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To evaluate the effect of 70% isopropyl alcohol–impregnated central venous catheter caps on ambulatory central-line–associated bloodstream infections (CLABSIs) in pediatric hematology-oncology patients.
This study was a 24-month, cluster-randomized, 2 period, crossover clinical trial.
The study was conducted in 15 pediatric healthcare institutions, including 16 pediatric hematology-oncology clinics.
All patients with an external central line followed at 1 of the 16 hematology-oncology clinics.
Usual ambulatory central-line care per each institution using 70% isopropyl alcohol–impregnated caps at home compared to usual ambulatory central-line care in each institution without using 70% isopropyl alcohol–impregnated caps.
Of the 16 participating clinics, 15 clinics completed both assignment periods. As assigned, there was no reduction in CLABSI incidence in clinics using 70% isopropyl alcohol–impregnated caps (1.23 per 1,000 days) compared with standard practices (1.38 per 1,000 days; adjusted incidence rate ratio [aIRR], 0.83; 95% CI, 0.63–1.11). In the per-protocol population, there was a reduction in positive blood culture incidence in clinics using 70% isopropyl alcohol-impregnated caps (1.51 per 1,000 days) compared with standard practices (1.88 per 1,000 days; aIRR, 0.72; 95% CI, 0.52–0.99). No adverse events were reported.
Isopropyl alcohol–impregnated central-line caps did not lead to a statistically significant reduction in CLABSI rates in ambulatory hematology-oncology patients. In the per-protocol analysis, there was a statistically significant decrease in positive blood cultures. Larger trials are needed to elucidate the impact of 70% isopropyl alcohol–impregnated caps in the ambulatory setting.
There is controversy regarding whether the addition of cover gowns offers a substantial benefit over gloves alone in reducing personnel contamination and preventing pathogen transmission.
Simulated patient care interactions.
To evaluate the efficacy of different types of barrier precautions and to identify routes of transmission.
In randomly ordered sequence, 30 personnel each performed 3 standardized examinations of mannequins contaminated with pathogen surrogate markers (cauliflower mosaic virus DNA, bacteriophage MS2, nontoxigenic Clostridioides difficile spores, and fluorescent tracer) while wearing no barriers, gloves, or gloves plus gowns followed by examination of a noncontaminated mannequin. We compared the frequency and routes of transfer of the surrogate markers to the second mannequin or the environment.
For a composite of all surrogate markers, transfer by hands occurred at significantly lower rates in the gloves-alone group (OR, 0.02; P < .001) and the gloves-plus-gown group (OR, 0.06; P = .002). Transfer by stethoscope diaphragms was common in all groups and was reduced by wiping the stethoscope between simulations (OR, 0.06; P < .001). Compared to the no-barriers group, wearing a cover gown and gloves resulted in reduced contamination of clothing (OR, 0.15; P < .001), but wearing gloves alone did not.
Wearing gloves alone or gloves plus gowns reduces hand transfer of pathogens but may not address transfer by devices such as stethoscopes. Cover gowns reduce the risk of contaminating the clothing of personnel.
With human influences driving populations of apex predators into decline, more information is required on how factors affect species at national and global scales. However, camera-trap studies are seldom executed at a broad spatial scale. We demonstrate how uniting fine-scale studies and utilizing camera-trap data of non-target species is an effective approach for broadscale assessments through a case study of the brown hyaena Parahyaena brunnea. We collated camera-trap data from 25 protected and unprotected sites across South Africa into the largest detection/non-detection dataset collected on the brown hyaena, and investigated the influence of biological and anthropogenic factors on brown hyaena occupancy. Spatial autocorrelation had a significant effect on the data, and was corrected using a Bayesian Gibbs sampler. We show that brown hyaena occupancy is driven by specific co-occurring apex predator species and human disturbance. The relative abundance of spotted hyaenas Crocuta crocuta and people on foot had a negative effect on brown hyaena occupancy, whereas the relative abundance of leopards Panthera pardus and vehicles had a positive influence. We estimated that brown hyaenas occur across 66% of the surveyed camera-trap station sites. Occupancy varied geographically, with lower estimates in eastern and southern South Africa. Our findings suggest that brown hyaena conservation is dependent upon a multi-species approach focussed on implementing conservation policies that better facilitate coexistence between people and hyaenas. We also validate the conservation value of pooling fine-scale datasets and utilizing bycatch data to examine species trends at broad spatial scales.
In this chapter we will explore early Jewish interpretations of Heidegger’s philosophy that understood it as exhibiting specific Christian presuppositions regarding human existence. As we have seen in Chapter 1, the question of the significance and role of the theological undertones in Heidegger’s Dasein analytic is central to its early Christian reception. From a common Jewish standpoint, insofar as Jewish thought seeks to stay clear of Christian influences, the question of whether or not Heidegger’s thought harbors layers of Christian tradition has ramifications for the possibility of its productivity for Jewish expression. Accordingly, one way to display its inappropriateness for Jewish thought is to uncover its Christian resonances, and conversely, establishing its potential suitability for Jewish thought would require reading it as a theologically neutral portrayal of human existence. Either way, the question of secularization must be confronted: if the existential analysis of Dasein involves de-theologization and ontologization of Christian notions, is the result universally valid and neutral structures which can potentially illuminate being-Jewish? Or is something of their origin inevitably preserved, so that regardless of the absence of any explicit Christian message, Heidegger’s system is stamped by a foreign doctrine and as such at odds with Judaism?
