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Regional Impact of a CRE Intervention Targeting High Risk Postacute Care Facilities (Chicago PROTECT)
- Michael Lin, Mary Carl Froilan, Jinal Makhija, Ellen Benson, Sarah Bartsch, Pamela B. Bell, Stephanie Black, Deborah Burdsall, Michelle Ealy, Anthony Fiore, Sharon Foy, Mabel Frias, Alice Han, David Hines, Olufemi Jegede, John Jernigan, Sarah K. Kemble, Mary Alice Lavin, Bruce Lee, George Markovski, Massimo Pacilli, Sujan Reddy, Erica Runningdeer, Michael Schoeny, Mitali Shah, Rachel Slayton, Elizabeth Soda, Nimalie Stone, Angela S. Tang, Karen Trimberger, Marion Tseng, Yingxu Xiang, Robert Weinstein, William Trick, Mary Hayden
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s48-s49
- Print publication:
- October 2020
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Background: Carbapenem-resistant Enterobacteriaceae (CRE) are endemic in the Chicago region. We assessed the regional impact of a CRE control intervention targeting high-prevalence facilities; that is, long-term acute-care hospitals (LTACHs) and ventilator-capable skilled nursing facilities (vSNFs). Methods: In July 2017, an academic–public health partnership launched a regional CRE prevention bundle: (1) identifying patient CRE status by querying Illinois’ XDRO registry and periodic point-prevalence surveys reported to public health, (2) cohorting or private rooms with contact precautions for CRE patients, (3) combining hand hygiene adherence, monitoring with general infection control education, and guidance by project coordinators and public health, and (4) daily chlorhexidine gluconate (CHG) bathing. Informed by epidemiology and modeling, we targeted LTACHs and vSNFs in a 13-mile radius from the coordinating center. Illinois mandates CRE reporting to the XDRO registry, which can also be manually queried or generate automated alerts to facilitate interfacility communication. The regional intervention promoted increased automation of alerts to hospitals. The prespecified primary outcome was incident clinical CRE culture reported to the XDRO registry in Cook County by month, analyzed by segmented regression modeling. A secondary outcome was colonization prevalence measured by serial point-prevalence surveys for carbapenemase-producing organism colonization in LTACHs and vSNFs. Results: All eligible LTACHs (n = 6) and vSNFs (n = 9) participated in the intervention. One vSNF declined CHG bathing. vSNFs that implemented CHG bathing typically bathed residents 2–3 times per week instead of daily. Overall, there were significant gaps in infection control practices, especially in vSNFs. Also, 75 Illinois hospitals adopted automated alerts (56 during the intervention period). Mean CRE incidence in Cook County decreased from 59.0 cases per month during baseline to 40.6 cases per month during intervention (P < .001). In a segmented regression model, there was an average reduction of 10.56 cases per month during the 24-month intervention period (P = .02) (Fig. 1), and an estimated 253 incident CRE cases were averted. Mean CRE incidence also decreased among the stratum of vSNF/LTACH intervention facilities (P = .03). However, evidence of ongoing CRE transmission, particularly in vSNFs, persisted, and CRE colonization prevalence remained high at intervention facilities (Table 1). Conclusions: A resource-intensive public health regional CRE intervention was implemented that included enhanced interfacility communication and targeted infection prevention. There was a significant decline in incident CRE clinical cases in Cook County, despite high persistent CRE colonization prevalence in intervention facilities. vSNFs, where understaffing or underresourcing were common and lengths of stay range from months to years, had a major prevalence challenge, underscoring the need for aggressive infection control improvements in these facilities.
Funding: The Centers for Disease Control and Prevention (SHEPheRD Contract No. 200-2011-42037)
Disclosures: M.Y.L. has received research support in the form of contributed product from OpGen and Sage Products (now part of Stryker Corporation), and has received an investigator-initiated grant from CareFusion Foundation (now part of BD).
