930 resultados para Over fifty years
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In this paper we focus on providing coordinated visual strategies to assist users in performing tasks driven by the presence of temporal and spatial attributes. We introduce temporal visualization techniques targeted at such tasks, and illustrate their use with an application involving a climate classification process. The climate classification requires extensive Processing of a database containing daily rain precipitation values collected along over fifty years at several spatial locations in the São Paulo state, Brazil. We identify user exploration tasks typically conducted as part of the data preparation required in this process, and then describe how such tasks may be assisted by the multiple visual techniques provided. Issues related to the use of the multiple techniques by an end-user are also discussed.
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Cardiovascular disease has been the leading cause of death in the United States for over fifty years. While multiple risk factors for cardiovascular disease have been identified, hypertension is one of the most commonly recognized and treatable. Recent studies indicate that the prevalence of hypertension among children and adolescents is between 3-5%, much higher than originally estimated and likely rising due to the epidemic of obesity in the U.S. In 2004, the National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents published new guidelines for the diagnosis and treatment of hypertension in this population. Included in these recommendations was the creation of a new diagnosis, pre-hypertension, aimed at identifying children at-risk for hypertension to provide early lifestyle interventions in an effort to prevent its ultimate development. In order to determine the risk associated with pre-hypertension for the development of incident HTN, a secondary analysis of a repeated cross-sectional study measuring blood pressure in Houston area adolescents from 2000 to 2007 was performed. Of 1006 students participating in the blood pressure screening on more than one occasion not diagnosed with hypertension at initial encounter, eleven were later found to have hypertension providing an overall incident rate of 0.5% per year. Incidence rates were higher among overweight adolescents–1.9% per year [IRR 8.6 (1.97, 51.63)]; students “at-risk for hypertension” (pre-hypertensive or initial blood pressure in the hypertensive range but falling on subsequent measures)–1.4% per year [IRR 4.77 (1.21, 19.78)]; and those with blood pressure ≥90th percentile on three occasions–6.6% per year [IRR 21.87 (3.40, 112.40)]. Students with pre-hypertension as currently defined by the Task Force did have an increased rate of hypertension (1.1% per year) but it did not reach statistical significance [IRR 2.44 (0.42, 10.18)]. Further research is needed to determine the morbidity and mortality associated with pre-hypertension in this age group as well as the effectiveness of various interventions for preventing the development of hypertensive disease among these at-risk individuals. ^
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El proyecto de una tienda concentra un poco de todo aquello que interesa al arquitecto: conforma una suerte de encrucijada en la que se dan cita, junto a cuestiones disciplinares que la hacen muy atractiva y ponen a prueba su habilidad como proyectista, la necesidad de aunar recursos compositivos procedentes de otros terrenos periféricos a la arquitectura para dar una respuesta adecuada a los requerimientos específicos de imagen y persuasión que la actividad comercial comporta. Las difíciles condiciones de partida, habitualmente configuraciones espaciales no excesivamente favorables, donde las preexistencias y los contornos coartan y encierran un espacio al que hay que dotar de un nuevo orden; el tamaño reducido y las posibilidades de control total de la obra que de éste se derivan; el corto plazo de tiempo y la rapidez de respuesta que la estrategia comercial impone; su posición estratégica, en relación directa con la calle, y la mayor evidencia que, por tanto, se le asigna a la fachada y al escaparate como ‘primeros anuncios’ de la actividad; la integración y el comentario recíproco entre arquitectura y objeto que tiene lugar en su seno…, son algunas de las razones que explican este interés y justifican que la tienda −ese espacio acotado tan apto para el invento y la innovación−, constituya un banco de pruebas donde poder ensayar nuevos conceptos de la arquitectura al reunir espacial y temporalmente los condicionantes ideales requeridos para la experimentación y la comprobación de hallazgos. Aunque escasas, existen en la arquitectura contemporánea tiendas que han logrado ocupar por méritos propios un lugar destacado dentro de la obra de sus autores. Entre las merecedoras de ese reconocimiento habría que citar la ‘mítica’ sastrería Kniže proyectada por Adolf Loos a comienzos del siglo XX en Viena, el Negozio Vitrum que Giuseppe Terragni diseñara en Como en los años treinta, o la sucursal londinense de las líneas aéreas de Iraq construida en los sesenta por Alison y Peter Smithson. La elección, lejos de ser gratuita, obedece a razones fundadas. Dentro de las circunstancias temporales en las que se gestaron −las tres fueron proyectadas y construidas a lo largo del pasado siglo en un arco que