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The findings regarding the associations between red meat, fish and poultry consumption, and the metabolic syndrome (Mets) have been inconclusive, and evidence from Chinese populations is scarce. A cross-sectional study was performed to investigate the associations between red meat, fish and poultry consumption, and the prevalence of the Mets and its components among the residents of Suzhou Industrial Park, Suzhou, China. A total of 4424 participants were eligible for the analysis. A logistic regression model was used to estimate the OR and 95 % CI for the prevalence of the Mets and its components according to red meat, fish and poultry consumption. In addition, the data of our cross-sectional study were meta-analysed under a random effects model along with those of published observational studies to generate the summary relative risks (RR) of the associations between the highest v. lowest categories of red meat, fish and poultry consumption and the Mets and its components. In the cross-sectional study, the multivariable-adjusted OR for the highest v. lowest quartiles of consumption was 1·23 (95 % CI 1·02, 1·48) for red meat, 0·83 (95 % CI 0·72, 0·97) for fish and 0·93 (95 % CI 0·74, 1·18) for poultry. In the meta-analysis, the pooled RR for the highest v. lowest categories of consumption was 1·20 (95 % CI 1·06, 1·35) for red meat, 0·88 (95 % CI 0·81, 0·96) for fish and 0·97 (95 % CI 0·85, 1·10) for poultry. The findings of both cross-sectional studies and meta-analyses indicated that the association between fish consumption and the Mets may be partly driven by the inverse association of fish consumption with elevated TAG and reduced HDL-cholesterol and, to a lesser extent, fasting plasma glucose. No clear pattern of associations was observed between red meat or poultry consumption and the components of the Mets. The current findings add weight to the evidence that the Mets may be positively associated with red meat consumption, inversely associated with fish consumption and neutrally associated with poultry consumption.
In the absence of pyuria, positive urine cultures are unlikely to represent infection. Conditional urine reflex culture policies have the potential to limit unnecessary urine culturing. We evaluated the impact of this diagnostic stewardship intervention.
We conducted a retrospective, quasi-experimental (nonrandomized) study, with interrupted time series, from August 2013 to January 2018 to examine rates of urine cultures before versus after the policy intervention. We compared 3 intervention sites to 3 control sites in an aggregated series using segmented negative binomial regression.
The study included 6 acute-care hospitals within the Veterans’ Health Administration across the United States.
Adult patients with at least 1 urinalysis ordered during acute-care admission, excluding pregnant patients or those undergoing urological procedures, were included.
At the intervention sites, urine cultures were performed if a preceding urinalysis met prespecified criteria. No such restrictions occurred at the control sites. The primary outcome was the rate of urine cultures performed per 1,000 patient days. The safety outcome was the rate of gram-negative bloodstream infection per 1,000 patient days.
The study included 224,573 urine cultures from 50,901 admissions in 24,759 unique patients. Among the intervention sites, the overall average number of urine cultures performed did not significantly decrease relative to the preintervention period (5.9% decrease; P = 0.8) but did decrease by 21% relative to control sites (P < .01). We detected no significant difference in the rates of gram-negative bloodstream infection among intervention or control sites (P = .49).
Conditional urine reflex culture policies were associated with a decrease in urine culturing without a change in the incidence of gram-negative bloodstream infection.
The hydrogen concentration and composition of garnets in the ultrahigh pressure eclogites at Shuanghe, eastern Dabieshan, were investigated using Fourier transform infrared spectroscopy and electron microprobe analysis. The OH absorption bands can be divided into four groups: (1) 3635–3655 cm–1; (2) 3600–3630 cm–1; (3) 3540–3580 cm–1; and (4) 3400–3450 cm–1 and the water content ranges from 45 to 2529 ppm. Based on the behaviour of the OH absorption band and the relationship between water content and the composition of garnets, the samples can be divided into two classes: samples with >400 ppm H2O and samples with ≤400 ppm H2O. The water content of the former shows an obvious positive correlation with Ca atoms and a negative correlation with the Si, Mg and Fe2+ atoms per 12 anions, whereas the water content of the latter shows no obvious linear correlation with cations. It is concluded that the major mechanism of hydroxyl incorporation in garnets with >400 ppm H2O is by the coupled substitution 4H +Z□ → □+ZSi in the tetrahedral site, and that several mechanisms are responsible for OH incorporation in garnets with ≤400 ppm H2O.
