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Mixed-methods process evaluation of a respiratory-culture diagnostic stewardship intervention
- Kathleen Chiotos, Deanna Marshall, Katherine Kellom, Jennifer Whittaker, Heather Wolfe, Charlotte Woods-Hill, Hannah Stinson, Garrett Keim, Jennifer Blumenthal, Joseph Piccione, Giyoung Lee, Guy Sydney, Jeffrey Gerber
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 44 / Issue 2 / February 2023
- Published online by Cambridge University Press:
- 03 January 2023, pp. 191-199
- Print publication:
- February 2023
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Objective:
To conduct a process evaluation of a respiratory culture diagnostic stewardship intervention.
Design:Mixed-methods study.
Setting:Tertiary-care pediatric intensive care unit (PICU).
Participants:Critical care, infectious diseases, and pulmonary attending physicians and fellows; PICU nurse practitioners and hospitalist physicians; pediatric residents; and PICU nurses and respiratory therapists.
Methods:This mixed-methods study was conducted concurrently with a diagnostic stewardship intervention to reduce the inappropriate collection of respiratory cultures in mechanically ventilated children. We quantified baseline respiratory culture utilization and indications for ordering using quantitative methods. Semistructured interviews informed by these data and the Consolidated Framework for Implementation Research (CFIR) were then performed, recorded, transcribed, and coded to identify salient themes. Finally, themes identified in these interviews were used to create a cross-sectional survey.
Results:The number of cultures collected per day of service varied between attending physicians (range, 2.2–27 cultures per 100 days). In total, 14 interviews were performed, and 87 clinicians completed the survey (response rate, 47%) and 77 nurses or respiratory therapists completed the survey (response rate, 17%). Clinicians varied in their stated practices regarding culture ordering, and these differences both clustered by specialty and were associated with perceived utility of the respiratory culture. Furthermore, group “default” practices, fear, and hierarchy were drivers of culture orders. Barriers to standardization included fear of a missed diagnosis and tension between practice standardization and individual decision making.
Conclusions:We identified significant variation in utilization and perceptions of respiratory cultures as well as several key barriers to implementation of this diagnostic test stewardship intervention.
Characteristics of healthcare personnel who reported concerns related to PPE use during care of COVID-19 patients
- Nora Chea, Stephanie Tavitian, Cedric Brown, Taniece Eure, Rebecca Alkis, Gregory Blazek, Austin Penna, Joelle Nadle, Linda Frank, Christopher Czaja, Helen Johnston, Devra Barter, Kathleen Angell, Kristen Marshall, James Meek, Monica Brackney, Stacy Carswell, Stepy Thomas, Scott Fridkin, Lucy Wilson, Ashley Fell, Sara Lovett, Sarah Lim, Ruth Lynfield, Ruth SarahShrum, Erin C. Phipps, Marla Sievers, Ghinwa Dumyati, Cate Concannon, Kathryn McCullough, Woods, Sandhya Seshadri, Christopher Myers, Rebecca Pierce, Valerie Ocampo, Judith Guzman-Cottrill, Gabriela Escutia, Monika Samper, Sandra Pena, Cullen Adre, Tiffanie Markus, Kathryn Billings, Matthew Groenewold, Ronda Sinkowitz-Cochran, Shelley Magill, Cheri Grigg, Betsy Miller
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 2 / Issue S1 / July 2022
- Published online by Cambridge University Press:
- 16 May 2022, pp. s8-s9
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Background: Healthcare facilities have experienced many challenges during the COVID-19 pandemic, including limited personal protective equipment (PPE) supplies. Healthcare personnel (HCP) rely on PPE, vaccines, and other infection control measures to prevent SARS-CoV-2 infections. We describe PPE concerns reported by HCP who had close contact with COVID-19 patients in the workplace and tested positive for SARS-CoV-2. Method: The CDC collaborated with Emerging Infections Program (EIP) sites in 10 states to conduct surveillance for SARS-CoV-2 infections in HCP. EIP staff interviewed HCP with positive SARS-CoV-2 viral tests (ie, cases) to collect data on demographics, healthcare roles, exposures, PPE use, and concerns about their PPE use during COVID-19 patient care in the 14 days before the HCP’s SARS-CoV-2 positive test. PPE concerns were qualitatively coded as being related to supply (eg, low quality, shortages); use (eg, extended use, reuse, lack of fit test); or facility policy (eg, lack of guidance). We calculated and compared the percentages of cases reporting each concern type during the initial phase of the pandemic (April–May 2020), during the first US peak of daily COVID-19 cases (June–August 2020), and during the second US peak (September 2020–January 2021). We compared percentages using mid-P or Fisher exact tests (α = 0.05). Results: Among 1,998 HCP cases occurring during April 2020–January 2021 who had close contact with COVID-19 patients, 613 (30.7%) reported ≥1 PPE concern (Table 1). The percentage of cases reporting supply or use concerns was higher during the first peak period than the second peak period (supply concerns: 12.5% vs 7.5%; use concerns: 25.5% vs 18.2%; p Conclusions: Although lower percentages of HCP cases overall reported PPE concerns after the first US peak, our results highlight the importance of developing capacity to produce and distribute PPE during times of increased demand. The difference we observed among selected groups of cases may indicate that PPE access and use were more challenging for some, such as nonphysicians and nursing home HCP. These findings underscore the need to ensure that PPE is accessible and used correctly by HCP for whom use is recommended.