abarca algo más de cincuenta años (1907-1961)−, los ejemplos seleccionados aúnan toda una serie de ‘coincidencias’ entre las que no resulta difícil establecer ciertos paralelismos: las tres marcan la talla de unos creadores que fueron capaces de dedicar la misma intensidad creativa a estos temas ‘menores’, corroborando que el carácter de la arquitectura también puede hacerse grande en lo pequeño; las tres, debido al momento de madurez en el que se abordó su diseño, reflejan su condición de laboratorio experimental al servicio de los intereses proyectuales que en ese momento ocupaban la mente de los arquitectos; las tres corroboran hipótesis ya apuntadas en arquitecturas anteriores, prueban líneas de trabajo no materializadas por falta de oportunidad y testan de manera menos comprometida soluciones que luego se trasladarán a obras con mayor vocación de permanencia; obras −y esto es algo especialmente sorprendente− con las que mantuvieron una estrecha relación en el espacio y en el tiempo, convirtiéndose incluso en plataformas de experimentación paralelas: baste en este sentido con apuntar la cercanía física −a ‘metros’ de distancia− y temporal −realizadas en los mismos años− entre la sastrería Kniže (1907- 1913;1928) y la Casa en la Michaelerplatz (1910-11); la tienda Vitrum (1930) y la Casa del Fascio (1929; 1932-36) o las oficinas de venta de las Iraqi Airways (1960-61) y la sede del The Economist (1959-64). Esta potencialidad que la tienda encierra para erigirse en laboratorio de experimentación y ensayo de la arquitectura, constituye la clave de la investigación que la tesis propone. ABSTRACT A little of everything that interests the architect is concentrated in the designing of a shop: it forms a kind of crossroads bringing together, apart from certain disciplinary questions rendering it particularly attractive and testing one’s ability as a designer, the need to coordinate compositional resources from fields peripheral to architecture in order to devise an adequate response to the specific requirements of image and persuasion that are part and parcel of business activity. The difficult start-up conditions, the generally not overly favourable spatial configurations ‒where the pre-existing conditions and shape of the site encroach on and enclose a space which has to be given a new order‒, the reduced size and possibilities afforded in terms of controlling the work, the short time frame and the rapid response imposed by the business tactics and its strategic position and direct frontal relationship with the street, make the shopfront and the display window are the ‘first advertisements” of the activity, or the integration and the reciprocal commentary between architecture and what takes place within: these are but some of the reasons explaining this interest and justifying the claim that the shop –a dimensional space so well suited to invention and innovation− constitutes a test-bed for trying out new concepts of architecture, combining in space and time the ideal conditions for experiment and the examination of its findings. Albeit not numerous, there are shops in contemporary architecture which have managed on their own merit to obtain a special place among the works of their authors. Among those earning such recognition, one should mention the ‘mythical’ Kniže tailoring establishment designed by Adolf Loos at the beginning of the 20th century in Vienna, the Negozio Vitrum designed by Giuseppe Terragni in Como in the thirties, or the London offices of Iraqi Airways built in the sixties by Alison and Peter Smithson. This selection, far from gratuitous, is based on well-founded reasons. Within the circumstances of the time-frame in which they were developed −the three were designed and built during the 20th century in a period that spans just over fifty years (1907-1961)− the chosen examples bring together a whole series of ‘coincidences’ where it is not difficult to draw certain parallels: the three bear witness to the stature of creators who were capable of devoting the same creative intensity to these ‘minor’ themes, thus corroborating the fact that the nature of the architecture can also be great in less important works; the three, thanks to the moment of maturity in which their design was carried out, reflect their condition as an experimental laboratory at the service of the particular designing interests which at the time occupied the minds of these architects; the three confirm hypotheses already displayed in previous architectures, they test lines of work which had not materialised through lack of opportunity, and in a less comprised manner check solutions that were later transferred to works with a greater vocation for permanence; works −and this is something especially surprising – with which they maintained a close relationship in time and space, even becoming parallel experimental platforms: in this sense, we need only to mention the physical proximity –just metres away− and proximity in time –built within the same years− between the Kniže shop (1907-1913; 1928) and the House of Michaelerplatz (1910-11); the Vitrum shop (1930) and the Casa del Fascio (1929;1932-36); and the Iraqi Airways sales offices (1960-61) and the headquarters of The Economist (1959-64). The potential of the shop to set itself up as an experimental laboratory and architectural rehearsal constitutes the main focus of the research put forward by this thesis.
