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Ventilator bundles encompass practices that reduce the risk of ventilator complications, including ventilator-associated pneumonia. The impact of ventilator bundles on the risk of developing ventilator-associated events (VAEs) is unknown. We sought to determine whether decreased compliance to the ventilator bundle increases the risk for VAE development.
Nested case-control study.
This study was conducted at 6 adult intensive care units at an academic tertiary-care center in Tennessee.
In total, 273 patients with VAEs were randomly matched in a 1:4 ratio to controls by mechanical ventilation duration and ICU type.
Controls were selected from the primary study population at risk for a VAE after being mechanically ventilated for the same number of days as a specified case. Using conditional logistic regression analysis, overall cumulative compliance, and compliance with individual components of the bundle in the 3 and 7 days prior to VAE development (or the control match day) were examined.
Overall bundle compliance at 3 days (odds ratio [OR], 1.15; P=.34) and 7 days prior to VAE diagnosis (OR, 0.96; P=.83) were not associated with VAE development. This finding did not change when limiting the outcome to infection-related ventilator-associated complications (IVACs) and after adjusting for age and gender. In the examination of compliance with specific bundle components increased compliance with chlorhexidine oral care was associated with increased risk of VAE development in all analyses.
Ventilator bundle compliance was not associated with a reduced risk for VAEs. Higher compliance with chlorhexidine oral care was associated with a greater risk for VAE development.
Arachidonic acid (ARA) and DHA, supplied primarily from the mother, are required for early development of the central nervous system. Thus, variations in maternal ARA or DHA status may modify neurocognitive development. We investigated the relationship between maternal ARA and DHA status in early (11·7 weeks) or late (34·5 weeks) pregnancy on neurocognitive function at the age of 4 years or 6–7 years in 724 mother–child pairs from the Southampton Women’s Survey cohort. Plasma phosphatidylcholine fatty acid composition was measured in early and late pregnancy. ARA concentration in early pregnancy predicted 13 % of the variation in ARA concentration in late pregnancy (β=0·36, P<0·001). DHA concentration in early pregnancy predicted 21 % of the variation in DHA concentration in late pregnancy (β=0·46, P<0·001). Children’s cognitive function at the age of 4 years was assessed by the Wechsler Preschool and Primary Scale of Intelligence and at the age of 6–7 years by the Wechsler Abbreviated Scale of Intelligence. Executive function at the age of 6–7 years was assessed using elements of the Cambridge Neuropsychological Test Automated Battery. Neither DHA nor ARA concentrations in early or late pregnancy were associated significantly with neurocognitive function in children at the age of 4 years or the age of 6–7 years. These findings suggest that ARA and DHA status during pregnancy in the range found in this cohort are unlikely to have major influences on neurocognitive function in healthy children.
Volume 14 spans the fields of textiles, dress, and fashion, including fashions in that most natural of garments, body hair!
Evidence for dress in multicultural, sixth-century Ravenna in a Latin charter is newly translated by Olga Magoula, who contextualises the inventory of bequests from a member of the Ravenna urban elite, a class who had seen better times. It reveals an extraordinary mixture of opulence and workaday in a document which lists silk garments alongside slaves and household goods ranging from silver spoons to a broken cauldron. Also concerning Italy, Megan Tiddeman, analyzing both literary and nonliterary textual sources, discusses the vocabulary and loanwords in Anglo-Italian mercantile transactions, mostly from the 1200s to the 1400s, when Italian merchants and bankers were prominent in England. She demonstrates a two-way linguistic traffic, with Italian terms transferring into Anglo-Norman/Middle English, especially with reference to luxury silk fabrics which Italians were importing, and from the languages of England into Italian, particularly relating to English wools which were being exported to Italy.
Anne Hedeager Krag examines the incidence of Byzantine and Oriental silks in Denmark, ranging from fragments decorating Viking women's dress to magnificent silks honouring the remains of saints, with suggestions as to how the precious textiles might have been transmitted. Surviving remains date from about 800 to about 1200. Monica L. Wright tackles the question of whether the mysterious garment called a bliaut in French literature is really shown on the statues decorating the Royal Portal of Notre-Dame de Chartres as has been generally supposed, and produces a decisive answer. Karen Margrethe Høskuldsson re-examines the appearance of the French hood in drawings and portrait medals as well as painted portraits, producing new theories about its construction, a proposed chronological development, and innovative suggestions about the evolution and purpose of the feature known as the bongrace. John Block Friedman discusses evidence from the late twelfth to late fifteenth centuries showing that removal of hair from the forehead, the eyebrows, and the body was a courtly feminine ideal promoted, to a considerable extent, by male gynophobia. He describes methods of depilation and professional practitioners of the art, relating some of their more disastrous treatments as well as their successes for women who wished to give the appearance of higher social class or simply to please their husbands.