Funding: None
Disclosures: None
Indications for and Utility of Tracheal Aspirate Cultures for the Diagnosis of VAI
- Kathleen Chiotos, Giyoung Lee, Guy Sydney, Heather Wolfe, Jennifer Blumenthal, Hannah Stinson, Julie Harab, Danielle Traynor, Joseph Piccione, Ashlee Doll, Garrett Keim, Charlotte Woods-Hill, Megan Jennings, Rebecca Harris, Jeffrey Gerber, Aaditya Dudhia, Nancy McGowan, Jennalyn Burke
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 1 / Issue S1 / July 2021
- Published online by Cambridge University Press:
- 29 July 2021, pp. s60-s61
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Background: Tracheal aspirate bacterial cultures are routinely collected in mechanically ventilated children for the evaluation of ventilator-associated infections (VAIs). However, frequent bacterial colonization of endotracheal and tracheostomy tubes contribute to the marginal performance characteristics of the test for diagnosing VAI. Published literature characterizing drivers of culture collection and the predictive value of positive cultures are limited. Methods: This single-center, retrospective cohort study included children admitted to the pediatric intensive care unit who were receiving mechanical ventilation for at least 48 hours and had 1 or more semiquantitative tracheal aspirate cultures collected between September 1, 2019, and August 31, 2020. Indications for culture collection were determined through medical record review and included fever, hypothermia, tracheal secretion changes, radiographic pneumonia, increased oxygen requirement, and/or increased positive end-expiratory pressure (PEEP). A positive culture was defined as moderate or heavy growth of a noncommensal bacterial organism. A purulent Gram stain was defined as detection of moderate or many white blood cells. Diagnosis of VAI was based on treating-clinician documentation and was ascertained through medical record review. Logistic regression accounting for clustering by patient was performed to estimate the association between indications for culture collection and (1) culture positivity, (2) purulent Gram stain, and (3) diagnosis of VAI. Results: In total, 625 tracheal aspirate cultures were performed in 261 unique patients. Common indications for culture collection included isolated fever or hypothermia (n = 124, 20%), fever with an increase in oxygen requirement or PEEP (n = 71, 11%), isolated increase in oxygen requirement or PEEP (n = 67, 11%), or isolated secretion change (n = 54, 9%) (Figure 1). Overall, 230 cultures (37%) were positive and 218 (35%) Gram stains were purulent. There were no associations between culture indications and a positive culture. Presence of isolated fever was negatively associated with a purulent Gram stain (odds ratio [OR], 0.49; 95% CI, 0.30–0.81; P = .005); otherwise, there were no associations between indication and purulent Gram stain. Finally, in a multivariable model, odds of VAI diagnosis increased with both the number of indications for culture collection and purulent Gram stain, but not with positive culture (Figure 2). Conclusions: Number and type of clinical signs were not associated with tracheal aspirate culture positivity or purulence on Gram stain, but they were associated with a clinical diagnosis of VAI. These findings suggest that positive tracheal aspirate cultures may not aid clinicians in the diagnosis of VAI, and they highlight the opportunity for improved diagnostic stewardship.
