Predictors Of Acquisition Research Articles

Genomic Epidemiology of MRSA During Incarceration at a Large Inner-City Jail.

Congregate settings, such as jails, may be a location where colonized detainees transmit methicillin-resistant Staphylococcus aureus (MRSA). We examined MRSA acquisition during incarceration and characterized the genomic epidemiology of MRSA entering the jail and isolated during incarceration. Males incarcerated at the Cook County Jail were enrolled within 72 h of intake and MRSA surveillance cultures collected. Detainees in jail at Day 30 were re-cultured to determine MRSA acquisition. A survey was administered to identify acquisition predictors. Genomic sequencing of surveillance and clinical isolates was integrated with epidemiologic and jail location data to track MRSA transmission pathways. 800 males were enrolled; 19% MRSA colonized at intake. Of 184 who reached Day 30 visit, 12 acquired MRSA. Heroin use before entering (OR 3.67, P = .05) and sharing personal items during incarceration (OR = 4.92, P = .01) were predictors of acquisition. Sequenced clinical USA300 isolates (n = 112) were more genetically similar than diverse intake USA300 strains (P < .001), suggesting jail transmission. Four acquired colonization isolates were within 20 single-nucleotide variant (SNVs) of other isolates; 4 were within 20 SNVs of an intake isolate, 2 for an acquisition isolate, and 1 for a clinical isolate. Individuals with genetically similar isolates were more likely to have had overlapping stays in the same buildings. There was a high MRSA burden entering jail. Genomic analysis of acquisition and clinical isolates suggests potential spread of incoming strains and networks of spread during incarceration, with spread often occurring among detainees housed in similar locations. Sharing personal items during incarceration is associated with MRSA acquisition and could be a focus for intervention.

Cervical Infection With Vaccine-Associated Human Papillomavirus (HPV) Genotypes as a Predictor of Acquisition and Clearance of Other HPV Infections.

Recent birth cohorts vaccinated against human papillomavirus (HPV) may be protected against up to 4 genotypes (HPV-6, -11, -16, and -18). If natural competition exists between these and other HPV types, then the prevalence of other types may increase after vaccination. Cohort information from 3 studies was used to compare acquisition and clearance of 30 different HPV types (individually and grouped by species), according to infection status with vaccine-targeted types at baseline and the time of the index infection, respectively. Hazard ratios (HRs) were adjusted for predictors of multiple-type infection. Among 3200 females across all studies, 857 were infected with HPV at baseline, and 994 acquired new infections during follow-up. Females infected with HPV-16 were at higher risk of acquiring other α-9 HPV types (HR, 1.9; 95% confidence interval [CI], 1.2-3.0) but at similar risk of clearing existing α-9 HPV infections (HR, 0.9; 95% CI, .7-1.3). Females infected with vaccine-targeted types were generally at higher risk of acquiring additional types (HRs, > 1.0) and at equal risk of clearing existing infections. Accounting for multiple comparisons, none of the HRs of < 1.0 or >1.0 were statistically significant in our analyses of acquisition or clearance. Vaccine-targeted HPV types do not appear to compete with other types, suggesting that HPV type replacement is unlikely to occur.

Predictors of the acquisition and portability of transferable skills: a longitudinal Portuguese case study on education

