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Current surveillance for healthcare-associated (HA) urinary tract infection (UTI) is focused on catheter-associated infection with hospital onset (HO-CAUTI), yet this surveillance does not represent the full burden of HA-UTI to patients. Our objective was to measure the incidence of potentially HA, community-onset (CO) UTI in a retrospective cohort of hospitalized patients.
Retrospective cohort study.
Academic, quaternary care, referral center.
Hospitalized adults at risk for HA-UTI from May 2009 to December 2011 were included.
Patients who did not experience a UTI during the index hospitalization were followed for 30 days post discharge to identify cases of potentially HA-CO UTI.
We identified 3,273 patients at risk for potentially HA-CO UTI. The incidence of HA-CO UTI in the 30 days post discharge was 29.8 per 1,000 patients. Independent risk factors of HA-CO UTI included paraplegia or quadriplegia (adjusted odds ratio [aOR], 4.6; 95% confidence interval [CI], 1.2–18.0), indwelling catheter during index hospitalization (aOR, 1.5; 95% CI, 1.0–2.3), prior piperacillin-tazobactam prescription (aOR, 2.3; 95% CI, 1.1–4.5), prior penicillin class prescription (aOR, 1.7; 95% CI, 1.0–2.8), and private insurance (aOR, 0.6; 95% CI, 0.4–0.9).
HA-CO UTI may be common within 30 days following hospital discharge. These data suggest that surveillance efforts may need to be expanded to capture the full burden to patients and better inform antibiotic prescribing decisions for patients with a history of hospitalization.
We report ∆14C measurements of cellulose extracted from near monthly tree ring growth for the 1960s of a white oak that grew in western Oregon, USA. Comparison with ∆14C measurements of atmospheric CO2 reveals that the tree ring ∆14C values were equal to or lower than those in atmospheric CO2 at the time of ring formation. We suggest that the low tree ring ∆14C values during the period 1962–1963 were caused by the presence of an atmospheric front or blocking between subpolar and temperate air masses that delayed the arrival of the bomb signal at the tree’s site.
Radiocarbon measurements are reported for dissolved organic carbon (DOC) and inorganic carbon (DIC) from seawater samples collected from the Alcyone-5 cruise in the central North Pacific Ocean in 1985. Differences between the UV-radiation techniques used here and those reported by Williams, Oeschger and Kinney (1969) to oxidize and recover the DOC from sea water are presented. UV unoxidizable DOC in these samples is discussed in a separate publication (Druffel, Williams & Suzuki, 1989). We briefly discuss the penetration of the bomb 14C signal into the DOC and DIC pools. The temporal variability of Δ 14C in DIC in surface samples taken every 2–3 days is presented. Concentrations of total dissolved free (FAA) plus combined (hydrolyzable) amino acids (THAA) and total dissolved carbohydrates (TCHO) measured in the same water samples are also reported. Our main aim is to present the chemical and isotopic data from samples collected during the Alcyone-5 cruise. Detailed interpretation is published elsewhere.
Restaurants are playing an increasingly important role in children’s dietary intake. Interventions to promote healthy ordering in restaurants have primarily targeted adults. Much remains unknown about how to influence ordering for and by children. Using an ecological lens, the present study sought to identify sources of influence on ordering behaviour for and by children in restaurants.
A mixed-methods study was conducted using unobtrusive observations of dining parties with children and post-order interviews. Observational data included: child’s gender, person ordering for the child and server interactions with the dining party. Interview data included: child’s age, restaurant visit frequency, timing of child’s decision making, and factors influencing decision making.
Ten independent, table-service restaurants in San Diego, CA, USA participated.
Complete observational and interview data were obtained from 102 dining parties with 150 children (aged 3–14 years).
Taste preferences, family influences and menus impacted ordering. However, most children knew what they intended to order before arriving at the restaurant, especially if they dined there at least monthly. Furthermore, about one-third of children shared their meals with others and all shared meals were ordered from adult (v. children’s) menus. Parents placed most orders, although parental involvement in ordering was less frequent with older children. Servers interacted frequently with children but generally did not recommend menu items or prompt use of the children’s menu.
