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  • Hospital-onset bacteremia in the neonatal intensive care unit: strategies for risk adjustment

  • Erica C. Prochaska, Shaoming Xiao, Elizabeth Colantuoni, Nora Elhaissouni, Reese H. Clark, Julia Johnson, Sagori Mukhopadhyay, Ibukunoluwa C. Kalu, Danielle M. Zerr, Patrick J. Reich, Jessica Roberts, Dustin D. Flannery, Aaron M. Milstone, Group Information: CDC Prevention Epicenters Program
  • Journal:
    Infection Control & Hospital Epidemiology , First View
    Published online by Cambridge University Press:
    17 February 2025, pp. 1-7
    • Article
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  • Objective:

    To quantify the impact of patient- and unit-level risk adjustment on infant hospital-onset bacteremia (HOB) standardized infection ratio (SIR) ranking.

    Design:

    A retrospective, multicenter cohort study.

    Setting and participants:

    Infants admitted to 284 neonatal intensive care units (NICUs) in the United States between 2016 and 2021.

    Methods:

    Expected HOB rates and SIRs were calculated using four adjustment strategies: birthweight (model 1), birthweight and postnatal age (model 2), birthweight and NICU complexity (model 3), and birthweight, postnatal age, and NICU complexity (model 4). Sites were ranked according to the unadjusted HOB rate, and these rankings were compared to rankings based on the four adjusted SIR models.

    Results:

    Compared to unadjusted HOB rate ranking (smallest to largest), the number and proportion of NICUs that left the fourth quartile (worst-performing) following adjustments were as follows: adjusted for birthweight (16, 22.5%), birthweight and postnatal age (19, 26.8%), birthweight and NICU complexity (22, 31.0%), birthweight, postnatal age and NICU complexity (23, 32.4%). Comparing NICUs that moved into the better-performing quartiles after birthweight adjustment to those that remained in the better-performing quartiles regardless of adjustment, the median percentage of low birthweight infants was 17.1% (Interquartile Range (IQR): 15.8, 19.2) vs 8.7% (IQR: 4.8, 12.6); and the median percentage of infants who died was 2.2% (IQR: 1.8, 3.1) vs 0.5% (IQR: 0.01, 12.0), respectively.

    Conclusion:

    Adjusting for patient and unit-level complexity moved one-third of NICUs in the worst-performing quartile into a better-performing quartile. Risk adjustment may allow for a more accurate comparison across units with varying levels of patient acuity and complexity.

The Cambridge Handbook of Violent Behavior and Aggression
  • 2nd edition
  • Edited by Alexander T. Vazsonyi, Daniel J. Flannery, Matt DeLisi
  • Published online:
    30 July 2018
    Print publication:
    26 July 2018
  • The Cambridge Handbook of Violent Behavior and Aggression presents the current state of knowledge related to the study of violent behaviors and aggression. An important extension of the first Handbook published ten years ago, the second edition maintains a distinctly cross-disciplinary focus by representing the newest scholarship and insights from behavior genetics, cross-cultural comparative psychology/criminology, evolutionary psychology, criminal justice, criminology, human development, molecular genetics, neurosciences, psychology, prevention and intervention sciences, psychiatry, psychopharmacology, public health, and sociology. The Handbook is divided into introductory and overview chapters on the study of violent behavior and aggression, followed by chapters on biosocial bases, individual and interpersonal factors, contextual factors, and prevention and intervention work and policy implications. It is an essential resource for researchers, scholars, and graduate students across social and behavioral science disciplines interested in the etiology, intervention, and prevention of violent behavior and aggression.

The Cambridge Handbook of Violent Behavior and Aggression
  • Edited by Daniel J. Flannery, Alexander T. Vazsonyi, Irwin D. Waldman
  • Published online:
    05 June 2012
    Print publication:
    03 September 2007
  • From a team of leading experts comes a comprehensive, multidisciplinary examination of the most current research including the complex issue of violence and violent behavior. The handbook examines a range of theoretical, policy, and research issues and provides a comprehensive overview of aggressive and violent behavior. The breadth of coverage is impressive, ranging from research on biological factors related to violence and behavior-genetics to research on terrrorism and the impact of violence in different cultures. The authors examine violence from international cross-cultural perspectives, with chapters that examine both quantitative and qualitative research. They also look at violence at multiple levels: individual, family, neighborhood, cultural, and across multiple perspectives and systems, including treatment, justice, education, and public health.

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