The basis for this longitudinal study was to find the predictors of transferable skills acquisition and portability among university sophomore students. The method employed was the path analysis using as variables: (1) the theoretical framework of transferable skills representations (Evers and Rush in Manag Learn 27(4):275–300, 1996; Evers et al. in The bases of competence: Skills for lifelong learning and employability. Jossey-Bass, San Francisco, 1998) in the freshman and sophomore years (2) the developmental dimensions of Career adaptability and Vocational development (Savickas in Contemporary models in vocational psychology. Lawrence Erlbaum, Mahwah, 2001, in Career choice and development. Jossey-Bass, San Francisco, 2002, in Career development and counseling: putting theory and research to work. Wiley, Hoboken, 2005, in Life-design International Research Group: Career Adaptability Project Meeting, 2009), and, (3) the grades for Project I and Project II (curricular units specially developed for the acquisition of groups of transferable skills in the first and second years of Economics and Management program at the Catholic University of Porto [herein referred to as Catholic University of Porto]. The criteria used were the grades from two second-year curricular units (Business Law and Statistics). The objective was to observe the impact of other dimensions on actual skills acquisition, considering the influence of the former on the grades of Business Law and Statistics as an indicator of portability of the transferable skills acquisition. All participants were male and female students at the Catholic University of Porto, Faculty of Economics and Management, between 18 and 25 years of age (M = 18.53, SD = 1.37) at the first assessment (N = 193). Results suggest that Project I grades are the best predictor of both Business Law and Statistics grades. However, results also reveal that student’s representations of their transferable skills measured at the first and the second year are mediated by Career adaptability measured at the second year. Results are discussed based on the aforementioned frameworks.

How does gender influence the recognition of cardiovascular risk and adherence to self-care recommendations?: a study in polish primary care

BackgroundStudies have shown a correlation between gender and an ability to change lifestyle to reduce the risk of disease. However, the results of these studies are ambiguous, especially where a healthy lifestyle is concerned. Additionally, health behaviors are strongly modified by culture and the environment. Psychological factors also substantially affect engagement with disease-related lifestyle interventions. This study aimed to examine whether there are differences between men and women in the frequency of health care behavior for the purpose of reducing cardiovascular risk (CVR), as well as cognitive appraisal of this type of risk. We also aimed to identify the psychological predictors of engaging in recommended behavior for reducing the risk of cardiovascular disease after providing information about this risk in men and women.MethodsA total of 134 consecutive eligible patients in a family practice entered a longitudinal study. At initial consultation, the individual’s CVR and associated health burden was examined, and preventive measures were recommended by the physician. Self-care behavior, cognitive appraisal of risk, and coping styles were then assessed using psychological questionnaires. Six months after the initial data collection, the frequency of subjects’ self-care behavior was examined.ResultsWe found an increase in health care behavior after providing information regarding the rate of CVR in both sexes; this increase was greater for women than for men. Women followed self-care guidelines more often than men, particularly for preventive measures and dietary advice. Women were more inclined to recognize their CVR as a challenge. Coping style, cognitive appraisal, age, level of health behaviors at baseline and CVR values accounted for 48% of the variance in adherence to self-care guidelines in women and it was 52% in men. In women, total risk of CVD values were most important, while in men, cognitive appraisal of harm/loss was most important.ConclusionsDifferent predictors of acquisition of health behavior are encountered in men and women. Our results suggest that gender-adjusted motivation models influencing the recognition process need to be considered to optimize compliance in patients with CVR.

Abstract 2903: Nutritional Access of Dysphagic Patients 3 Months after Onset of Acute Stroke -From Database of 5,000 Patients in a Single Stroke Center-

Background and purpose: Prediction of swallowing function in dysphagic patients with acute stroke is indispensable for discussing percutaneous endoscopic gastrostomy (PEG) placement. We performed a retrospective study using database of a large number of acute ischemic stroke patients to clarify predictors for acquisition of oral intake in chronic phase. Methods: A total 4,972 consecutive acute stroke patients were admitted to our stroke center during 8.5 years; a questionnaire was sent to all the survivors after 3 months of onset. We investigated nutritional access after 3 months of onset in 588 patients who could not eat orally 10 days after admission, and analyzed predictive factors for their acquisition of oral intake. Continuous variables were dichotomized to identify the most sensitive predictors; the cutoff values were investigated by receiver operating characteristics curve analysis. Results: Out of 588 dysphagic patients, 75 died during the 3 months, and 143 (28%) of the residual 513 achieved oral intake after 3 months. In logistic-regression models, age ≤80 years, absence of hyperlipidemia, absence of atrial fibrillation, modified Rankin Scale score 0 before onset, and low National Institutes of Health Stroke Scale (NIHSS) score independently predicted oral intake 3 months after onset. From two different model analyses, NIHSS score ≤17 on day 10 (OR 3.63, 95% CI 2.37-5.56) was found to be a stronger predictor for oral intake than NIHSS score ≤17 on admission (OR 2.34, 95% CI 1.52-3.59). At 3 months, 17/143 (12%) patients with oral intake were living at home, while only 1/370 (0.3%) patients without oral intake were. Conclusion: A quarter of dysphagic patients with acute stroke obtained oral intake 3 months after onset. Clinicians should be cautious about PEG placement for stroke patients with severe dysphagia who were independent prior to the stroke, aged ≤80 years, and show NIHSS score ≤17 on day 10, because their swallowing dysfunction may improve in a few months.

