Using a longitudinal model to estimate the effect of methicillin-resistant staphylococcus aureus infection on length of stay in an intensive care unit

Healthcare-associated methicillin-resistant Staphylococcus aureus(MRSA) infection may cause increased hospital stay or, sometimes, death. Quantifying this effect is complicated because it is a time-dependent exposure: infection may prolong hospital stay, while longer stays increase the risk of infection. We overcome these problems by using a multinomial longitudinal model for estimating the daily probability of death and discharge. We then extend the basic model to estimate how the effect of MRSA infection varies over time, and to quantify the number of excess ICU days due to infection. We find that infection decreases the relative risk of discharge (relative risk ratio = 0.68, 95% credible interval: 0.54, 0.82), but is only indirectly associated with increased mortality. An infection on the first day of admission resulted in a mean extra stay of 0.3 days (95% CI: 0.1, 0.5) for a patient with an APACHE II score of 10, and 1.2 days (95% CI: 0.5, 2.0) for a patient with an APACHE II score of 30. The decrease in the relative risk of discharge remained fairly constant with day of MRSA infection, but was slightly stronger closer to the start of infection. These results confirm the importance of MRSA infection in increasing ICU stay, but suggest that previous work may have systematically overestimated the effect size.

Aging, retirement, and changes in physical activity : prospective cohort findings from the globe study

There is increased recognition that determinants of health should be investigated in a life-course perspective. Retirement is a major transition in the life course and offers opportunities for changes in physical activity that may improve health in the aging population. The authors examined the effect of retirement on changes in physical activity in the GLOBE Study, a prospective cohort study known by the Dutch acronym for "Health and Living Conditions of the Population of Eindhoven and surroundings," 1991–2004. They followed respondents (n = 971) by postal questionnaire who were employed and aged 40–65 years in 1991 for 13 years, after which they were still employed (n = 287) or had retired (n = 684). Physical activity included 1) work-related transportation, 2) sports participation, and 3) nonsports leisure-time physical activity. Multinomial logistic regression analyses indicated that retirement was associated with a significantly higher odds for a decline in physical activity from work-related transportation (odds ratio (OR) = 3.03, 95% confidence interval (CI): 1.97, 4.65), adjusted for sex, age, marital status, chronic diseases, and education, compared with remaining employed. Retirement was not associated with an increase in sports participation (OR = 1.12, 95% CI: 0.71, 1.75) or nonsports leisure-time physical activity (OR = 0.80, 95% CI: 0.54, 1.19). In conclusion, retirement introduces a reduction in physical activity from work-related transportation that is not compensated for by an increase in sports participation or an increase in nonsports leisure-time physical activity.

Combination strategies for a factor analysis phone-conditioned speaker verification system

This work aims to take advantage of recent developments in joint factor analysis (JFA) in the context of a phonetically conditioned GMM speaker verification system. Previous work has shown performance advantages through phonetic conditioning, but this has not been shown to date with the JFA framework. Our focus is particularly on strategies for combining the phone-conditioned systems. We show that the classic fusion of the scores is suboptimal when using multiple GMM systems. We investigate several combination strategies in the model space, and demonstrate improvement over score-level combination as well as over a non-phonetic baseline system. This work was conducted during the 2008 CLSP Workshop at Johns Hopkins University.

Becoming “Librarian 2.0” : the skills, knowledge, and attributes required by library and information science professionals in a Web 2.0 world (and beyond)

In 2005, Stephen Abram, vice president of Innovation at SirsiDynix, challenged library and information science (LIS) professionals to start becoming “librarian 2.0.” In the last few years, discussion and debate about the “core competencies” needed by librarian 2.0 have appeared in the “biblioblogosphere” (blogs written by LIS professionals). However, beyond these informal blog discussions few systematic and empirically based studies have taken place. This article will discuss a research project that fills this gap. Funded by the Australian Learning and Teaching Council, the project identifies the key skills, knowledge, and attributes required by “librarian 2.0.” Eighty-one members of the Australian LIS profession participated in a series of focus groups. Eight themes emerged as being critical to “librarian 2.0”: technology, communication, teamwork, user focus, business savvy, evidence based practice, learning and education, and personal traits. This article will provide a detailed discussion on each of these themes. The study’s findings also suggest that “librarian 2.0” is a state of mind, and that the Australian LIS profession is undergoing a significant shift in “attitude.”

Supporting informed learners in the 21st century

This paper elaborates the concept of informed learning and locates it in educational, workplace and community settings. Drawing from existing research into people's experience of information literacy, it identifies critical experiences of informed learners in each of these three settings. It also explores the support required in educational, community and workplace contexts which makes informed learning possible. Recognising strong implications for policy makers in different sectors, the paper presents a set of guiding principles for developing informed learning and learners. The idea of informed learning represents and advances understandings of information literacy that incorporate the broader concept of using information to learn: those understandings that go beyond the functional or generic information literacy paradigm and draw attention to the transformational, situated and critical aspects of information literacy. Using information to learn is a natural, but often implicit part of all formal and informal learning environments, and is a vital component of the lifelong learning agendas of many nations worldwide. Supporting informed learning requires conscious attention to the use of information in the learning process, by educators, managers, trainers, and policy makers in all sectors. It requires a far reaching response to policy directions involving a wide range of stakeholders.

Within and without family in the Icelandic sagas

The Icelandic sagas reflect a deep social interest in the nature of family obligations. Narrative tension and drama often result from carefully plotted increases in competition between families,while considerable space is given over to family biographies and genealogical information. As a result, the saga authors’ conception of the historical seems closely bound to a desire to represent family life. In Gísla saga Súrssonar and Íslendinga saga, the representation of family life extends to the situation of internal family conflicts, when the strict ethical codes underpinning the centrality of family obligations seem to be complicated and perhaps even threatened by characters’ formation of stronger bonds outside the family. The portrayal of internal family conflicts in these two sagas enabled the authors to express complex and often conflicting ethical issues.

