Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment

Post-discharge breastfeeding patterns of mothers and their preterm infants born at 30 to 34 weeks gestation

Little is known about how preterm infants make the transition from breastfeeding and bottle feeding to exclusive breastfeeding in the weeks following hospital discharge. The thesis examined breastfeeding patterns for 66 infants between 30 and 35 weeks gestation over a four-week period after hospital discharge. The relationships among breastmilk feeding, feeding mode, maternal confidence and competence were also examined. Daily feeding diaries were completed by 53 mothers. From a detailed examination of the feeding diaries, the proportion of breastmilk feeds, and feeding mode (feeds directly at breast) were described. The infants received a high proportion of breastmilk feeds with 60% receiving breastmilk exclusively for the first week, and 56% receiving breastmilk exclusively for the four-week period. The number of feeds directly at breast increased steadily over the four-week period. Twins received significantly (F [1, 58] = 2.58, p. = .055) fewer breastmilk feeds than singletons, and were fed directly at breast significantly (F [1, 61] = 13.84, p = .0004) less often. In week one, mothers giving breastmilk feeds exclusively had higher levels of competence than those giving breastmilk and artificial milk (F [1, 48] = 5.71, p = .02). Mothers who fed directly at breast more than half of the time were significantly more confident (F [1, 49] = 5.32, p = .03) and competent (F [1, 49] = 4.24, p = .05) in week one than those who fed directly at breast less than half of the time. Maternal confidence (t [50] = - 5.13, p < .01) and competence (t [50] = -4.25, p < .01) increased significantly from week one to week four for the whole group. The findings are discussed in relation to the literature, and the implications for nursing practice, education, administration and research are presented.Applied Science, Faculty ofNursing, School ofGraduat

Erratum to: Relationships between parental sleep quality, fatigue, cognitions about infant sleep, and parental depression pre and post-intervention for infant behavioral sleep problems

Applied Science, Faculty ofNon UBCNursing, School ofReviewedFacult

A randomized controlled trial of an intervention for infants’ behavioral sleep problems

Background: Infant behavioral sleep problems are common, with potential negative consequences. We conducted a randomized controlled trial to assess effects of a sleep intervention comprising a two-hour group teaching session and four support calls over 2 weeks. Our primary outcomes were reduced numbers of nightly wakes or parent report of sleep problem severity. Secondary outcomes included improvement in parental depression, fatigue, sleep, and parent cognitions about infant sleep. Methods: Two hundred thirty five families of six-to-eight month-old infants were randomly allocated to intervention (n = 117) or to control teaching sessions (n = 118) where parents received instruction on infant safety. Outcome measures were observed at baseline and at 6 weeks post intervention. Nightly observation was based on actigraphy and sleep diaries over six days. Secondary outcomes were derived from the Multidimensional Assessment of Fatigue Scale, Center for Epidemiologic Studies Depression Measure, Pittsburgh Sleep Quality Index, and Maternal (parental) Cognitions about Infant Sleep Questionnaire. Results: One hundred eight intervention and 107 control families provided six-week follow-up information with complete actigraphy data for 96 in each group: 96.9 % of intervention and 97.9 % of control infants had an average of 2 or more nightly wakes, a risk difference of −0.2 % (95 % CI: −1.32, 0.91). 4 % of intervention and 14 % of control infants had parent-assessed severe sleep problems: relative risk 0.3, a risk difference of −10 % (CI: 0.11, 0.84-16.8 to −2.2). Relative to controls, intervention parents reported improved baseline-adjusted parental depression (CI: −3.7 to −0.4), fatigue (CI: −5.74 to −1.68), sleep quality (CI: −1.5 to −0.2), and sleep cognitions: doubts (CI: −2.0 to −0.6), feeding (CI: − 2.1 to - 0.7), anger (CI: − 1.8 to - 0.4) and setting limits (CI: −3.5 to −1.5). Conclusions: The intervention improved caregivers' assessments of infant sleep problem severity and parental depression, fatigue, sleep, and sleep cognitions compared with controls. Trial registration ISRCTN42169337 , NCT00877162Applied Science, Faculty ofMedicine, Faculty ofScience, Faculty ofOther UBCNon UBCNursing, School ofStatistics, Department ofReviewedFacult

Young People’s More Permissive Views About Marijuana: Local Impact of State Laws or National Trend?

Objectives. To determine whether state medical marijuana laws “send the wrong message,” that is, have a local influence on the views of young people about the risks of using marijuana. Methods. We performed multilevel, serial, cross-sectional analyses on 10 annual waves of the US National Survey on Drug Use and Health (2004–2013) nationally and for states with marijuana laws using individual- and state-level controls. Results. Living in medical marijuana states was associated with more permissive views regarding marijuana across 5 different measures. However, these associations became non–statistically significant after we adjusted for state-level differences. By contrast, there was a consistent and significant national time trend toward more permissive attitudes, which was less pronounced among children of middle school age than it was among their older counterparts. Conclusions. Passing medical marijuana laws does not seem to directly affect the views of young people in medical marijuana states. However, there is a national trend toward young people taking more permissive views about marijuana independent of any effects within states

Educational expenditure in urban China: income effects, family characteristics and the demand for domestic and overseas education

Analysing survey data from 32 selected cities across China in 2003, this article examines parents' expenditure on their children's education from two aspects: factors affecting domestic education expenditure and factors affecting expenditure on overseas education. The main findings that emerge from this study are as follows. First, household income has significant effects on the magnitude of the domestic and overseas educational expenditures. Second, households where mothers have senior secondary school or college education, and fathers are working in professional occupations are likely to spend more on education for their children. Third, being in the highest income category, having a college-educated father, having a mother who is a cadre or middle professional and living in a coastal area significantly enhances the probabilities for the households sending their children overseas for education.

Do Wages Matter?: A Backward Bend in the 2004 California RN Labor Supply

Using data from the 2004 California Board of Registered Nursing Survey, a two-stage least-square equation was estimated to examine the effect of wages on hours worked by female registered nurses. Wages were found to have a nonlinear effect on hours worked, with a backward bending supply curve. Wages had a positive effect on the average hours worked per week up to $24.99 per hour and a negative effect between$30.00 and $100.00 per hour when compared with the wage category of$25.00 to $29.99. Results suggest that wages are important to secure the labor supply but do not increase aggregate supply beyond a wage threshold