The importance of colonization pressure in multiresistant Acinetobacter baumannii acquisition in a Greek intensive care unit.

IntroductionWe investigated the role of colonization pressure on multiresistant Acinetobacter baumannii acquisition and defined patient-related predictors for carriage at admission and acquisition during hospitalization in intensive care unit (ICU) patients.MethodsThis was a 12-month, prospective, cohort study of all patients admitted to a single ICU of a tertiary hospital. Screening samples were collected at ICU admission to identify imported carriers, and weekly during hospitalization to identify acquisition. Colonization pressure (carriers' patient-days × 100/all patients' patient-days) and the absolute number of carriers were calculated weekly, and the statistical correlation between these parameters and acquisition was explored. Multivariable analysis was performed to identify predictors for A. baumannii carriage at admission and acquisition during hospitalization. A. baumannii isolates were genotyped by repetitive-extragenic-palindromic polymerase chain reaction (PCR; rep-PCR).ResultsAt ICU admission, 284 patients were screened for carriage. A. baumannii was imported in 16 patients (5.6%), and acquisition occurred in 32 patients (15.7%). Acquisition was significantly correlated to weekly colonization pressure (correlation coefficient, 0.379; P = 0.004) and to the number of carriers per week (correlation coefficient, 0.499; P <0.001). More than one carrier per week significantly increased acquisition risk (two to three carriers, odds ratio (OR), 12.66; P = 0.028; more than four carriers, OR, 25.33; P = 0.004). Predictors of carriage at admission were infection at admission (OR, 11.03; confidence interval (CI), 3.56 to 34.18; P < 0.01) and hospitalization days before ICU (OR, 1.09; CI, 1.01 to 1.16; P = 0.02). Predictors of acquisition were a medical reason for ICU admission (OR, 5.11; CI, 1.31 to 19.93; P = 0.02), duration of antibiotic administration in the unit (OR, 1.24; CI, 1.12 to 1.38; P < 0.001), and duration of mechanical ventilation (OR, 1.08; CI, 1.04 to 1.13; P = 0.001). All strains were multiresistant. Rep-PCR analysis showed one dominant cluster.ConclusionsAcquisition of multiresistant A. baumannii in ICU patients is strongly correlated to colonization pressure. High levels of colonization pressure and more than two carriers per week independently increase acquisition risk. Patient-related factors, such as infection at admission and long hospitalization before the ICU, can identify imported A. baumannii carriers. Medical patients with extended administration of antibiotics and long duration of mechanical ventilation in the ICU were the most vulnerable to acquisition.

Predictors of Chain Acquisition among Independent Dialysis Facilities

To determine the predictors of chain acquisition among independent dialysis providers. Retrospective facility-level data combined from CMS Cost Reports, Medical Evidence Forms, Annual Facility Surveys, and claims for 1996-2003. Independent dialysis facilities' probability of acquisition by a dialysis chain (overall and by chain size) was estimated using a discrete time hazard rate model, controlling for financial and clinical performance, practice patterns, market factors, and other facility characteristics. The sample includes all U.S. freestanding dialysis facilities that report not being chain affiliated for at least 1 year between 1997 and 2003. Above-average costs and better quality outcomes are significant determinants of dialysis chain acquisition. Facilities in larger markets were more likely to be acquired by a chain. Furthermore, small dialysis chains have different acquisition strategies than large chains. Dialysis chains appear to employ a mix of turn-around and cream-skimming strategies. Poor financial health is a predictor of chain acquisition as in other health care sectors, but the increased likelihood of chain acquisition among higher quality facilities is unique to the dialysis industry. Significant differences among predictors of acquisition by small and large chains reinforce the importance of using a richer classification for chain status.

