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The 2013 Infection Prevention and Control (IP&C) Guideline for Cystic Fibrosis (CF) was commissioned by the CF Foundation as an update of the 2003 Infection Control Guideline for CF. During the past decade, new knowledge and new challenges provided the following rationale to develop updated IP&C strategies for this unique population:
1. The need to integrate relevant recommendations from evidence-based guidelines published since 2003 into IP&C practices for CF . These included guidelines from the Centers for Disease Control and Prevention (CDC)/Healthcare Infection Control Practices Advisory Committee (HICPAC), the World Health Organization (WHO), and key professional societies, including the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA). During the past decade, new evidence has led to a renewed emphasis on source containment of potential pathogens and the role played by the contaminated healthcare environment in the transmission of infectious agents. Furthermore, an increased understanding of the importance of the application of implementation science, monitoring adherence, and feedback principles has been shown to increase the effectiveness of IP&C guideline recommendations.
2. Experience with emerging pathogens in the non-CF population has expanded our understanding of droplet transmission of respiratory pathogens and can inform IP&C strategies for CF . These pathogens include severe acute respiratory syndrome coronavirus and the 2009 influenza A H1N1. Lessons learned about preventing transmission of methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant gram-negative pathogens in non-CF patient populations also can inform IP&C strategies for CF.
To evaluate long-term patterns of weight change and progression to overweight and obesity during adulthood.
Prospective study. Changes in mean BMI, waist circumference (WC) and weight were assessed over a mean 26-year follow-up (1971–1975 to 1998–2001). Mean BMI (95 % CI) and mean WC (95 % CI) of men and women in BMI and age groups were computed. Mean weight change in BMI and age categories was compared using analysis of covariance.
Framingham Heart Study Offspring/Spouse Nutrition Study.
Men and women (n 2394) aged 20–63 years.
During follow-up, increases in BMI (men: 2·2 kg/m2; women: 3·7 kg/m2) and WC (men: 5·7 cm; women: 15·1 cm) were larger in women than men. BMI gains were greatest in younger adults (20–39 years) and smallest in obese older adults (50–69 years). The prevalence of obesity doubled in men (to 33·2 %) and tripled in women (to 26·6 %). Among normal-weight individuals, abdominal obesity developed in women only. The prevalence of abdominal obesity increased 1·8-fold in men (to 53·0 %) and 2·4-fold in women (to 71·2 %). Weight gain was greatest in the youngest adults (20–29 years), particularly women. Gains continued into the fifth decade among men and then declined in the sixth decade; in women gains continued into the sixth decade.
Patterns of weight change and progression to obesity during adulthood differ in men and women. Preventive intervention strategies for overweight and obesity need to consider age- and sex-specific patterns of changes in anthropometric measures.
In the globally significant Australian tropical rainforests, poor performance of community-based natural resource management (CBNRM) approaches mandated by national policy highlights the importance of the global search for better models. This paper reports on co-research to develop, apply and test the transferability and effectiveness of a new model and tools for CBNRM in biodiversity conservation. Adaptive co-management, designed with specific communities and natural resources, recognized as linked multi-scalar phenomena, is the new face of CBNRM. New tools used to achieve adaptive co-management include a collaborative focal species approach focused on the iconic southern cassowary, scenario analysis, science brokering partnerships, a collaborative habitat investment atlas and institutional brokering. An intermediate-complexity analytical framework was used to test the robustness of these tools and therefore likely transferability. The tools meet multiple relevant standards across three dimensions, namely empowering institutions and individuals, ongoing systematic scientific assessment and securing effective on-ground action. Evaluation of effectiveness using a performance criteria framework identified achievement of many social and environmental outcomes. Effective CBNRM requires multi-scale multi-actor collaborative design, not simply devolution to local-scale governance. Bridging/boundary organizations are important to facilitate the process. Further research into collaborative design of CBNRM structures, functions, tools and processes for biodiversity conservation is recommended.
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