrobial use despite low rates of PVAP or positive laboratory testing for infection suggests that AVAC may provide a lever for antimicrobial stewardship programs to improve utilization.