Treatment motives as predictors of acquisition and transfer of relaxation methods to everyday life

This article presents results from four studies of the significance of type and number of initial treatment motives for acquisition and transfer to everyday life of progressive relaxation (PR) and autogenic training (AT). On the basis of theories of treatment motivation and compliance, we hypothesize that motives for participation are determinants of learning and transfer. Results are reported from (1) two studies with 113 participants in introductory courses on AT and 94 participants in introductory courses on PR and (2) two replication studies with 94 (AT) and 101 participants (PR). Participants indicated their motives for participation. Short-term indicators of treatment success include number of dropouts and subjective evaluations of relaxation exercises; long-term outcomes include transfer of relaxation exercises to everyday life and evaluations of exercise evaluations at follow-up 3 to 6 months after the end of course. Results suggest that for both AT and PR, dropout and subjective relaxation exercise evaluations can be predicted from participation motives. Long-term outcomes can be predicted only for AT. However, for both PR and AT it is shown that for up to four motives, the number of initial course motives is correlated with short-term and long-term predictors of course outcome. We conclude that motivation for participation is highly relevant to client-course matching and adaptive indication of relaxation therapies. Results lead to a threshold hypothesis about the relationship between the number of participation motives and short-term as well as long-term learning and transfer outcome.

Incidence and risk factors for sexually transmitted infections among women in an Alabama HIV clinic.

The objectives of this study were to assess the prevalence and incidence of curable sexually transmitted infections (STI), i.e., gonorrhea, chlamydial infection, or trichomoniasis, in a cohort of HIV-infected women. The study population was derived from women seeking primary care at an outpatient university HIV clinic who were participants in a women's natural history study. Enrollees (n = 225) were predominantly African-American, heterosexually infected, with mean age 35 years. Mean entry CD4+ T cell count was 405 cells/mm3. Over 6% were STI positive at initial screening. Subsequently, the combined curable STI incidence was 4.82/1000 woman-months over a median of 33 months of observation. Of 36 incident STIs, trichomoniasis was most common (n = 32). Predictors for acquisition of a curable STI included absenteeism at scheduled clinic appointments, RR = 1.99 (1.28, 3.08), and a higher CD4+ T cell count, RR = 1.15 (1.0028, 1.3115) for 100 cells. Interventions to prevent curable STI in HIV-infected women are warranted in primary care settings.

Age as a Predictor of Acquisition Rates as Measured by Curriculum-Based Assessment: Evidence of Consistency with Cognitive Research

It has been suggested that in order to truly understand student achievement, data must be collected with an assessment tool that includes a measure of performance, is psychometrically sound, and is consistent with cognitive psychology. Curriculum-based assessment for instructional design (CBA-ID) is presented as an assessment model that addresses those three criteria. The current article expands the literature on behavioral and psychometric components of CBA-ID by asking if age is a predictor of CBA-ID acquisition rate data, which allowed for a comparison between CBA-ID and memory research. The acquisition rates of 91 first-, third-, and fifth-grade students were obtained and correlated with their respective ages. Age was found to be a signficant predictor of acqusition rates for the total sample and for students in grades 1 and 3, but not for students in grade 5. A comparison of corrected coefficients suggested qualitative differences between younger and older children, which was consistent with results of previous memory research, thus supporting the consistency of CBA-ID with research from cogntive psychology.