Interventions to promote healthy ordering should consider the multiple sources of influence that are operating when ordering for and by children in restaurants.
To estimate the folate status of New Zealand women of childbearing age following the introduction, in 2010, of a new voluntary folic acid fortification of bread programme.
The 2011 Folate and Women’s Health Survey was a cross-sectional survey of women aged 18–44 years carried out in 2011. The survey used a stratified random sampling technique with the Electoral Roll as the sampling frame. Women were asked about consumption of folic-acid-fortified breads and breakfast cereals in a telephone interview. During a clinic visit, blood was collected for serum and erythrocyte folate measurement by microbiological assay.
A North Island (Wellington) and South Island (Dunedin) city centre in New Zealand.
Two hundred and eighty-eight women, of whom 278 completed a clinic visit.
Geometric mean serum and erythrocyte folate concentrations were 30 nmol/l and 996 nmol/l, respectively. Folate status was 30–40 % higher compared with women of childbearing age sampled as part of a national survey in 2008/09, prior to the introduction of the voluntary folic acid bread fortification programme. In the 2011 Folate and Women’s Health Survey, reported consumption of fortified bread and fortified breakfast cereal in the past week was associated with 25 % (P=0·01) and 15 % (P=0·04) higher serum folate concentrations, respectively.
Serum and erythrocyte folate concentrations have increased in New Zealand women of childbearing age since the number of folic-acid-fortified breads was increased voluntarily in 2010. Consumption of fortified breads and breakfast cereals was associated with a higher folate status.
To determine what factors are associated with parental motivation to change body weight in overweight children.
Dunedin, New Zealand.
Two hundred and seventy-one children aged 4–8 years, recruited in primary and secondary care, were identified as overweight (BMI≥85th percentile) after screening. Parents completed questionnaires on demographics; motivation to improve diet, physical activity and weight; perception and concern about weight; parenting; and social desirability, prior to being informed that their child was overweight. Additional measures of physical activity (accelerometry), dietary intake and child behaviour (questionnaire) were obtained after feedback.
Although all children were overweight, only 42 % of parents perceived their child to be so, with 36 % indicating any concern. Very few parents (n 25, 8 %) were actively trying to change the child’s weight. Greater motivation to change weight was observed for girls compared with boys (P=0·001), despite no sex difference in BMI Z-score (P=0·374). Motivation was not associated with most demographic variables, social desirability, dietary intake, parenting or child behaviour. Increased motivation to change the child’s weight was observed for heavier children (P<0·001), those who were less physically active (P=0·002) and more sedentary (P<0·001), and in parents who were more concerned about their child’s weight (P<0·001) or who used greater food restriction (P<0·001).
Low levels of parental motivation to change overweight in young children highlight the urgent need to determine how best to improve motivation to initiate change.
Parents report that children’s eating behaviours are a major barrier to providing them with a healthy diet. Links between problem eating behaviours and parental feeding practices are not well established and have not previously been examined in overweight children. The aim of the present study was to assess associations between problem food behaviours, dietary intake and parental feeding practices of overweight children aged 4–8 years.
Participants were recruited for a lifestyle intervention (n 203). At baseline, children’s BMI was measured and parents completed comprehensive questionnaires about the feeding practices they used, the problem food behaviours their children exhibited and the foods their child consumed. A fussy eating scale was developed and associations were determined using correlations and regression analysis, including interactions.
Dunedin, New Zealand.
Overweight children aged 4–8 years.
Healthy eating guidance and monitoring by parents were related to the consumption of fewer unhealthy foods (B=−0·4, P=0·001 and B=−0·4, P<0·001). Conversely, a lack of parental control (child control) was related to a higher intake of unhealthy foods (B = 0·5, P<0·001). Parents of children who were fussy eaters monitored their child’s food intake less (P<0·001) and allowed the child more freedom over what he/she ate (P<0·001). These children consumed fewer fruit and vegetables than those who were not fussy eaters (P<0·001). However, fussy eaters with food-restrictive parents ate more fruit and vegetables (B=2·9, P<0·001).
