Multilevel competing risk models to evaluate the risk of nosocomial infection

Introduction Risk factor analyses for nosocomial infections (NIs) are complex. First, due to competing events for NI, the association between risk factors of NI as measured using hazard rates may not coincide with the association using cumulative probability (risk). Second, patients from the same intensive care unit (ICU) who share the same environmental exposure are likely to be more similar with regard to risk factors predisposing to a NI than patients from different ICUs. We aimed to develop an analytical approach to account for both features and to use it to evaluate associations between patient- and ICU-level characteristics with both rates of NI and competing risks and with the cumulative probability of infection. Methods We considered a multicenter database of 159 intensive care units containing 109,216 admissions (813,739 admission-days) from the Spanish HELICS-ENVIN ICU network. We analyzed the data using two models: an etiologic model (rate based) and a predictive model (risk based). In both models, random effects (shared frailties) were introduced to assess heterogeneity. Death and discharge without NI are treated as competing events for NI. Results There was a large heterogeneity across ICUs in NI hazard rates, which remained after accounting for multilevel risk factors, meaning that there are remaining unobserved ICU-specific factors that influence NI occurrence. Heterogeneity across ICUs in terms of cumulative probability of NI was even more pronounced. Several risk factors had markedly different associations in the rate-based and risk-based models. For some, the associations differed in magnitude. For example, high Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were associated with modest increases in the rate of nosocomial bacteremia, but large increases in the risk. Others differed in sign, for example respiratory vs cardiovascular diagnostic categories were associated with a reduced rate of nosocomial bacteremia, but an increased risk. Conclusions A combination of competing risks and multilevel models is required to understand direct and indirect risk factors for NI and distinguish patient-level from ICU-level factors.

Discovery of a lipid synthesising organ in the auditory system of an insect

Weta possess typical Ensifera ears. Each ear comprises three functional parts: two equally sized tympanal membranes, an underlying system of modified tracheal chambers, and the auditory sensory organ, the crista acustica. This organ sits within an enclosed fluid-filled channel-previously presumed to be hemolymph. The role this channel plays in insect hearing is unknown. We discovered that the fluid within the channel is not actually hemolymph, but a medium composed principally of lipid from a new class. Three-dimensional imaging of this lipid channel revealed a previously undescribed tissue structure within the channel, which we refer to as the olivarius organ. Investigations into the function of the olivarius reveal de novo lipid synthesis indicating that it is producing these lipids in situ from acetate. The auditory role of this lipid channel was investigated using Laser Doppler vibrometry of the tympanal membrane, which shows that the displacement of the membrane is significantly increased when the lipid is removed from the auditory system. Neural sensitivity of the system, however, decreased upon removal of the lipid-a surprising result considering that in a typical auditory system both the mechanical and auditory sensitivity are positively correlated. These two results coupled with 3D modelling of the auditory system lead us to hypothesize a model for weta audition, relying strongly on the presence of the lipid channel. This is the first instance of lipids being associated with an auditory system outside of the Odentocete cetaceans, demonstrating convergence for the use of lipids in hearing.

Public health interventions for increasing physical activity in children, adolescents and adults : an overview of systematic reviews

This is the protocol for a review and there is no abstract. The objectives are as follows: This overview intends to: a) summarise the existing evidence on interventions that aim to increase PA; b) explore whether any effects of the intervention are different within and between populations, and whether these differences form an equity gradient such as an effect that differs according the advantage/disadvantage (e.g. low income and ethnic minorities); c) highlight gaps in the present evidence base that may warrant a Cochrane systematic review to be completed; and c) identify 'up to date' Cochrane reviews. .

Structuring representations of continuous data through investigations in grade 1

The study of data modelling with elementary students involves the analysis of a developmental process beginning with children’s investigations of meaningful contexts: visualising, structuring, and representing data and displaying data in simple graphs (English, 2012; Lehrer & Schauble, 2005; Makar, Bakker, & Ben-Zvi, 2011). A 3-year longitudinal study investigated young children’s data modelling, integrating mathematical and scientific investigations. One aspect of this study involved a researcher-led teaching experiment with 21 mathematically able Grade 1 students. The study aimed to describe explicit developmental features of students’ representations of continuous data...

Predictors of recent HIV testing among male street laborers in urban Vietnam

This study assessed the prevalence of and factors associated with HIV testing among male street laborers. In a cross-sectional survey, social mapping was done to recruit and interview 450 men aged 18–59 years in Hanoi. Although many of these men engaged in multiple risk behaviors for HIV, only 19.8 percent had been tested for HIV. A modified theoretical model provided better fit than the conventional Information–Motivation–Behavioral Skills model, as it explained much more variance in HIV testing. This model included three Information–Motivation–Behavioral components and four additional factors, namely, the origin of residence, sexual orientation, the number of sexual partners, and the status of condom use.

The Killing of Angel Street

Synopsis and review of the Australian feature film The Killing of Angel Street, directed by Donald Crombie.

Gone Girl and the mediatization of crime

Gone Girl (David Fincher, 2014) will not be remembered for its representation of journalists, although both lead characters are, as the narrative opens in 2012, magazine writers made redundant in the wake of the 2008 global financial crisis. To this extent they personify the “death of journalism” narrative of recent years in the United States, but we never see them in a newsroom or doing journalistic work. The marriage of Nick and Amy Dunne (Ben Affleck and Rosamund Pike) is cast as a victim of, among other things, the downturn in the US economy which accompanied the credit crunch. But this is not the subject of Gone Girl, so much as a context for the marital dysfunctionality at the heart of its plot...