When Sein und Zeit appeared, it was hardly an isolated work of philosophy. Self-consciously rebellious, it operated within a highly charged set of assumptions, values, and views in a crisis-laden cultural context in which philosophy, theology, and politics were tensely intertwined. As noted in the introduction, the world this work rebelled against was, inter alia, represented by the philosophical idealism of the neo-Kantian schools that had increasingly lost their appeal in the minds of many younger students. From the perspective of the younger generation of Jewish intellectuals who sought to shake off the devitalizing legacy of the Enlightenment and embrace a more existential and expressive mode of thinking, Heidegger’s framework would be, potentially, an ally in their effort of revitalizing Jewish existence. However, while it is figures from this rebellious generation of German Jews who are often taken to represent the Weimarian intellectual and aesthetical world in the narrative of twentieth-century European intellectual history –
Emmanuel Levinas is arguably the most famous Jewish student of Martin Heidegger (alongside, perhaps, Hannah Arendt). Levinas’s philosophical effort could be summarized, somewhat succinctly, as the attempt to put to the fore the idea of “ethics as first philosophy.” Levinas seeks to dethrone what he takes to be philosophy’s prioritization of ontology and establish that undergirding ontology is infinite and asymmetrical responsibility for the other person. Often the ethical encounter is portrayed as a relation to the other’s (Autrui) face, an “infinite,” overabundant excess conditioning the finite; a relation beyond the horizon of being, through which the trace of the divine Other shines through. The revelation of the face does not manifest itself as, nor is it mediated through, concepts or representations, but rather as the demand and command of ethics. Intersubjectivity is not contingent on the self, but precedes and conditions it. I am obligated to the other person before comprehension. The insight of “ethics as first philosophy” is expressed with typical hyperbole: my responsibility to the other includes a responsibility for the other’s responsibility, even for my oppressor and prosecutor; I am demanded to substitute for the other, to death. Throughout the course of Western thought, Levinas claims, Otherness
In May 1963, Abraham Joshua Heschel delivered the Raymond Fred West Memorial Lectures at Stanford University. The three lectures – “In the Likeness and Unlikeness of God,” “In Search of Meaning,” and “Existence and Exaltation” – were later compiled in the book Who Is Man?, published in 1965. In this condensed and mature expression of many steadfast positions, Heschel challenges modern secularism through presenting his phenomenological “theology of man” in an implicit and explicit confrontation with Heidegger’s existential ontology. In Heschel’s formulation, Heidegger’s philosophy “seeks to relate the human being to a transcendence called being as such” while his own thought, “realizing that human being is more than just being, that human being is living being, seeks to relate man to divine living, to a transcendence called the living God.” The aim of this chapter is to organize Heschel’s otherwise unsystematic critique of Heidegger as a unified theological argument and critically assess it.
Martin Buber’s critique of Heidegger is centered on what he takes to be the latter’s neglect of the dialogical principle in human existence. This critique is one instance of a reading of Sein und Zeit that interprets Dasein as a solipsistic entity impervious to intersubjective relations. We have encountered this interpretation in Chapter 2, in Cassirer’s criticism against the individualistic theological traditions Heidegger draws on, and in Löwith’s claim that Heidegger cannot account for the “second person” in the context of his analysis of Rosenzweig and Heidegger. This was not an uncommon reading of Heidegger: Ernst Simon voiced a similar view, as did Eugen Rosenstock-Huessy, who recalled that the editors of the Die Kreature journal “were aware that Martin Heidegger’s ‘thrown man’ certainly exists, but it is dumb.
Since the publication of the “earliest” Heidegger’s lectures and notes, it has become undeniable that the trajectory of his philosophy as a whole is thoroughly indebted to his Christian origins. Biographically, the young Heidegger was raised in a devout Catholic home in the rural town of Messkirch in Baden. As he came of age, he aspired to become a priest and began formation in a Jesuit seminary. While his quest for priesthood was cut short, Heidegger remained a passionate disciple of the Catholic faith, publishing polemical and apologetic pieces in various conservative Catholic journals and enrolling as a student of Catholic theology at the University of Freiburg. His initial philosophical training was in neo-Scholasticism and neo-Kantianism, and he wrote his dissertation on psychologism (1913) and his Habilitationsschift on “Duns Scotus’ Doctrine of Categories and Signification” (1915). Increasing dissatisfaction with the assumptions and efficiency of his philosophical commitments and his eventual marriage to the Protestant Elfride Petri in 1917 contributed to his estrangement from Catholicism and adoption of the Protestant confession.
