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We compared the individual-level risk of hospital-onset infections with multidrug-resistant organisms (MDROs) in hospitalized patients prior to and during the coronavirus disease 2019 (COVID-19) pandemic. We also quantified the effects of COVID-19 diagnoses and intrahospital COVID-19 burden on subsequent MDRO infection risk.
Multicenter, retrospective, cohort study.
Patient admission and clinical data were collected from 4 hospitals in the St. Louis area.
Data were collected for patients admitted between January 2017 and August 2020, discharged no later than September 2020, and hospitalized ≥48 hours.
Mixed-effects logistic regression models were fit to the data to estimate patients’ individual-level risk of infection with MDRO pathogens of interest during hospitalization. Adjusted odds ratios were derived from regression models to quantify the effects of the COVID-19 period, COVID-19 diagnosis, and hospital-level COVID-19 burden on individual-level hospital-onset MDRO infection probabilities.
We calculated adjusted odds ratios for COVID-19–era hospital-onset Acinetobacter spp., P. aeruginosa and Enterobacteriaceae spp infections. Probabilities increased 2.64 (95% confidence interval [CI], 1.22–5.73) times, 1.44 (95% CI, 1.03–2.02) times, and 1.25 (95% CI, 1.00–1.58) times relative to the prepandemic period, respectively. COVID-19 patients were 4.18 (95% CI, 1.98–8.81) times more likely to acquire hospital-onset MDRO S. aureus infections.
Our results support the growing body of evidence indicating that the COVID-19 pandemic has increased hospital-onset MDRO infections.
OBJECTIVES/SPECIFIC AIMS: The central goal of this proposal is to characterize the mechanisms that mediate success or failure of immature intestinal barrier in necrotizing enterocilitis. METHODS/STUDY POPULATION: To do this, I will utilize stem cell derived human intestinal organoids (HIOs), an innovative model of the immature intestine, and a cohort of bacterial isolates collected from premature infants who developed NEC to interrogate the cause-effect relationship of these strains on maintenance of the intestinal barrier. I hypothesize that the epithelial response to bacterial colonization is strain-dependent and results in differences in inflammatory signaling that shape epithelial barrier function in the immature intestine. RESULTS/ANTICIPATED RESULTS: Preliminary data shows that colonization of HIOs with different bacteria leads to species-specific changes in barrier function, and some species selectively damage the epithelial barrier while others enhance epithelial barrier function. I have identified key inflammatory signals that serve as central drivers of intestinal barrier function. DISCUSSION/SIGNIFICANCE OF IMPACT: Characterization of this process is expected to substantially advance scientific understanding of early events in NEC pathogenesis and lead to new opportunities for targeted therapeutic intervention to accelerate barrier maturation or prevent hyperinflammatory reactivity in the neonatal intestine. The research proposed in this application represents an entirely novel approach to studying host-microbial interactions in the immature. Conceptually, this novel translational approach will help to define the pivotal role of colonizing bacteria in initiating epithelial inflammation in NEC patients.
To compare the nutritional content, serving size and taxation potential of supermarket beverages from four different Western countries.
Cross-sectional analysis. Multivariate regression analysis and χ2 comparisons were used to detect differences between countries.
Supermarkets in New Zealand (NZ), Australia, Canada and the UK.
Supermarket beverages in the following categories: fruit juices, fruit-based drinks, carbonated soda, waters and sports/energy drinks.
A total of 4157 products were analysed, including 749 from NZ, 1738 from Australia, 740 from Canada and 930 from the UK. NZ had the highest percentage of beverages with sugar added to them (52 %), while the UK had the lowest (9 %, P<0·001). Differences in energy, carbohydrate and sugar content were observed between countries and within categories, with UK products generally having the lowest energy and sugar content. Up to half of all products across categories/countries exceeded the US Food and Drug Administration’s reference single serving sizes, with fruit juices contributing the greatest number. Between 47 and 83 % of beverages in the different countries were eligible for sugar taxation, the UK having the lowest proportion of products in both the low tax (5–8 % sugar) and high tax (>8 % sugar) categories.
There is substantial difference between countries in the mean energy, serving size and proportion of products eligible for fiscal sugar taxation. Current self-regulatory approaches used in these countries may not be effective to reduce the availability, marketing and consumption of sugar-sweetened beverages and subsequent intake of free sugars.