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Andrew Croswell kept this account book while an undergraduate at Harvard College. It contains entries from 1794, the year he entered, until his graduation in 1798. There is also one entry on the back cover apparently made in 1802. The entries, divided by school term, are very detailed. Croswell indicates the cost of the following, among many other expenses and purchases: transportation, most often to Hingham and Plymouth; payment for "passing the bridge"; candles; hiring a horse; wood and having it cut; laundry; quills and pencils; paper and ink; razors, haircuts, hair ribbons; a trunk; clothing and cloth for trousers; furniture; tickets to the theater; door locks; a bowl and spoon; "batts and balls" and "other necessaries"; tobacco; toothbrushes; shoe and boot repair; fruit; wine, brandy and rum; cheese; coffee and tea; butter; lemons; sugar; and wafers. There are also entries for college-related costs, including the payment of quarter bills, buttery bills, Hasty Pudding Club dues, and a fee to the President of Harvard College related to Croswell's graduation. There are also entries pertaining to the cost of celebrating various special occasions, including Election Day, Christmas Eve, "Independent Day," and George Washington's birthday.
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Furniture and appliance related injuries in children under 5 years of age accounts for an estimated 180 emergency presentations annually in Queensland. Injuries occur when children push or pull items over, climb and fall off furniture, or climb and tip the item over. Children under 2 years of age tend to injure themselves by pulling items over onto themselves Children over 2 years of age are more likely to be injured after climbing the item and either falling off or tipping the item over onto themselves. Tip over injuries (where the item falls over and injures the child) in children under 5 years of age account for an estimated 115 emergency presentations annually in Queensland. The item most commonly associated with a tip over injury is a television (with or without the cabinet) Prevention requires better design and selection of furniture with inherent stability coupled with mechanisms to install or fix less stable items
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How influential is the Australian Document Computing Symposium (ADCS)? What do ADCS articles speak about and who cites them? Who is the ADCS community and how has it evolved? This paper considers eighteen years of ADCS, investigating both the conference and its community. A content analysis of the proceedings uncovers the diversity of topics covered in ADCS and how these have changed over the years. Citation analysis reveals the impact of the papers. The number of authors and where they originate from reveal who has contributed to the conference. Finally, we generate co-author networks which reveal the collaborations within the community. These networks show how clusters of researchers form, the effect geographic location has on collaboration, and how these have evolved over time.
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PURPOSE: This systematic review aimed to report and explore the survival of dental veneers constructed from non-feldspathic porcelain over 5 and 10 years.