Healthcare worker attire may become contaminated with pathogenic organisms during a normal shift. We performed a randomized crossover study to assess whether treatment with an antimicrobial coating would decrease bacterial contamination on scrubs. Thirty percent of all scrubs were contaminated; there was no difference in the rate of contamination between the intervention and control groups
Infect Control Hosp Epidemiol 2014;35(11):1411–1413
To quantify the association between admission to an intensive care unit (ICU) room most recently occupied by a patient positive for extended-spectrum β-lactamase (EBSL)-producing gram-negative bacteria and acquisition of infection or colonization with that pathogen.
Retrospective cohort study.
Setting and Patients.
The study included patients admitted to medical and surgical ICUs of an academic medical center between September 1, 2001, and June 30, 2009.
Perianal surveillance cultures were obtained at admission to the ICU, weekly, and at discharge from the ICU. Patients were included if they had culture results that were negative for ESBL-producing gram-negative bacteria at ICU admission and had an ICU length of stay longer than 48 hours. Pulsed-field gel electrophoresis (PFGE) was performed on ESBL-positive isolates from patients who acquired the same bacterial species (eg, Klebsiella species or Escherichia coli) as the previous room occupant.
Among 9, 371 eligible admissions (7, 651 unique patients), 267 (3%) involved patients who acquired an ESBL-producing pathogen in the ICU; of these patients, 32 (12%) were hospitalized in a room in which the prior occupant had been positive for ESBL. Logistic regression results suggested that the prior occupant's ESBL status was not significantly associated with acquisition of an ESBL-producing pathogen (adjusted odds ratio, 1.39 [95% confidence interval, 0.94-2.08]) after adjusting for colonization pressure and antibiotic exposure in the ICU. PFGE results suggested that 6 (18%) of 32 patients acquired a bacterial strain that was the same as or closely related to the strain obtained from the prior occupant.
These data suggest that environmental contamination may not play a substantial role in the transmission of ESBL-producing pathogens among ICU patients. Intensifying environmental decontamination may be less effective than other interventions in preventing transmission of ESBL-producing pathogens.
We assessed whether age modified the association between methicillin-resistant Staphylococcus aureus (MRSA) anterior nares colonization and subsequent infection. Among 7,405 patients (9,511 admissions), MRSA colonization was significantly associated with infection (adjusted odds ratio, 13.7 [95% confidence interval, 7.325.7]) but did not differ significantly by age group.
In this study we investigated the importance of two species of fruit bat (Rousettus leschenaulti and Cynopterus sphinx) as seed dispersers for a species of fruit tree (Syzygium oblatum) found in the Xishuangbanna Tropical Botanical Garden in South-West China. We found that although R. leschenaulti and C. sphinx were the two primary seed dispersers of S. oblatum over half of the fruit produced by the tree (65%) fell to the ground. Out of the fruit collected, R. leschenaulti and C. sphinx were able to disperse seeds up to 73 m from the parent tree with the highest density of feeding roosts occurring at 21.3 m (SE = 5.2 m). We found no signs that either species of bat used the parent tree as a feeding roost, instead choosing specific trees that were at lower densities compared with other trees in the forest that were not used. When comparing the viability of seeds in three different habitats (under parent tree, in forest gap, under feeding roost) survival analysis revealed that seedling survival was significantly higher in the forest gap (91.7% ± 4.41%) than under the parent tree (78.3% ± 1.67%), but was not significantly different to seedling survival underneath feeding roosts (86.7 ± 1.67%). Further work also showed that the seeds did not have to be removed from the fruit or ingested by the bat in order to germinate. We conclude that although S. oblatum is not dependent on R. leschenaulti and C. sphinx for successful germination of its seeds, these two species of bat are important seed dispersers and can move seeds to areas where there is a greater chance of germination success and survival.