Classifying external causes of injury : history, current approaches, and future directions

The International Classification of Diseases (ICD) is used to categorise diseases, injuries and external causes, and is a key epidemiological tool enabling the storage and retrieval of data from health and vital records to produce core international mortality and morbidity statistics. The ICD is updated periodically to ensure the classification remains current and work is now underway to develop the next revision, ICD-11. There have been almost 20 years since the last ICD edition was published and over 60 years since the last substantial structural revision of the external causes chapter. Revision of such a critical tool requires transparency and documentation to ensure that changes made to the classification system are recorded comprehensively for future reference. In this paper, the authors provide a history of external causes classification development and outline the external cause structure. Approaches to manage ICD-10 deficiencies are discussed and the ICD-11 revision approach regarding the development of, rationale for and implications of proposed changes to the chapter are outlined. Through improved capture of external cause concepts in ICD-11, a stronger evidence base will be available to inform injury prevention, treatment, rehabilitation and policy initiatives to ultimately contribute to a reduction in injury morbidity and mortality.

Review of "Postcolonial Issues in Australian Literature" edited by Nathanael O’Reilly (Cambria Press, 2010)

Some years ago I opened the 1998 edition of the Johns Hopkins Guide to Literary Theory and Criticism and turned to the entry ‘Australian Theory and Criticism.’ This read: ‘Australia has produced no single critic or theorist of international stature, nor has it developed a distinct school of criticism or theory.’ Postcolonial content was listed under a section called Postcolonial Cultural Studies and there one found key names including Tiffin, Ashcroft, Stephen Slemon, and During...

Strolling through the (post)modern city: Modes of being a flaneur in picture books

The city and the urban condition, popular subjects of art, literature, and film, have been commonly represented as fragmented, isolating, violent, with silent crowds moving through the hustle and bustle of a noisy, polluted cityspace. Included in this diverse artistic field is children’s literature—an area of creative and critical inquiry that continues to play a central role in illuminating and shaping perceptions of the city, of city lifestyles, and of the people who traverse the urban landscape. Fiction’s textual representations of cities, its sites and sights, lifestyles and characters have drawn on traditions of realist, satirical, and fantastic writing to produce the protean urban story—utopian, dystopian, visionary, satirical—with the goal of offering an account or critique of the contemporary city and the urban condition. In writing about cities and urban life, children’s literature variously locates the child in relation to the social (urban) space. This dialogic relation between subject and social space has been at the heart of writings about/of the flâneur: a figure who experiences modes of being in the city as it transforms under the influences of modernism and postmodernism. Within this context of a changing urban ontology brought about by (post)modern styles and practices, this article examines five contemporary picture books: The Cows Are Going to Paris by David Kirby and Allen Woodman; Ooh-la-la (Max in love) by Maira Kalman; Mr Chicken Goes to Paris and Old Tom’s Holiday by Leigh Hobbs; and The Empty City by David Megarrity. I investigate the possibility of these texts reviving the act of flânerie, but in a way that enables different modes of being a flâneur, a neo-flâneur. I suggest that the neo-flâneur retains some of the characteristics of the original flâneur, but incorporates others that take account of the changes wrought by postmodernity and globalization, particularly tourism and consumption. The dual issue at the heart of the discussion is that tourism and consumption as agents of cultural globalization offer a different way of thinking about the phenomenon of flânerie. While the flâneur can be regarded as the precursor to the tourist, the discussion considers how different modes of flânerie, such as the tourist-flâneur, are an inevitable outcome of commodification of the activities that accompany strolling through the (post)modern urban space.

Sink or Swim? : Revising Ophelia in contemporary young adult fiction

Shakespeare’s Hamlet has in recent years been used by a number of young adult novels to define and authorise representations of gendered adolescent subjectivity. In so doing, these novels attend not only to Shakespeare’s play but also to other adaptations of the play. For example, the long cultural history of Ophelia being used as a template for depicting adolescent femininity as risky or dangerous is as influential as the play itself in early twenty-first century novels. This paper reads such novels for the ways in which codes of gender and of genre circulate in adolescent fiction when linked explicitly with Shakespearean texts and traditions.

Flag state responsibility for maritime terrorism

Modern international shipping is largely a flag state-based system. Only the flag state has complete authority over the vessels that fly its flag, and as a result, other states’ jurisdiction over these vessels is very limited. Against this backdrop, this article examines the flag state’s responsibility for maritime terrorism, a major security issue and vulnerability in the global supply chain. It is not an exaggeration that the global community’s repeated statements regarding the illegality of terrorism have created a customary international law obligation for states to take all possible steps for the prevention of terrorism. This article argues that providing flags to suspicious entities in an obscure registration system is not compatible with this obligation.

A bricoleur (or two) in the consulting room

In popular contemporary use, the French term bricolage refers to the activities of the home handyman. It is sometimes used in a disparaging way to refer to work that is improvised, uninformed by expertise or specialist knowledge, and probably inferior in its results when compared with the work of a tradesman or professional. In 1962, anthropologist and philosopher Claude Lévi-Strauss argued that bricolage is a modality of human thought. Since then, the importance of bricolage as a mental activity has been identified in relation to art and architecture, as well as other fields of cultural activity. In this paper I consider bricolage as an activity of the ego and explore its role in the consulting room. I argue that by necessity the psychoanalytic work undertaken between patient and analyst relies on this modality of thought and, furthermore, that the use of bricolage is entirely compatible with evidence-based practice.