MATERIALS AND METHODS: A total of 4,294 articles were identified through a systematic search involving all databases in the Cochrane Library, MEDLINE (OVID), EMBASE, Web of Knowledge, specific journals (hand-search), conference proceedings, clinical trials registers, and collegiate contacts. Articles, abstracts, and gray literature were sought by two independent researchers. There were no language limitations. One hundred sixteen studies were identified for full-text assessment, with 10 included in the analysis (5 qualitative, 5 quantitative). Study characteristics and survival (Kaplan-Meier estimated cumulative survival and 95% confidence interval [CI]) were extracted or recalculated. A failed veneer was one which required an intervention that disrupted the original marginal integrity, had been partially or completely lost, or had lost retention more than twice. A meta-analysis and sensitivity analysis of Empress veneers was completed, with an assessment of statistical heterogeneity and publication bias. Clinical heterogeneity was explored for results of all veneering materials from included studies.
RESULTS: Within the 10 studies, veneers were fabricated with IPS Empress, IPS Empress 2, Cerinate, and Cerec computer-aided design/computer-assisted manufacture (CAD/CAM) materials VITA Mark I, VITA Mark II, Ivoclar ProCad. The meta-analysis showed the pooled estimate for Empress veneers to be 92.4% (95% CI: 89.8% to 95.0%) for 5-year survival and 66% to 94% (95% CI: 55% to 99%) for 10 years. Data regarding other non-feldspathic porcelain materials were lacking, with only a single study each reporting outcomes for Empress 2, Cerinate, and various Cerec porcelains over 5 years. The sensitivity analysis showed data from one study had an influencing and stabilizing effect on the 5-year pooled estimate.
CONCLUSION: The long-term outcome (> 5 years) of non-feldspathic porcelain veneers is sparsely reported in the literature. This systematic review indicates that the 5-year cumulative estimated survival for etchable non-feldspathic porcelain veneers is over 90%. Outcomes may prove clinically acceptable with time, but evidence remains lacking and the use of these materials for veneers remains experimental.
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The social construction of sexuality over the past one hundred and fifty years has created a dichotomy between heterosexual and non-heterosexual identities that essentially positions the former as “normal” and the latter as deviant. Even Kinsey’s and others’ work on the continuum of sexualities did little to alter the predominantly heterosexist perception of the non-heterosexual as “other” (Kinsey, Pomeroy and Martin 2007; Esterberg 2006; Franceour and Noonan 2007). Some political action and academic work is beginning to challenge such perceptions. Even some avenues of social interaction, such as the recent proliferation of online communities, may also challenge such views, or at least contribute to their being rethought in some ways. This chapter explores a specific kind of online community devoted to fan fiction, specifically homoerotic – or what is known colloquially as “slash” – fan fiction. Fan fiction is fiction, published on the internet, and written by fans of well-known books and television shows, using the characters to create new and varied plots. “Slash” refers to the pairing of two of the male characters in a romantic relationship, and the term comes from the punctuation mark dividing the named pair as, for example, Spock/Kirk from the Star Trek television series. Although there are some slash fan-fiction stories devoted to female-female relationships – called “femmeslash” – the term “slash” generally refers to male-male relationships, and will be utilized throughout this chapter, given that the research discussed focuses on communities centered around one such male pairing.
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Findings from an Australian case study of adult women expose general, light and basic use of mobile phones. Participants used their mobile phone mainly for coordination and to a lesser extent for practicing intrinsic interactions motivated by emotional support purposes. This paper focuses on social and emotional support over the mobile phone. Though crucial to individuals, emotional support seems to be a neglected area of research among mobile communication studies, all the more so when focusing on adult women. This study addresses this literature gap. The empirical findings are based on a case study of 26 women over 35 years of age residing in one coastal Australian town. The research design included a combination of quantitative and qualitative methods. This paper examines the communication methods adult women use for social and emotional support, and analyses reasons and social implications of this limited intrinsic communication use pattern over the mobile phone.