The impact of nutrient and health claims on perceived healthiness and the amount of food eaten: An experimental breakfast study
- Sinead Watson, Tony Benson, Michelle Spence, Moira Dean, Jayne Woodside
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E543
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A previous study has demonstrated that when people thought they were eating a low-calorie milkshake (versus a high-calorie labelled equivalent though same product) their physiological satiety, as measured by the gut peptide ghrelin, was consistent with what they believed they were consuming rather than the actual nutritional content (Crum et al., 2011). If replicated and shown for different food types, this finding could have implications for nutrient and health claims labelling and advertising. The aim of the study was to examine whether satiation (self-reported and physiological) varies depending on the mindset in which one approaches food consumption. On two separate visits (1 week between), participants (n = 50) were asked to consume a 380-calorie yoghurt and granola breakfast product under the pretence that it was either a 500-calorie ‘indulgent’ breakfast (high in fat and sugar) or a 250-calorie ‘sensible’ breakfast (low in fat and sugar). At each visit blood samples were collected at three timepoints to measure acylated ghrelin: after a 20-minute rest period (baseline), after 60-minutes (pre-consumption) and after 90-minutes (post-consumption). Self-reported appetite scales were completed 10 minutes prior to each blood sample. During the first interval (between 20 and 60 minutes) participants rated the breakfast label's appearance and perceived healthiness, and during the second interval (between 60 and 90 minutes) participants consumed the breakfast product while rating its sensory appeal. Participants (mean [SD]: 30.1 [10.4] yrs.) rated the ‘indulgent’ breakfast as more appealing than the ‘sensible’ breakfast (mean difference: 5.00 [95% CI: 0.71, 9.30]; P = 0.024), but felt less healthy when consuming the ‘indulgent’ breakfast (mean difference: -13.17 [95% CI: -18.75, -7.60]; P < 0.001). The breakfasts were not rated differently according to their taste, smell, overall palatability and enjoyment. Participants reported a higher mean change in self-reported fullness for the ‘indulgent’ breakfast than the ‘sensible’ breakfast from pre-consumption to post-consumption (mean difference: 7.19 [95% CI: -0.73, 13.6]; P = 0.030). This relationship was not observed between baseline and post-consumption, or for the other self-reported appetite measures (hunger, satiety, quantity and desire to eat). Mean change in acylated ghrelin was not significantly different between the breakfasts at any timepoint. This study demonstrated an increase in self-reported fullness after consuming the ‘indulgent’ breakfast compared to the ‘sensible’ breakfast despite the fact the two breakfast products were identical. A physiological response, however, was not observed.
The Dynamics of Ethnonationalist Contention
- Michelle Benson, Gregory Saxton
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- Journal:
- British Journal of Political Science / Volume 40 / Issue 2 / April 2010
- Published online by Cambridge University Press:
- 17 March 2010, pp. 305-331
- Print publication:
- April 2010
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Ethnopolitical expression spans three primary forms: electoral politics, non-violent protest and violent rebellion. Previous literature has studied these strategies in isolation from one another. Using original data on the seventeen autonomous communities of Spain, this article combines a new method for operationalizing contentious strategies with Gurr’s ethnopolitical conflict model to explain communities’ movements between categories of the full range of nationalist political behaviour. The findings confirm that organizations acting within a community respond to altered incentives and changing political contexts by moving up and down the ‘ladder of contention’; they suggest an under-explored ‘strategic dynamism’ in ethnonational communities. Capturing this dynamic movement allows for a better understanding of which features of a group’s environment have an ‘escalatory’ impact on conflict and which, conversely, have an ‘ameliorative’ effect.
Contributors
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- By Elias Aboujaoude, Tina S. Alster, April Lane Benson, Wolfgang Berner, Donald W. Black, Dana Bodnik, Peer Briken, Raul Caetano, Celal Çalıkuşu, Joan C. Chrisler, Emil F. Coccaro, Pinhas N. Dannon, Helga Dittmar, Sheila Ferguson, Candice Germain, Jon E. Grant, John H. Greist, Andreas Hill, Lorrin M. Koran, Michel Lejoyeux, Laura M. Letson, Timothy Liu, Eileen M. Luna-Firebaugh, Michael S. McCloskey, Duane C. McKay, Christy M. McKinney, Amy McMichael, Drew Miller, Brad Novak, Brian L. Odlaug, Christina S. Pearson, Guy Porter, Marc N. Potenza, Paul Schwartzman, William M. Spice, Vladan Starcevic, Özlem Tecer, Benjamin T. P. Tucker, Michael R. Walther, Rungsima Wanitphakdeedecha, Sven E. Widmalm, Timothy Ivor Williams, Reeta Wolfsohn, Douglas W. Woods
- Edited by Elias Aboujaoude, Stanford University School of Medicine, California, Lorrin M. Koran, Stanford University School of Medicine, California
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- Book:
- Impulse Control Disorders
- Published online:
- 06 July 2010
- Print publication:
- 08 February 2010, pp ix-xii
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