BUYING VERSUS BUILDING COMPETENCE: ACQUISITION PATTERNS IN THE INFORMATION AND TELECOMMUNICATIONS INDUSTRY 1995–2000

Acquisitions are widely argued to be an increasingly common solution for technology needs. This paper uses the information and telecommunications industry as background for assessing how technical knowledge and absorptive capacity, the rate of invention and prior acquisition experience affect the likelihood of acquisition. The results indicate that in this standards-based industry, even firms with relevant patent portfolios and R&amp;D expenditures are as likely as less knowledgeable firms to acquire rather than enter the market with internally developed products. The strong predictors of acquisition are experience in acquisitions and the ability to pay. Thus, while the number of acquisitions has increased dramatically, the use of this approach is limited to a small group of firms and is not a widespread solution.

Bacteraemia in adults due to glucose non-fermentative Gram-negative bacilli other than P. aeruginosa.

Glucose non-fermentative Gram-negative bacilli other than P. aeruginosa (NF) are emerging pathogens. To evaluate the epidemiology, clinical characteristics, predictors of acquisition, and outcome of bacteraemia due to NF. Retrospective analysis of prospectively recorded data. We reviewed episodes of NF bacteraemia in patients older than 14 years, recorded through a blood culture surveillance program. Patients were identified at the time of their bacteraemia and prospectively followed. Between January 1991 and December 2000, 296 episodes of NF bacteraemia were detected: 87% were due to Acinetobacter sp., Pseudomonas sp. other than P. aeruginosa, or Stenotrophomonas maltophilia. The global incidence (0.87 cases per 1000 discharges) remained stable during the study period. Patients were of all ages and both sexes, and 282/296 (95.3%) had some predisposing underlying disease or condition, the most common being haematological malignancies without transplantation (85/296, 28.7%), treatment with steroids (78/296, 26.3%), and transplantation (bone marrow or solid organ) (70/296, 23.6%). Fifty (16.9%) were neutropenic. The most common sources of bacteraemia were central venous catheter infection (117/296, 39.5%) and unknown primary site (97/296, 32.8%). Sixty-one episodes (20.6%) were community-acquired and 235 (79.4%) were nosocomial. Forty-three patients (14.5%) died. Pneumonia (RR 1.5, 95%CI 1.1-14.2), age<65 (RR 3.1, 95%CI 1.4-10.3), hospitalization in the intensive care unit (ICU) (RR 3.2, 95%CI 1.3-9.8), rapidly fatal disease (RR 4.9, 95%CI 3.1-12.6), and severe sepsis (RR 9.8, 95%CI 1.6-19.7) were independent predictors of death. Factors predicting the probability that an episode of nosocomial bacteraemia was due to NF included: rapidly fatal disease (RR 1.23, 95%CI 1.02-4.1), age<65 (RR 2.05, 95%CI 1.4-3), hospitalization in the ICU (RR 2.06, 95%CI 1.4-3, and pneumonia (RR 2.1, 95%CI 1.05-4.8). NF bacteraemia mainly affects patients with malignant haematological disease, with and without transplantation, and patients in the ICU. The most common known source is a central venous catheter, though many sources are unknown. Mortality is relatively low, and depends on the severity of the underlying disease.

Cervical coinfection with human papillomavirus (HPV) types as a predictor of acquisition and persistence of HPV infection.

Interest in coinfection with multiple types of human papillomavirus (HPV) has increased in response to the possibility of vaccination and the discovery that the host immune response appears to be mainly type specific. This study attempts to document the occurrence of coinfection with multiple HPV types and to determine whether these coinfections predicted acquisition or persistence of other HPV types in a prospective cohort of women in Brazil. Multiple HPV types were detected at the same visit in one-fifth of all women who tested positive for HPV at any time. Acquisition of an HPV infection was more likely among women with any HPV type detected on study entry. Persistence of HPV infection, the true precursor of cervical abnormalities, was independent of coinfection with other HPV types. Given the increasing prominence of HPV vaccination as a potential preventive approach, it is imperative that additional insights on cross-type protection be obtained from longer-term longitudinal investigations.

Acquisition of vancomycin-resistant enterococci during scheduled antimicrobial rotation in an intensive care unit.