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Issues of equity and inequity have always been part of employment relations and are a fundamental part of the industrial landscape. For example, in most countries in the nineteenth century and a large part of the twentieth century women and members of ethnic groups (often a minority in the workforce) were barred from certain occupations, industries or work locations, and received less pay than the dominant male ethnic group for the same work. In recent decades attention has been focused on issues of equity between groups, predominantly women and different ethnic groups in the workforce. This has been embodied in industrial legislation, for example in equal pay for women and men, and frequently in specific equity legislation. In this way a whole new area of law and associated workplace practice has developed in many countries. Historically, employment relations and industrial relations research has not examined employment issues disaggregated by gender or ethnic group. Born out of concern with conflict and regulation at the workplace, studies tended to concentrate on white, male, unionized workers in manufacturing and heavy industry (Ackers, 2002, p. 4). The influential systems model crafted by Dunlop (1958) gave rise to The discipline’s preoccupation with the ‘problem of order’ [which] ensures the invisibility of women, not only because women have generally been less successful in mobilizing around their own needs and discontents, but more profoundly because this approach identifies the employment relationship as the ultimate source of power and conflict at work (Forrest, 1993, p. 410). While ‘the system approach does not deliberately exclude gender . . . by reproducing a very narrow research approach and understanding of issues of relevance for the research, gender is in general excluded or looked on as something of peripheral interest’ (Hansen, 2002, p. 198). However, long-lived patterns of gender segregation in occupations and industries, together with discriminatory access to work and social views about women and ethnic groups in the paid workforce, mean that the employment experience of women and ethnic groups is frequently quite different to that of men in the dominant ethnic group. Since the 1980s, research into women and employment has figured in the employment relations literature, but it is often relegated to a separate category in specific articles or book chapters, with women implicitly or explicitly seen as the atypical or exceptional worker (Hansen, 2002; Wajcman, 2000). The same conclusion can be reached for other groups with different labour force patterns and employment outcomes. This chapter proposes that awareness of equity issues is central to employment relations. Like industrial relations legislation and approaches, each country will have a unique set of equity policies and legislation, reflecting their history and culture. Yet while most books on employment and industrial relations deal with issues of equity in a separate chapter (most commonly on equity for women or more recently on ‘diversity’), the reality in the workplace is that all types of legislation and policies which impact on the wages and working conditions interact, and their impact cannot be disentangled one from another. When discussing equity in workplaces in the twenty-first century we are now faced with a plethora of different terms in English. Terms used include discrimination, equity, equal opportunity, affirmative action and diversity with all its variants (workplace diversity, managing diversity, and so on). There is a lack of agreed definitions, particularly when the terms are used outside of a legislative context. This ‘shifting linguistic terrain’ (Kennedy-Dubourdieu, 2006b, p. 3) varies from country to country and changes over time even within the one country. There is frequently a division made between equity and its related concepts and the range of expressions using the term ‘diversity’ (Wilson and Iles, 1999; Thomas and Ely, 1996). These present dilemmas for practitioners and researchers due to the amount and range of ideas prevalent – and the breadth of issues that are covered when we say ‘equity and diversity in employment’. To add to these dilemmas, the literature on equity and diversity has become bifurcated: the literature on workplace diversity/management diversity appears largely in the business literature while that on equity in employment appears frequently in legal and industrial relations journals. Workplaces of the twenty-first century differ from those of the nineteenth and twentieth century not only in the way they deal with individual and group differences but also in the way they interpret what are fair and equitable outcomes for different individuals and groups. These variations are the result of a range of social conditions, legislation and workplace constraints that have influenced the development of employment equity and the management of diversity. Attempts to achieve employment equity have primarily been dealt with through legislative means, and in the last fifty years this legislation has included elements of anti-discrimination, affirmative action, and equal employment opportunity in virtually all OECD countries (Mor Barak, 2005, pp. 17–52). Established on human rights and social justice principles, this legislation is based on the premise that systemic discrimination has and/or continues to exist in the labour force and particular groups of citizens have less advantageous employment outcomes. It is based on group identity, and employment equity programmes in general apply across all workplaces and are mandatory. The more recent notions of diversity in the workplace are based on ideas coming principally from the USA in the 1980s which have spread widely in the Western world since the 1990s. Broadly speaking, diversity ideas focus on individual differences either on their own or in concert with the idea of group differences. The diversity literature is based on a business case: that is diversity is profitable in a variety of ways for business, and generally lacks a social justice or human rights justification (Burgess et al., 2009, pp. 81–2). Managing diversity is represented at the organizational level as a voluntary and local programme. This chapter discusses some major models and theories for equity and diversity. It begins by charting the history of ideas about equity in employment and then briefly discusses what is meant by equality and equity. The chapter then analyses the major debates about the ways in which equity can be achieved. The more recent ideas about diversity are then discussed, including the history of these ideas and the principles which guide this concept. The following section discusses both major frameworks of equity and diversity. The chapter then raises some ways in which insights from the equity and diversity literature can inform employment relations. Finally, the future of equity and diversity ideas is discussed.