Funding: No
Disclosures: None
Figure 1.
Figure 2.
The provision of ultra-processed foods and their contribution to sodium availability in Australian long day care centres
- Siobhan A O’Halloran, Kathleen E Lacy, Julie Woods, Carley A Grimes, Karen J Campbell, Caryl A Nowson
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- Journal:
- Public Health Nutrition / Volume 21 / Issue 1 / January 2018
- Published online by Cambridge University Press:
- 29 June 2017, pp. 134-141
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Objectives
To categorize and assess all foods, beverages and ingredients provided over one week at Australian long day care (LDC) centres according to four levels of food processing and to assess the contribution of Na from each level of processing.
DesignCross-sectional.
SettingMenus for lunch, morning and afternoon snacks were collected from LDC centres. The level of food processing of all foods, beverages and ingredients was assessed utilizing a four-level food processing classification system: minimally processed (MP), processed culinary ingredients (PCI), processed (P) and ultra-processed (ULP).
ResultsA total of thirty-five menus (lunch, n 35; snacks, n 70) provided to 1–5-year-old children were collected from seven LDC centres. Proportions of foodstuffs classified as MP, PCI, P and ULP were 54, 10, 15 and 21 %, respectively. All lunches were classified as MP. ULP foods accounted for 6 % of morning snacks; 41 % of afternoon snacks. Mean daily amount of Na provided per child across all centres was 633 (sd 151) mg. ULP foods provided 40 % of Na, followed by P (35 %), MP (23 %) and PCI (2 %).
ConclusionsCentres provided foods resulting in a mean total daily Na content that represented 63 % of the recommended Upper Level of Intake for Na in this age group. A significant proportion of ULP snack foods were included, which were the major contributor to total daily Na intake. Replacement of ULP snack foods with MP lower-Na alternatives is recommended.
Inpatient Urine Cultures Are Frequently Performed Without Urinalysis or Microscopy: Findings From a Large Academic Medical Center
- Abigail L. Carlson, Satish Munigala, Anthony J. Russo, Kathleen M. McMullen, Helen Wood, Ronald Jackups, David K. Warren
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 38 / Issue 4 / April 2017
- Published online by Cambridge University Press:
- 05 January 2017, pp. 455-460
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- April 2017
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OBJECTIVE
To describe the frequency of urine cultures performed in inpatients without additional testing for pyuria
DESIGNRetrospective cohort study
SETTINGA 1,250-bed academic tertiary referral center
PATIENTSHospitalized adults
METHODSThis study included urine cultures drawn on 4 medical and 2 surgical wards from 2009 to 2013 and in the medical and surgical intensive care units (ICUs) from 2012 to 2013. Patient and laboratory data were abstracted from the hospital’s medical informatics database. We identified catheter-associated urinary tract infections (CAUTIs) in the ICUs by routine infection prevention surveillance. Cultures without urinalysis or urine microscopy were defined as “isolated.” The primary outcome was the proportion of isolated urine cultures obtained. We used multivariable logistic regression to assess predictors of isolated cultures.
RESULTSDuring the study period, 14,743 urine cultures were obtained (63.5 cultures per 1,000 patient days) during 11,820 patient admissions. Of these, 2,973 cultures (20.2%) were isolated cultures. Of the 61 CAUTIs identified, 31 (50.8%) were identified by an isolated culture. Predictors for having an isolated culture included male gender (adjusted odds ratio [aOR], 1.22; 95%; confidence interval [CI], 1.11–1.35], urinary catheterization (aOR, 2.15; 95% CI, 1.89–2.46), ICU admission (medical ICU aOR, 1.72; 95% CI, 1.47–2.00; surgical ICU aOR, 1.82; 95% CI, 1.51–2.19), and obtaining the urine culture ≥1 calendar day after admission (1–7 days aOR, 1.91; 95% CI. 1.71–2.12; >7 days after admission aOR, 2.81; 95% CI, 2.37–3.34).
CONCLUSIONSIsolated urine cultures are common in hospitalized patients, particularly in patients with urinary catheters and those in ICUs. Interventions targeting inpatient culturing practices may improve the diagnosis of urinary tract infections.