Scheduled rotation of treatment of gram-negative antimicrobial agents has been associated with reduction of serious gram-negative infections. The impact of this practice on other nosocomial infections has not been assessed. The purpose of this study was to determine if scheduled antimicrobial rotation reduced rates of acquisition of enteric vancomycin-resistant enterococci (VRE) among 740 patients admitted to an intensive care unit (ICU). The preferred gram-negative agent was ceftazidime during rotation 1 and ciprofloxacin during rotation 2. Unadjusted VRE acquisition rates were 8.5 cases per 1000 ICU days and 11.7 cases per 1000 ICU days during rotations 1 and 2, respectively (P<.01). However, scheduled antimicrobial rotation of ceftazidime with ciprofloxacin had no effect on the risk of acquiring VRE in the ICU after adjustment for known risk factors. Independent predictors of acquisition of VRE were enteral feedings, higher colonization pressure, and increased duration of anaerobic therapy. Our findings can confirm no additional beneficial or adverse effect on VRE acquisition among ICU patients as a result of this practice.

The Epidemiology of Resistance to Ofloxacin and Oxacillin Among Clinical Coagulase‐Negative Staphylococcal Isolates: Analysis of Risk Factors and Strain Types

Coagulase-negative staphylococci are important nosocomial pathogens that increasingly are resistant to oxacillin and fluoroquinolones. To determine predictors of acquisition of oxacillin and ofloxacin resistance, we prospectively identified 150 patients from whose clinical specimens coagulase-negative staphylococci were isolated that differed in susceptibility to oxacillin and ofloxacin. In multivariate analysis, isolation of ofloxacin-resistant coagulase-negative staphylococci was associated with receipt of aminoglycosides (odds ratio [OR] = 8.45; 95% confidence interval [CI] = 2.10-34.1; P = .001) and fluoroquinolones (OR = 11.50; 95% CI = 4.15-31.6; P < .001) within 30 days; oxacillin resistance was associated with prior receipt of beta-lactam agents (OR = 5.99; 95% CI = 2.91-12.3; P < .001). Among oxacillin-resistant strains, there was heterogeneity of pulsed-field gel electrophoresis (PFGE) types, and no type was common between ofloxacin-resistant and ofloxacin-susceptible strains. Thus ofloxacin resistance may have emerged de novo among diverse oxacillin-resistant strains following the selection pressures of antimicrobial therapy. In contrast, 50% of patients with oxacillin-susceptible/ofloxacin-resistant strains had one of two PFGE types, a finding suggesting that person-to-person transmission resulted in the dissemination of some of these strains.

Introduction to the special series: Innovations in cognitive-behavioral approaches to schizophrenia

The purpose of this series is to highlight innovative cognitive-behavioral research on schizophrenia. Comprising six articles, the series covers state-of-the-art biobehavioral treatment, new approaches for treating delusions and hallucinations in neuroleptic-resistant patients, attributional predictors of psychotic relapse, and information-processing predictors of acquisition of medication self-management skills. These articles document the relevance and vitality of contemporary behavioral research on schizophrenia.

Concreteness, Imagery, Comprehensibility, and Complexity Ratings for Technical Vocabulary

Mean ratings and standard errors of ratings were obtained on four stimulus attributes of the meanings of 138 low-frequency relatively technical words. A group of 34 undergraduates rated the concreteness, imagery, comprehensibility, and complexity of the items. A second group of 22 undergraduates rated imagery, comprehensibility, and complexity. Within- and between-groups' measures of reliabilities exceeded .79. Test-retest reliabilities for a subsample of 25 items indicated negligible confounding of attributes ratings from rating other attributes in the same sitting. Imagery correlated highly (.714) with concreteness and comprehensibility (.743). Complexity was highly negatively correlated with comprehensibility (−.675) and moderately negatively correlated with imagery (−.408). Patterns of relationships among the variables were similar to those described by Paivio, et al. (1968) for familiar nouns and extend the documented viability of those relationships and the dual coding position to the more complex and educationally useful realm of meanings for technical vocabulary. The reported ratings of concreteness, imagery, and comprehensibility, in particular, have been shown to be important predictors of acquisition of technical vocabulary.