The herbicide fluridone is a soil-residual herbicide that should provide effective control of several problematic agronomic weeds, but because of herbicide persistence, injury to rotational crops is possible. In this experiment, multiple rates of fluridone were applied PRE to cotton at four irrigated locations across Arkansas to determine the risk of fluridone persisting and injuring subsequently planted wheat, corn, soybean, rice, grain sorghum, and sunflower. The multiple rates of fluridone were compared with fluometuron and evaluated for percentage of crop injury, crop density, and potential yield loss for each crop at the end of the subsequent growing season. Regardless of the location, wheat exhibited the greatest injury with 13 to 26% at Fayetteville (silt loam), 8 to 15% at Pine Tree (silt loam), 2 to 7% at Keiser (silty clay), and 3 to 8% at Rohwer (silty clay). Along with high levels of injury to wheat, fluridone at 900 g ai ha−1 caused loss of wheat stands to 29 plants m−1 row compared with fluometuron, which had stands of 49 plants m−1 row. Although injury occurred in wheat at all locations, no rate of fluridone reduced wheat yields compared with fluometuron. Injury to grain sorghum ranged from 5 to 10% from all rates of fluridone at Pine Tree. Fluridone at 900 g ha−1 (11 plants m−1 row) also reduced grain sorghum stands at Pine Tree over that of fluometuron (19 plants m−1 row). A decrease in grain sorghum yield was also observed from fluridone at 448, 673, and 900 g ha−1 compared with fluometuron at Pine Tree. At Keiser, rice exhibited significant levels of injury (1 to 13%) from fluridone 393 d after treatment. In conclusion, injury to a wheat rotational crop is more likely following an application of fluridone in cotton than is injury to other rotational crops, but yield reductions are not expected for most rotational crops when fluridone is applied to cotton at an anticipated labeled rate of 224 g ha−1.
Rice production in Arkansas usually involves intensive tillage. No-till rice has been studied, but the focus has been limited to impacts on yields and per acre returns. This study uses mixed integer programming to model optimal machinery selection and evaluate whole-farm profitability of no-till management for rice-soybean farms. Results indicate that lower machinery ownership expenses combined with lower fuel and labor expenses do enhance the profitability of no-till management, but the monetary gains appear to be modest, implying that other incentives may be necessary to entice producers to use the practice.
Simply put, compulsory voting exists where the state imposes a legal requirement to vote. The idea of being compelled to vote is anathema to many who live in Western democracies because it seems to run counter to both democratic and liberal values. But even though I agree that, in principle, voluntary political participation is preferable to obligatory participation, I argue in the following chapters that requiring people to vote can be reconciled with both liberal and democratic values.
In defending compulsory voting, I write as a normative political theorist, but I also approach the issue as a political scientist who is wary of normative arguments about elections and voting that do not engage with the empirical world. These kinds of arguments tend, either consciously or unconsciously, to embody assumptions about that world that, in turn, justify real-world laws and practice. Therefore, my argument is informed, where possible, by the empirical data and actual trends in electoral and political behavior. But, in the end, it is a normative argument written from a political-theory perspective.
Much has been written and said about compulsory voting, but quite a lot of it is controvertible. For this reason, the following set of arguments tends to be structured in response to criticism of compulsory voting and the high and socially even turnout it is able to deliver.
Before moving on to my general conclusion, I offer first a broad summary of the various steps and components of the rather dense argument I have given in the preceding chapters.
Compulsory voting is the only really reliable and decisive means by which to raise turnout.
Elections and the way they operate are important because voting is the agreed procedure for legitimizing governments.
High turnout is preferable to low turnout because low-turnout elections are less legitimate. Low-turnout elections are less legitimate because they are less procedurally legitimate: they only give a partial and biased picture of the priorities of the electorate. This makes the governments of low-turnout election less substantively legitimate because government attention is directed only to those sections of the population who vote. Because such people also happen to be better off than nonvoters, this exacerbates political inequality and results in unrepresentative government. Universal, socially even voting confers legitimacy on both the electoral process and the government that wins office.
There is no such thing as a right not to vote. The right to vote is fundamental: it is protective of all other rights, and its existence defines the very structure of representative democracy. It cannot, therefore, be legally waived, and any state’s refusal to allow citizens to waive it is justified.
Voting is not a privilege right: it is a claim-power-right. Further, it is not just a (claim-power) right: it is also a duty. Voting is a duty-right. Voting is a duty we owe to other voters so that (a) together we can constitute and perpetuate representative democracy so that (b) we can meet other classes of voters on equal terms for the purposes of self-protection and self-government.
Voting is not just any duty; it is a special duty because the existence and proper functioning of representative democracy depend on its performance. So too do our welfare and rights. When democracy functions well, rights are more secure.