Colonization pressure is an important infection control metric. The aim of this study was to describe the definition and measurement of and adjustment for colonization pressure in nosocomial-acquisition risk factor studies of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and Clostridium difficile.
We performed a computerized search of studies of nosocomial MRSA, VRE, and C. difficile acquisition published before July 1, 2009, through MEDLINE. Studies were included if a study outcome was MRSA, VRE, or C. difficile acquisition; the authors identified risk factors associated with MRSA, VRE, or C. difficile acquisition; and the study measured colonization pressure.
The initial MEDLINE search yielded 505 articles. Sixty-six of these were identified as studies of nosocomial MRSA, VRE, or C. difficile acquisition; of these, 18 (27%) measured colonization pressure and were included in the final review. The definition of colonization pressure varied considerably between studies: the proportion of MRSA- or VRE-positive patients (5 studies), the proportion of MRSA- or VRE-positive patient-days (6 studies), or the total or mean number of MRSA-, VRE-, or C. difficile-positive patients or patient-days (7 studies) in the unit over periods of varying length. In 10 of 13 studies, colonization pressure was independently associated with MRSA, VRE, or C. difficile acquisition.
There is a need for a simple and consistent method to quantify colonization pressure in both research and routine clinical care to accurately assess the effect of colonization pressure on cross-transmission of antibiotic-resistant bacteria.
To assess risk factors for methicillin-resistant Staphylococcus aureus (MRSA) acquisition among extended care residents focusing on level of care (residential vs rehabilitation) and room placement with an MRSA-positive resident.
Prospective cohort study.
Extended care units at 2 healthcare systems in Maryland.
Four hundred forty-three residents with no history of MRSA and negative MRSA surveillance cultures of the anterior nares and areas of skin breakdown at enrollment.
Follow-up cultures were collected every 4 weeks and/or at discharge for a period of 12 weeks. Study data were collected by a research nurse from the medical staff and the electronic medical records. Cox proportional hazards modeling was used to calculate adjusted hazards ratios (aHRs) and 95% confidence intervals (CIs).
Residents in rehabilitation care had 4-fold higher risk of MRSA acquisition compared with residents in residential care (hazard ratio [HR], 4. [95% CI, 2.2-8.8]). Being bedbound was significantly associated with MRSA acquisition in both populations (residential care, aHR, 4.3 [95% CI, 1.5-12.2]; rehabilitation care, aHR, 4.8 [95% CI, 1.2-18.7]). Having an MRSA-positive roommate was not significantly associated with acquisition in either population (residential care, aHR, 1.4 [95% CI, 0.5-3.9]; rehabilitation care, aHR, 0.5 [95% CI, 0.1-2.2]); based on concordant spa typing, only 2 of 8 residents who acquired MRSA and had room placement with an MRSA-positive resident acquired their MRSA isolate from their roommate.
Residents in rehabilitation care appear at higher risk and have different risk factors for MRSA acquisition compared to those in residential care.
We performed a retrospective cohort study (n = 129) to assess whether residents of extended care facilities who were initially colonized or infected with the methicillin-resistant Staphylococcus aureus (MRSA) strain USA300 were less likely to have prolonged colonization than were residents colonized or infected with other MRSA strains. We found no difference in prolonged colonization (adjusted odds ratio, 1.1 [95% confidence interval, 0.5–2.4]).
The anterior nares are the most sensitive single site for detecting methicillin-resistant Staphylococcus aureus (MRSA) colonization. Colonization patterns of USA300 MRSA colonization are unknown.
To assess whether residents of extended care facilities who are colonized with USA300 MRSA have different nares or skin colonization findings, compared with residents who are colonized with non-USA300 MRSA strains.
The study population included residents of 5 extended care units in 3 separate facilities who had a recent history of MRSA colonization. Specimens were obtained weekly for surveillance cultures from the anterior nares, perineum, axilla, and skin breakdown (if present) for 3 weeks. MRSA isolates were categorized as USA300 MRSA or non-USA300 MRSA.