Infect Control Hosp Epidemiol 2017;38:455–460
A Central Line Care Maintenance Bundle for the Prevention of Central Line–Associated Bloodstream Infection in Non–Intensive Care Unit Settings
- Caroline O’Neil, Kelly Ball, Helen Wood, Kathleen McMullen, Pamala Kremer, S. Reza Jafarzadeh, Victoria Fraser, David Warren
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 37 / Issue 6 / June 2016
- Published online by Cambridge University Press:
- 21 March 2016, pp. 692-698
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- June 2016
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OBJECTIVE
To evaluate a central line care maintenance bundle to reduce central line–associated bloodstream infection (CLABSI) in non–intensive care unit settings.
DESIGNBefore-after trial with 12-month follow-up period.
SETTINGA 1,250-bed teaching hospital.
PARTICIPANTSPatients with central lines on 8 general medicine wards. Four wards received the intervention and 4 served as controls.
INTERVENTIONA multifaceted catheter care maintenance bundle consisting of educational programs for nurses, update of hospital policies, visual aids, a competency assessment, process monitoring, regular progress reports, and consolidation of supplies necessary for catheter maintenance.
RESULTSData were collected for 25,542 catheter-days including 43 CLABSI (rate, 1.68 per 1,000 catheter-days) and 4,012 catheter dressing observations. Following the intervention, a 2.5% monthly decrease in the CLABSI incidence density was observed on intervention floors but this was not statistically significant (95% CI, −5.3% to 0.4%). On control floors, there was a smaller but marginally significant decrease in CLABSI incidence during the study (change in monthly rate, −1.1%; 95% CI, −2.1% to −0.1%). Implementation of the bundle was associated with improvement in catheter dressing compliance on intervention wards (78.8% compliance before intervention vs 87.9% during intervention/follow-up; P<.001) but improvement was also observed on control wards (84.9% compliance before intervention vs 90.9% during intervention/follow-up; P=.001).
CONCLUSIONSA multifaceted program to improve catheter care was associated with improvement in catheter dressing care but no change in CLABSI rates. Additional study is needed to determine strategies to prevent CLABSI in non–intensive care unit patients.
Infect Control Hosp Epidemiol 2016;37:692–698
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- The Cambridge Dictionary of Philosophy
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- 05 August 2015
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- 27 April 2015, pp ix-xxx
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Time for a Revolution: Smart Energy and Microgrid Use in Disaster Response
- David Wayne Callaway, Erin Noste, Peter Woods McCahill, A.J. Rossman, Dominique Lempereur, Kathleen Kaney, Doug Swanson
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- Disaster Medicine and Public Health Preparedness / Volume 8 / Issue 3 / June 2014
- Published online by Cambridge University Press:
- 11 June 2014, pp. 252-259
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Modern health care and disaster response are inextricably linked to high volume, reliable, quality power. Disasters place major strain on energy infrastructure in affected communities. Advances in renewable energy and microgrid technology offer the potential to improve mobile disaster medical response capabilities. However, very little is known about the energy requirements of and alternative power sources in disaster response. A gap analysis of the energy components of modern disaster response reveals multiple deficiencies. The MED-1 Green Project has been executed as a multiphase project designed to identify energy utilization inefficiencies, decrease demands on diesel generators, and employ modern energy management strategies to expand operational independence. This approach, in turn, allows for longer deployments in potentially more austere environments and minimizes the unit's environmental footprint. The ultimate goal is to serve as a proof of concept for other mobile medical units to create strategies for energy independence. (Disaster Med Public Health Preparedness. 2014;0:1–8)
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- Catia Acosta, Mark Ashraph, John Bainton, David Baird, Lindsay Banham, Anna Barnes, Caroline Biddle, Sulagna Chakrabarti, Katrina Davis, Tom Dixon, Jacek Donocik, Sarah Dorrington, Muhammad Firdosi, Marcella Fok, Christopher Garrett, Lauren Gavaghan, Vishaal Goel, Ben Goldacre, Surya Goudaman, Jemima Gregory, Duncan Harding, Simon Harrison, Jenna Hathway, James Hecker, Brad Hillier, Daniel Hume, Rosemary Humphreys, Elizabeth Hunt, Jonathan Huntley, Nicolas Crossley Karmelic, Adam Kasparek, Tom Lavender, William Lee, Kathleen Levick, Geraldine Lines, Vanessa Loftus, Catherine Louise Murphy, Deirdre MacManus, Rebecca Marriot, Ian McClelland, Isabel McMullen, Ben McNeillis, Amritha Mishra, Valeria Mondelli, Omer Moghaby, Ana Morelli, Christoph Mueller, Omar Murad, David Nelson, Tim Nicholson, Sarah Nyame, Aspasia Paspali, Areti Pavlidou, Tom Pollak, Catherine Polling, Sotiris Posporelis, Annabel Price, Jalon Quinn, Lena Rane, Muffazal Rawala, Ricardo Sainz-Fuertes, Gregory Shields, Pratima Singh, Sarah Stringer, Alex Thomson, Alex Tulloch, Tom Walker-Tilley, Wojtek Wojcik, Felicity Wood, Angeliki Zoumpouli