These results suggest that a more structured food environment might be beneficial for the diet and food behaviours of young overweight children.
This study examined how front-line home and community-care (H&CC) case managers view the role of informal caregivers, and the factors that contribute to H&CC managers’ resource allocation decisions. The study research used two methods of data collection: (a) secondary analysis of the results from balance of care (BoC) simulations conducted in nine regions of Ontario, and (b) in-depth follow-up interviews with participating BoC case managers. Results suggest that case managers unanimously agree that the unit of care in the H&CC sector is not confined to the individual, as in acute care, but encompasses both the individual and the caregiver. We found, however, considerable variation in the mix and volume of H&CC services recommended by case managers. We conclude that variability in decision making may reflect the lack of regulations, best practices, and accountability guidelines in the H&CC sector.
To examine the micronutrient status of disadvantaged pre-schoolers from Northeast Brazil, following the introduction of pro-poor policies, by assessing the prevalence of anaemia and micronutrient deficiencies and the role of sociodemographic factors, genetic Hb disorders and parasitic infections.
In a cross-sectional study, data on sociodemographic status, health, growth, genetic Hb disorders, parasites and nutrient supply from day-care meals were obtained. Fasting blood samples were collected and analysed for Hb, serum ferritin, transferrin receptor, folate, vitamin B12, retinol, Zn and Se.
Pre-schoolers aged 3–6 years from disadvantaged households.
Of the 376 sampled children, 94 % were of black or mixed race; 33 % and 29 % had at least one genetic Hb disorder and intestinal parasite, respectively. Stunting and underweight were ≤5 %; 14 % were overweight. Day-care centres supplied micronutrient-dense meals and snacks each weekday. Less than 10 % of pre-schoolers had anaemia and micronutrient deficiencies. Predictors (P < 0·05) of Hb were α3·7 thalassaemia, Se and retinol (but not ferritin). Micronutrient predictors (P < 0·05) were: elevated α1-glycoprotein for ferritin, Hb AS and BMI Z-score >1 for transferrin receptor, Zn and elevated α1-glycoprotein for retinol, sex and helminths for Se, helminths for vitamin B12, and Giardia intestinalis infection for serum folate.
Impaired growth, anaemia and micronutrient deficiencies were uncommon among these disadvantaged pre-schoolers attending day care. A range of interventions including provision of micronutrient-dense, fortified day-care meals, deworming and vitamin A supplementation likely contributed to improved micronutrient status, suggesting expanded coverage of these programmes.
The diagnosis of smear-positive pulmonary tuberculosis in a medical officer working in a metropolitan Australian neonatal intensive care unit led to a contact investigation involving 125 neonates, 165 relatives, and 122 healthcare workers with varying degrees of exposure. There was no evidence of nosocomial tuberculosis transmission from the index case.
To examine the use of vitamin D supplements during infancy among the participants in an international infant feeding trial.
Information about vitamin D supplementation was collected through a validated FFQ at the age of 2 weeks and monthly between the ages of 1 month and 6 months.
Infants (n 2159) with a biological family member affected by type 1 diabetes and with increased human leucocyte antigen-conferred susceptibility to type 1 diabetes from twelve European countries, the USA, Canada and Australia.
Daily use of vitamin D supplements was common during the first 6 months of life in Northern and Central Europe (>80 % of the infants), with somewhat lower rates observed in Southern Europe (>60 %). In Canada, vitamin D supplementation was more common among exclusively breast-fed than other infants (e.g. 71 % v. 44 % at 6 months of age). Less than 2 % of infants in the USA and Australia received any vitamin D supplementation. Higher gestational age, older maternal age and longer maternal education were study-wide associated with greater use of vitamin D supplements.
Most of the infants received vitamin D supplements during the first 6 months of life in the European countries, whereas in Canada only half and in the USA and Australia very few were given supplementation.