Of the 193 residents who tested positive for MRSA, 165 were colonized in the anterior nares, and 119 were colonized on their skin. Eighty-four percent of USA300 MRSA-colonized residents had anterior nares colonization, compared with 86% of residents colonized with non-USA300 MRSA (P = .80). Sixty-six percent of USA300 MRSA–colonized residents were colonized on the skin, compared with 59% of residents colonized with non-USA300 MRSA (P = .30).
Colonization patterns of USA300 MRSA and non-USA300 MRSA are similar in residents of extended care facilities. Anterior nares cultures will detect most—but not all—people who are colonized with MRSA, regardless of whether it is USA300 or non-USA300 MRSA.
To quantify the clinical impact of methicillin-resistance in Staphylococcus aureus causing infection complicated by bacteremia in adult patients, while controlling for the severity of patients' underlying illnesses.
Retrospective cohort study from October 1, 1995, through December 31, 2003.
Patients and Setting.
A total of 438 patients with S. aureus infection complicated by bacteremia from a single Veterans Affairs healthcare system.
We found that 193 (44%) of the 438 patients had methicillin-resistant S. aureus (MRSA) infection and 114 (26%) died of causes attributable to S. aureus infection within 90 days after the infection was identified. Patients with MRSA infection had a higher mortality risk, compared with patients with methicillin-susceptible S. aureus (MSSA) infections (relative risk, 1.7 [95% confidence interval, 1.3-2.4]; P < .01), except for patients with pneumonia (relative risk, 0.7 [95% confidence interval, 0.4-1.3]). Patients with MRSA infections were significantly older (P < .01), had more underlying diseases (P = .02), and were more likely to have severe sepsis in response to their infection (P < .01) compared with patients with MSSA bacteremia. Patients who died within 90 days after S. aureus infection was identified were significantly older (P < .01) and more likely to have severe sepsis (P < .01) and pneumonia (P = .01), compared with patients who survived. After adjusting for age as a confounder, comorbidities, and pneumonia as an effect modifier, S. aureus infection-related mortality remained significantly higher in patients with MRSA infection than in those with MSSA infection, among those without pneumonia (hazard ratio, 1.8 [95% confidence interval, 1.2-3.0]); P < .01.
The results of this study suggest that patients with MRSA infections other than pneumonia have a higher mortality risk than patients with MSSA infections other than pneumonia, independent of the severity of patients' underlying illnesses.
Frugivorous bats are important seed dispersers for many plant species (Cox et al. 1991, Fleming & Heithaus 1981, Hodgkison et al. 2003a, McConkey & Drake 2006, Nyhagen et al. 2005, Utzurrum 1995). They regularly consume figs in the wild (Fujita & Tuttle 1991, Kalko et al. 1996, Shilton et al. 1999). Various species of pteropodid bats have been reported foraging on the fruits of more than 30 fig species in tropical and subtropical Asia, Africa and Australia (Bhat 1994, Fujita & Tuttle 1991, Marshall & McWilliam 1982, Thomas 1984). Food transit times in frugivorous bats are relatively rapid; generally less than 30 min (Laska 1990, Tedman & Hall 1985). Several studies have demonstrated that seed germination was either enhanced or unaffected after passage through the digestive tract of bats (Figueiredo & Perin 1995, Fleming & Heithaus 1981, Lieberman & Lieberman 1986).
The wear behavior of bulk Zr41Ti14Cu12.5Ni10Be22.5 metallic glasses has been studiedusing sliding wear tests and scanning electron microscopy in both as-prepared and annealed samples. It was found that the wear resistance of differently processed samples increases in the following order: crystallized state; as-prepared state; relaxed state. The thermal stability of worn samples was also investigated by means of differential scanning calorimetry. Under the experiment conditions, no sliding wear-induced crystallization is observed in either as-prepared or relaxed samples indicating good thermal stability of the bulk metallic glasses.
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