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- The Psychiatrist / Volume 36 / Issue 7 / July 2012
- Published online by Cambridge University Press:
- 02 January 2018, pp. 273-274
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- July 2012
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Borderline personality features in childhood: A short-term longitudinal study
- NICKI R. CRICK, DIANNA MURRAY–CLOSE, KATHLEEN WOODS
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- Development and Psychopathology / Volume 17 / Issue 4 / December 2005
- Published online by Cambridge University Press:
- 12 December 2005, pp. 1051-1070
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Borderline personality disorder is a particularly devastating, yet understudied form of psychopathology. One of the most significant gaps in existing knowledge is the lack of systematic, prospective empirical attention to the developmental precursors of borderline personality. The present investigation was an exploratory attempt to address this limitation through (a) development of a psychometrically sound self-report instrument that assesses borderline personality features in childhood, the Borderline Personality Features Scale for Children (BPFS-C); (b) examination of the stability of BPF in childhood; (c) evaluation of gender differences in BPF in childhood; and (d) evaluation of the specificity of the BPFS-C for assessing borderline personality features. These goals were achieved through the prospective study of a normative sample of 400 (54% female) fourth though sixth graders who were assessed during the Fall of Year 1, Spring of Year 1, and Fall of Year 2. The use of linear mixed modeling techniques provided evidence for the construct validity of the BPFS-C. Further, borderline personality features as assessed with the BPFS-C were found to be moderately stable over the course of the study, with girls reporting higher levels of BPF than boys. Results also demonstrated that children's scores on the BPFS-C were uniquely related to indicators of borderline personality pathology above and beyond their scores on the Children's Depression Inventory. The implications of these results for the study of the development and etiology of borderline pathology are discussed.
This research was supported by a grant to the first author from the National Institute of Mental Health (MH063684). We acknowledge Leslie Morey and Carol Rockhill for their extensive assistance with the development of the BPFS-C. We also thank the staff of the School Buddies Project and the teachers and children who participated in this study for their significant contributions.
10 - Estimating age-at-death distributions from skeletal samples: a multivariate latent-trait approach
- Edited by Robert D. Hoppa, University of Manitoba, Canada, James W. Vaupel, Max-Planck-Institut für demografische Forschung, Rostock
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- Paleodemography
- Published online:
- 28 August 2009
- Print publication:
- 03 January 2002, pp 193-221
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Summary
Introduction
Most approaches to age estimation currently used in paleodemography and forensic science are not based on formal (or even informal) statistical methods. Instead, various ad hoc procedures have been developed, based frequently on simple tabulations of skeletal markers by age. The classic methods of Todd (1920) and McKern and Stewart (1957), for example, involve a nonstatistical assignment of a skeleton's age-at-death according to documented changes in the pubic symphysis. These methods produce either a nonstatistical age range or a point estimate of age, without any assessment of the error structure of the estimate based on formal probability arguments. The individual ages produced in this way are then aggregated to estimate the age-at-death distribution for an entire sample. As discussed elsewhere in this volume, the age-at-death distribution produced by this procedure will usually be biased in the direction of the age distribution of whatever reference sample was used to generate the individual estimates in the first place. In addition, we are left with little understanding of the degree of estimation error involved, either in the individual age estimates or the estimate of the aggregate-level age-at-death distribution as a whole.