Compulsory voting seems illiberal because it violates one conception of liberty: negative liberty. But, because it enhances other conceptions of liberty such as nondomination, autonomy, and positive liberty, it can be reconciled with liberal values.
The main argument against compulsory voting is the sheer weakness of the arguments for it. Over the past three chapters, we examined many attempts to justify compulsory voting. Some of these arguments were incoherent or self-contradictory. Others relied on questionable or discredited empirical speculations. Others relied on false or implausible normative premises. Even if we ignored these serious flaws, none of these arguments could then explain why a voting lottery would not be superior to compulsory voting. All the arguments were defective. The best of the arguments gave us little reason to support compulsory voting. Most of the arguments gave us no reason to support it at all.
At this point, we must conclude compulsory voting is unjust. Governments may not impose compulsory voting on their citizens, even if the overwhelming majority of citizens enthusiastically support compulsory voting. Australia, Belgium, and other countries must repeal their compulsory-voting laws immediately.
In this chapter, I stop refuting arguments for compulsory voting and instead produce an independent argument against it. In a sense, previous chapters argued that compulsory voting is bad because it is not good. This chapter argues compulsory voting is bad because it is bad. Remember, however, that the other side bears the burden of proof. Strictly speaking, to undermine compulsory voting, I do not need my argument in this chapter to succeed. The arguments of the other three chapters suffice.
In Chapter 2, I examined arguments that claimed compulsory voting is justified because it would produce good consequences. None of these arguments was sound. So far the case for compulsory voting isn’t just weak – it’s practically nonexistent.
In this chapter, I focus instead on deontological arguments for compulsory voting. Some of these arguments try to establish that, for one reason or another, citizens have a duty to vote. The arguments then try to show that this justifies government in making them vote. Others argue that compulsory voting would in some way make citizens more autonomous or more efficacious. I argue none of these arguments succeeds in justifying compulsory voting.
Not All Moral Duties Are Enforceable
For the sake of argument, suppose citizens have a moral duty to vote. (Some people prefer to say we have a civic duty to vote, but that doesn’t change anything. It just specifies what kind of moral duty the duty to vote is supposed to be.) Now spot the flaw in the following argument:
The Duty-to-Vote Argument
Citizens have a moral duty to vote.
If citizens have a moral duty to do something, then government may force them to do it.
Therefore, government may force citizens to vote (i.e., compulsory voting is justified).
Democracy is rule by the people. But what if the people refuse to rule? Many people worry if we do not have government by the people, then we will not have government for the people – at least not for all of them.
During presidential elections in the late nineteenth century, 70–80 percent of eligible Americans voted. For whatever reason, in the twentieth century, participation rates seem to have dropped to 50–60 percent. Midterm national, state, and local elections averaged a mere 40 percent.
A U.S. president has never been elected by a majority of eligible voters. In the 1964 election, 61.05 percent of voters cast their ballots for Lyndon Johnson – the largest majority any president has ever enjoyed. Yet, at the same time, because turnout was so low, Johnson was in fact elected by less than 38 percent of all voting-eligible Americans. We call Reagan’s 1984 victory a “landslide,” but less than a third of voting-age Americans actually voted for him. Less than a quarter of eligible Americans voted to reelect Bill Clinton in 1996. In all elections, a minority of the voting-eligible population imposes a president on the majority.
In this chapter, I examine and undermine two sets of arguments for compulsory voting. The first set of arguments concerns ideas about democratic legitimacy. The second set of arguments claims compulsory voting would produce good consequences.
The connection between these two sets of arguments is psychological. While none of the arguments I examine here are sound, the arguments in the first set are particularly flawed. However, many lay-people, journalists, politicians, and even some political theorists find this first set of arguments appealing. But they find these arguments appealing because they are confused. Arguments in the first set are really just confused, badly articulated versions of the arguments in the second set. For instance, some people say compulsory voting is necessary to ensure democratic legitimacy. However, probably no one who says that actually means that democracies without compulsory voting are illegitimate. Instead, she probably just intends to say that compulsory voting would make democracy more responsive to the needs of the poor.
Compulsory Voting and Government by Consent
Alfred Apps, former president of Canada’s Liberal Party, and I once debated compulsory voting. Apps probably supports compulsory voting because he believes it would benefit the Liberal Party. (However, during the debate, Apps admitted he had not read any empirical research on compulsory voting. In fact, the best available evidence indicates it does not help small parties.) But Apps is a cunning politician. He cannot say, “I advocate compulsory voting because I believe it would help me.”