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To examine self-reported practices and policies to reduce infection and transmission of multidrug-resistant organisms (MDRO) in healthcare settings outside the United States.
International members of the Society for Healthcare Epidemiology of America (SHEA) Research Network.
Electronic survey of infection control and prevention practices, capabilities, and barriers outside the United States and Canada. Participants were stratified according to their country’s economic development status as defined by the World Bank as low-income, lower-middle-income, upper-middle-income, and high-income.
A total of 76 respondents (33%) of 229 SHEA members outside the United States and Canada completed the survey questionnaire, representing 30 countries. Forty (53%) were high-, 33 (43%) were middle-, and 1 (1%) was a low-income country. Country data were missing for 2 respondents (3%). Of the 76 respondents, 64 (84%) reported having a formal or informal antibiotic stewardship program at their institution. High-income countries were more likely than middle-income countries to have existing MDRO policies (39/64 [61%] vs 25/64 [39%], P=.003) and to place patients with MDRO in contact precautions (40/72 [56%] vs 31/72 [44%], P=.05). Major barriers to preventing MDRO transmission included constrained resources (infrastructure, supplies, and trained staff) and challenges in changing provider behavior.
In this survey, a substantial proportion of institutions reported encountering barriers to implementing key MDRO prevention strategies. Interventions to address capacity building internationally are urgently needed. Data on the infection prevention practices of low income countries are needed.
Inverse associations between dairy consumption and CVD have been reported in several epidemiological studies. Our objective was to conduct a meta-analysis of prospective cohort studies of dairy intake and CVD. A comprehensive literature search was conducted to identify studies that reported risk estimates for total dairy intake, individual dairy products, low/full-fat dairy intake, Ca from dairy sources and CVD, CHD and stroke. Random-effects meta-analyses were used to generate summary relative risk estimates (SRRE) for high v. low intake and stratified intake dose–response analyses. Additional dose–response analyses were performed. Heterogeneity was examined in sub-group and sensitivity analyses. In total, thirty-one unique cohort studies were identified and included in the meta-analysis. Several statistically significant SRRE below 1.0 were observed, namely for total dairy intake and stroke (SRRE=0·91; 95 % CI 0·83, 0·99), cheese intake and CHD (SRRE=0·82; 95 % CI 0·72, 0·93) and stroke (SRRE=0·87; 95 % CI 0·77, 0·99), and Ca from dairy sources and stroke (SRRE=0·69; 95 % CI 0·60, 0·81). However, there was little evidence for inverse dose–response relationships between the dairy variables and CHD and stroke after adjusting for within-study covariance. The results of this meta-analysis of prospective cohort studies have shown that dairy consumption may be associated with reduced risks of CVD, although additional data are needed to more comprehensively examine potential dose–response patterns.
For many years, philosophers and other scholars have commented on the remarkable similarity between Spinoza and the Stoics, with some even going so far as to speak of 'Spinoza the Stoic'. Until now, however, no one has systematically examined the relationship between the two systems. In Spinoza and the Stoics Jon Miller takes on this task, showing how key elements of Spinoza's metaphysics, epistemology, philosophical psychology, and ethics relate to their Stoic counterparts. Drawing on a wide range of secondary literature including the most up-to-date scholarship and a close examination of the textual evidence, Jon Miller not only reveals the sense in which Spinoza was, and was not, a Stoic, but also offers new insights into how each system should be understood in itself. His book will be of great interest to scholars and students of ancient philosophy, early modern philosophy, Spinoza, and the philosophy of the Stoics.
We examine the degree of consensus in quality ratings of prominent U.S. wine publications. For the purposes of wine consumption and research, are ratings on the ubiquitous 100-point scale reliable measures of quality? The value of expert judgment has been called into question by a number of studies, especially in the context of wine competitions and tasting events. Using data on 853 wines, we find a moderately high level of consensus, measured by the correlation coefficient, between most pairs of publications, similar to the level found by Ashton (2013). Rank and intraclass correlations are similar. Consensus is not found to be related to the blinding policies (or lack thereof) of the critical publications. (JEL Classifications: C93, D46)