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Humans have altered environments and enhanced their wellbeing unlike any other creature on the planet (Hielman & Donda, 2007); this is no different whether the environment is ecological, social or organizational. In recent times, the debate regarding greenhouse effects on the global weather patterns and the sustainment of the earth’s temperature necessary for life support has become quite infamously problematic as society pushes to find new sources of energy both renewable and environmentally sustainable. The feedback received on CSG from both government and companies alike is that the opportunities this industry creates has a lasting range of social and economic benefits worth over fifty (50) billion dollars in projects (Queensland Government, 2013). This however, has been overshadowed by social activist and lobbyist groups as ‘Lock the Gate Alliance’ saying, as one part of their report noted from the National Water Commission, “coal seam gas development could cause significant social impacts by disrupting current land-use practices and the local environment through infrastructure construction and access” (Lock the Gate Alliance, n.d.), and “In recent years both a NSW and Federal Senate inquiry into coal seam gas production were deliberately mislead by an organization that claims to work on behalf of the farming community, This is the battle for the end of the fossil fuel industry. This is the end game..." (Ward, 2013).
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Dengue fever (DF) is a serious public health concern in many parts of the world. An increase in DF incidence has been observed globally over the past decades. Multiple factors including urbanisation, increased international travels and global climate change are thought to be responsible for increased DF. However, little research has been conducted in the Asia-Pacific region about the impact of these changes on dengue transmission. The overarching aim of this thesis is to explore the spatiotemporal pattern of DF transmission in the Asia-Pacific region and project the future risk of DF attributable to climate change. Annual data of DF outbreaks for sixteen countries in the Asia-Pacific region over the last fifty years were used in this study. The results show that the geographic range of DF in this region increased significantly over the study period. Thailand, Vietnam and Laos were identified as the highest risk areas and there was a southward expansion observed in the transmission pattern of DF which might have originated from Philippines or Thailand. Additionally, the detailed DF data were obtained and the space-time clustering of DF transmission was examined in Bangladesh. Monthly DF data were used for the entire country at the district level during 2000-2009. Dhaka district was identified as the most likely DF cluster in Bangladesh and several districts of the southern part of Bangladesh were identified as secondary clusters in the years 2000-2002. In order to examine the association between meteorological factors and DF transmission and to project the future risk of DF using different climate change scenarios, the climate-DF relationship was examined in Dhaka, Bangladesh. The results show that climate variability (particularly maximum temperature and relative humidity) was positively associated with DF transmission in Dhaka. The effects of climate variability were observed at a lag of four months which might help to potentially control and prevent DF outbreaks through effective vector management and community education. Based on the quantitative assessment of the climate-DF relationship, projected climate change will likely increase mosquito abundance and activity and DF in this area. Assuming a temperature increase of 3.3oC without any adaptation measures and significant changes in socio-economic conditions, the consequence will be devastating, with a projected annual increase of 16,030 cases in Dhaka, Bangladesh by the end of this century. Therefore, public health authorities need to be prepared for likely increase of DF transmission in this region. This study adds to the literature on the recent trends of DF and impacts of climate change on DF transmission. These findings may have significant public health implications for the control and prevention of DF, particularly in the Asia- Pacific region.