In this chapter we explore some statistical methods for estimating age-at-death distributions from skeletal samples, with special emphasis on recovering the parameters of parametric models of the age-at-death distribution (see Wood et al., Chapter 7, this volume). Only methods compatible with the Rostock protocol, described elsewhere in this book, are discussed.
7 - Mortality models for paleodemography
- Edited by Robert D. Hoppa, University of Manitoba, Canada, James W. Vaupel, Max-Planck-Institut für demografische Forschung, Rostock
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- Paleodemography
- Published online:
- 28 August 2009
- Print publication:
- 03 January 2002, pp 129-168
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Summary
Introduction
Population scientists concerned with long-term trends in human mortality ought to be interested in skeletal samples from extinct communities. Such samples are, in principle, the only possible source of information for most pre-industrial populations lacking written records – by far the most common kind of human community that has ever existed. Samples of skeletons provide two broad classes of information of potential interest to demographers and other population specialists: frequency counts of bony lesions that may reveal something about pathological processes active in the population, and data on ages-at-death from which age patterns of mortality may be inferred. Of these, the latter class of information has generally been deemed to be the less problematic. It has been assumed that skeletal age-at-death can be estimated well enough, albeit with some inevitable degree of error, to support a few crude but revealing statistics such as mean age-at-death, life expectancies, and age-specific mortality rates. And so for decades it has been considered perfectly acceptable to use skeletal data to compute “life tables”, the traditional demographic tool for investigating age patterns of mortality. All that is needed, in this view, are a few simple modifications of standard life table techniques, modifications that were laid down 30 years ago by Acsádi and Nemeskéri (1970:60–65).
Arthur Stanley Eddington Memorial Lectureship
- Joseph Barcroft, E. W. Birmingham, Max Born, R. B. Braithwaite, W. Maude Brayshaw, G. A. Chase, Henry Dale, Howard Diamond, Herbert Dingle, Winifred Eddington, Wilson Harris, G. B. Jeffery, Martin Johnson, Rufus M. Jones, Harold Spencer Jones, Kathleen Lonsdale, E. J. Maskell, A. Victor Murray, C. E. Raven, F. J. M. Stratton, Hilda Sturge, W. H. Thorpe, Henry T. Tizard, G. M. Trevelyan, Elsie Watchorn, A. N. Whitehead, Edmund T. Whittaker, Alex Wood, H. G. Wood
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- Journal:
- Philosophy / Volume 21 / Issue 80 / November 1946
- Published online by Cambridge University Press:
- 25 February 2009, p. 287
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- November 1946
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II. Some Aspects of the History of the Chantries during the Reign of Edward III
- Kathleen L. Wood-Legh
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- Cambridge Historical Journal / Volume 4 / Issue 1 / 1932
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- 20 December 2011, pp. 26-50
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- 1932
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Of all the institutions that grew up in the medieval church none has received so little attention from English scholars as the chantries. That they played an important part in the religious life of this country before the Reformation is indeed generally recognised; but our historians have done little more than to indicate the purposes for which chantries were founded, and to point out that their numbers increased greatly towards the end of the Middle Ages. In the present essay an attempt is made to render our knowledge of the chantries less vague by discussing at length some of the more important problems of their history, giving a detailed account of them during a single half century. For this purpose the reign of Edward III has been chosen, partly because its close is practically contemporaneous with our most important literary references to the chantries, those of Chaucer and Langland, but mainly because, since the Black Death occurred within a few years of the middle of this period, it affords an opportunity of studying the effects of the pestilence on this phase of English life.
II. The Appropriation of Parish Churches during the reign of Edward III1
- Kathleen L. Wood-Legh
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- Journal:
- Cambridge Historical Journal / Volume 3 / Issue 1 / 1929
- Published online by Cambridge University Press:
- 20 December 2011, pp. 15-22
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- 1929
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The vicarage system has already attracted a number of historians and owing to their investigations the main points in its origin and development are well known. The subject, however, still presents difficult problems, and it is in the hope of contributing towards a solution of some of these that the present paper has been prepared.