Indicators can contribute to land use management, particularly in the context of sustainable urban development. Together with scenario analysis, they are key instruments in producing information for stakeholders and policy makers and aid their understanding of urban development processes. Based on such information, stakeholders and policy makers can understand better the driving forces, the current state of urban development, how their decision can influence the future trends, and what impacts their decisions can have on the urban landscape. This article presents an application of scenario modeling and indicator evaluation for sustainable land use management in the Greater Dublin Region, based on discussions with scientists, policy makers, and stakeholders in order to guarantee its relevance to practice. This research was a core contribution to the Strategic Environmental Assessment and the Habitats Directive Appropriate Assessment procedures (areas for conservation and protection) for the 2010 Regional Planning Guidelines for Dublin.
The growth of InAs quantum dots (QDs) by organometallic vapor phase epitaxy (OMVPE) for use in GaAs based photovoltaics devices was investigated. Growth of InAs quantum dots was optimized according to their morphology and photoluminescence using growth temperature and V/III ratio. The optimized InAs QDs had sizes near 7×40 nm with a dot density of 5(±0.5)×1010 cm-2. These optimized QDs were incorporated into GaAs based p-i-n solar cell structures. Cells with single and multiple (5x) layers of QDs were embedded in the i-region of the GaAs p-i-n cell structure. An array of 1 cm2 solar cells was fabricated on these wafers, IV curves collected under 1 sun AM0 conditions, and the spectral response measured from 300-1100 nm. The quantum efficiency for each QD cell clearly shows sub-bandgap conversion, indicating a contribution due to the QDs. Unfortunately, the overarching result of the addition of quantum dots to the baseline p-i-n GaAs cells was a decrease in efficiency. However, the addition of thin GaP strain compensating layers between the QD layers, was found to reduce this efficiency degradation and significantly enhance the subgap conversion in comparison to the un-compensated quantum dot cells.
The effects of strain within stacked layers of InAs quantum dots (QDs) were investigated. InAs QD test structures with and without strain compensation (SC) were analyzed using atomic force microscopy, transmission electron microscopy, and X-ray diffraction. The affects of strain compensation on test structure morphology and on GaAs-based QD solar cell performance was studied as a function of the thickness of the SC layer. X-ray diffraction analysis of the QD embedded test structures reveals a relationship between the SC thickness and the observed crystalline quality. Air mass zero illuminated current vs. voltage data and spectral responsivity measurements were used for the solar cell comparison. When SC is employed, QD insertion shows a lower open circuit voltage, in reference to a baseline device without QDs, but leads to an enhancement in the short circuit current of the device.
Interventions to combat mild Fe deficiency in women of childbearing age may affect Zn nutriture. We used dietary and laboratory indices to assess change in Zn status during a 4-month partially blinded placebo-controlled Fe intervention in women with low Fe stores (serum ferritin < 20 μg/l and Hb ≥ 120 g/l) from Dunedin, New Zealand. Subjects aged 18–40 years were randomly assigned to three groups: dietary advice (diet group; DG; n 29), daily Fe supplement with meals (supplement group; SG; n 23; 50 mg Fe as amino acid chelate) and placebo (placebo group; PG, n 26). A validated semi-quantitative FFQ (SFFQ) was administered at baseline, and at 4, 8 and 15 weeks; fasting morning blood samples were assayed for serum Zn, alkaline phosphatase (ALP) and C-reactive protein at baseline, and at 4, 8, 12 and 16 weeks; hair Zn and taste detection thresholds by electrogustometry were measured at baseline and at 16 weeks. Intakes of flesh foods and vitamin C but not Zn or Fe increased, whereas phytate and phytate:Zn molar ratios decreased (all P ≤ 0·01) in the DG compared with the PG and SG, based on three SFFQ. Serum Zn increased in both the DG and PG (adjusted, P ≤ 0·002), so the between-group difference was not significant; the lack of a parallel rise in the SG was significant when compared with the PG (P = 0·02). ALP activity (but not hair Zn or taste acuity) followed a similar trend. In conclusion, Zn status was not improved compared with placebo by an Fe-based dietary intervention. However, a daily moderate-dose Fe supplement with meals appeared to lower Zn status in these young adult women.