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BACKGROUND: Dengue fever (DF) is one of the most important emerging arboviral human diseases. Globally, DF incidence has increased by 30-fold over the last fifty years, and the geographic range of the virus and its vectors has expanded. The disease is now endemic in more than 120 countries in tropical and subtropical parts of the world. This study examines the spatiotemporal trends of DF transmission in the Asia-Pacific region over a 50-year period, and identified the disease's cluster areas. METHODOLOGY AND FINDINGS: The World Health Organization's DengueNet provided the annual number of DF cases in 16 countries in the Asia-Pacific region for the period 1955 to 2004. This fifty-year dataset was divided into five ten-year periods as the basis for the investigation of DF transmission trends. Space-time cluster analyses were conducted using scan statistics to detect the disease clusters. This study shows an increasing trend in the spatiotemporal distribution of DF in the Asia-Pacific region over the study period. Thailand, Vietnam, Laos, Singapore and Malaysia are identified as the most likely clusters (relative risk = 13.02) of DF transmission in this region in the period studied (1995 to 2004). The study also indicates that, for the most part, DF transmission has expanded southwards in the region. CONCLUSIONS: This information will lead to the improvement of DF prevention and control strategies in the Asia-Pacific region by prioritizing control efforts and directing them where they are most needed.
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Introduction Environmental and biological samples taken around Da Nang Air Base have shown elevated levels of dioxin over many years [1-3]. A pre-intervention knowledge, attitudes and practices (KAP) survey (2009), a risk reduction program (2010) and a post intervention KAP survey (2011) were undertaken in four wards surrounding Danang Airbase. A follow-up evaluation was undertaken in 2013. Methods A KAP survey was implemented among 400 randomly selected food handlers. Eleven indepth interviews and four focus group discussions were also undertaken. Results The knowledge of respondents remained positive and/or improved at 2.5 years follow-up. There were no significant differences in attitudes toward preventing dioxin exposure across surveys; most respondents were positive in all three surveys. An increase in households (69.5%) undertaking measures to prevent exposure was observed, which was higher than in the pre-intervention survey (39.6%) and post- intervention survey (60.4%) (χ2 = 95.6; p < 0.001). The proportion of respondents practicing appropriate preventive measures was also significantly improved. Conclusions Despite most of the intervention program’s activities ceasing in 2010, the risk reduction program has resulted in positive outcomes over the longer-term, with many knowledge and attitude measures remaining stable or imporving. Some KAP indicators decreased, but these KAP indicators were still significantly higher than the pre-intervention levels.
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Background Clostridium difficile infection (CDI) possibly extends hospital length of stay (LOS); however, the current evidence does not account for the time-dependent bias, ie, when infection is incorrectly analyzed as a baseline covariate. The aim of this study was to determine whether CDI increases LOS after managing this bias. Methods We examined the estimated extra LOS because of CDI using a multistate model. Data from all persons hospitalized >48 hours over 4 years in a tertiary hospital in Australia were analyzed. Persons with health care-associated CDIs were identified. Cox proportional hazards models were applied together with multistate modeling. Results One hundred fifty-eight of 58,942 admissions examined had CDI. The mean extra LOS because of infection was 0.9 days (95% confidence interval: −1.8 to 3.6 days, P = .51) when a multistate model was applied. The hazard of discharge was lower in persons who had CDI (adjusted hazard ratio, 0.42; P < .001) when a Cox proportional hazard model was applied. Conclusion This study is the first to use multistate models to determine the extra LOS because of CDI. Results suggest CDI does not significantly contribute to hospital LOS, contradicting findings published elsewhere. Conversely, when methods prone to result in time-dependent bias were applied to the data, the hazard of discharge significantly increased. These findings contribute to discussion on methods used to evaluate LOS and health care-associated infections.