Heidegger’s pivotal impact on Leo Strauss’s thought is widely acknowledged. As one commentator notes: “One could almost say that Heidegger is the unnamed presence to whom or against whom all of Strauss’s writings are in large part directed.” This view is confirmed by Strauss himself, who proclaimed that “the only question of importance … is the question whether Heidegger’s teaching is true or not.” While much has been written on Strauss and Heidegger, here I wish to focus on the intersections of Strauss’s understanding of Heidegger and Judaism. The chapter’s argument is threefold: first, that Strauss’s lifelong grappling with matters Jewish are importantly marked by the philosophical, theological, and political challenges reflected in Heidegger; second, that his engagement with Heidegger unfolds within the context of his reflections on the Jewish engagement with modernity, understood as a project indebted to the Christian horizon; and third, that while he sees Heidegger as representing the “danger” and high point of the modern crisis in both philosophy and religion, it is, paradoxically, Heidegger who offers the theoretical breakthrough that directs out of the crisis.
From many, the publication of the Black Notebooks introduced Judaism into the orbit of Heidegger’s thought. The sorry insertion of Judentum and the Judenfrage into the apparatus of Heidegger’s deliberations on the Seinsfrage in these notebooks has led to much reflection on whether and how to situate Judaism in the task of thinking. tHowever, thinking about Judaism vis-à-vis Heidegger is in fact a long-standing endeavor. Throughout the twentieth century, leading Jewish thinkers have transgressed Heidegger’s objection to confessional readings of his philosophy and engaged with it as a provocation and challenge to Judaism.
Self-critical rumination is the process of repetitively thinking about one’s past instances of failure without actively problem-solving. Shame has a central role within self-critical rumination and is accompanied by physiological changes that resemble stress responses.
To experimentally investigate the effects of self-critical rumination on shame and stress following perceived failure.
Sixty volunteers engaged in an impossible task that resulted in guaranteed failure. Four groups, combining presence or absence of induced self-critical rumination with high or low performance expectations, were created. Self-reports were used to measure levels of shame and stress at baseline immediately after the task, as well as following a debrief on the real purpose of the study.
Participants experiencing self-critical rumination accompanied by high performance expectations reported higher levels of shame and stress, especially immediately following the impossible task. On average, members of the high-expectations groups tended to score higher on shame and stress scales. Reported levels of trait self-critical rumination were also significantly correlated with levels of shame and stress across time when controlling for group membership and baseline stress and shame, respectively.
Self-critical rumination in highly evaluative circumstances increased levels of shame and stress following perceived failure. Even though highly evaluative conditions are considered a particularly strong predictor of shame and stress, they could potentially result in self-critical rumination; this matter needs to be addressed in future research.
In this book, Daniel Herskowitz examines the rich, intense, and persistent Jewish engagement with one of the most important and controversial modern philosophers, Martin Heidegger. Contextualizing this encounter within wider intellectual, cultural, and political contexts, he outlines the main patterns and the diverse Jewish responses to Heidegger. Herskowitz shows that through a dialectic of attraction and repulsion, Jewish thinkers developed a version of Jewishness that sought to offer the way out of the overall crisis plaguing their world, which was embodied, as they saw it, in Heidegger's life and thought. Neither turning a blind eye to Heidegger's anti-Semitism nor using it as an excuse for ignoring his philosophy, they wrestled with his existential analytic and what they took to be its religious, ethical, and political failings. Ironically, Heidegger's thought proved itself to be fertile ground for re-conceptualizing what it means to be Jewish in the modern world.
The seroprevalence of Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-COV-2) IgG antibody was evaluated among employees of a Veterans Affairs Healthcare System to assess potential risk factors for transmission and infection.
All employees were invited to participate in a questionnaire and serological survey to detect antibodies to SARS-CoV-2 M protein as part of a facility-wide quality improvement and infection prevention initiative regardless of clinical or non-clinical duties. The initiative was conducted from June 8 to July 8, 2020.
Of the 2900 employees, 50.9% participated in the study, revealing a positive SARS-COV-2 seroprevalence of 4.9% (72/1476), [95% CI of 4.04% - 5.89%]. There were no statistically significant differences in the presence of antibody based on gender, age, frontline worker status, job title, performance of aerosol generating procedures or exposure to known patients with coronavirus infectious disease 2019 (COVID-19) within the hospital. Employees who reported exposure to a known COVID-19 case outside of work had a significantly higher seroprevalence at 14.84% (23/155) compared to those that did not 3.70% (48/1296), OR 4.53 [95% CI 2.67-7.68] p<0.0001. Notably, 29% of seropositive employees reported no history of symptoms for SARS-CoV-2 infection.
Seroprevalence of SARS-COV-2 among employees was not significantly different among those who provided direct patient care and those who did not, suggesting facility-wide infection control measures based were effective. Employees who reported direct personal contact with COVID-19 positive persons outside of work were more likely to have SARS-CoV-2 antibodies. Employee exposure to SARS-CoV-2 outside of work may introduce infection into hospitals.