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Our findings demonstrate that ClearGuard caps are statistically superior to Tego+Curos for reducing CRBSI, representing an important advancement in improved patient care.

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Design

This was a prospective, cluster-randomized comparative effectiveness trial of ClearGuard versus Tego+Curos among patients dialyzing with CVCs.

The study was conducted at 40 dialysis facilities. All facilities had previously used Tego before inclusion in the study. Also, all facilities had indicated willingness to adhere to treatment allocation upon eventual randomization and all underwent a 30-minute training session describing procedures necessary to both study arms.

These 40 facilities were pair matched on the basis of: () prestudy BSI rate, as reported to the CDC NHSN from February to July of 2015; () the number of patients with a CVC; and () geographic location. Within each matched pair, one facility was randomly allocated to ClearGuard and the other to Tego+Curos using a computer-generated algorithm.

The unit of randomization was the facility and all eligible patients within the study were treated according to the corresponding intervention. Eligible patients were those who dialyzed using a CVC. Beyond this, exclusions were made only for known hypersensitivity to heparin (nine patients) or to chlorhexidine (none).

The study was approved by New England Independent Review Board (IRB# 15–281), which also granted a patient informed consent waiver. The informed consent waiver was important for conducting the study in a pragmatic manner, adherence to the prescribed intervention, and broad inclusion.

Run-In Phase

Upon randomization, facilities entered into a 3-month run-in phase. During this phase both study arms were treated according to facility standard policy (including use of Tego). The purpose of this period was to assess whether BSI rates were equivalent between study arms before institution of study interventions.

Intervention Phase

After the run-in period, facilities entered a 13-month intervention phase. During this phase, patients in the Tego+Curos group began including Curos (and continued using Tego). Patients in the ClearGuard group converted from Tego to ClearGuard. Patients with a CVC received the facility’s assigned intervention at their first dialysis session after the study start date, and new patients with CVCs coming into the facility were added as appropriate throughout the study.

In the Tego+Curos group, Curos was replaced each session and Tego was replaced once per week according to existing facility protocols. In the ClearGuard group, ClearGuard caps were replaced each session.

Aside from CVC capping, all patients were treated according to local standard of care and existing physician orders. This included standard surveillance for potential BSI, which adhered to the NHSN guidelines. All blood cultures were sent to and processed by a single clinical lab (DaVita Labs, Deland, FL). As is standard policy, blood culture results were reported into the electronic health record in automated fashion, from which they were abstracted for analysis.

Outcomes and Analysis

The primary study outcome was blood culture positivity rate. This was calculated by dividing the cumulative number of PBCs (as defined according to NHSN guidelines) by CVC time at-risk ( Figure 4 ). To avoid double-counting the same BSI, patients were censored using the CDC’s NHSN-recommended 21-day rule: a PBC is counted only if it occurred 21 days or more after a previously reported PBC in the same patient. To account for biologic latency between catheter seeding and clinical manifestation of BSI, at-risk time began on day 21 after first receipt of study intervention and continued until end of study, death, CVC removal, or loss to follow up; by extension, patients treated with a CVC for <21 days were excluded from analysis. In addition, multiple exploratory analyses were conducted using DaVita electronic records, which include microbiology, NHSN surveillance, and other records.

The IRRs and the corresponding 95% confidence intervals for the final analysis were calculated using a Poisson regression model with a log link function and the natural logarithm of patient-days at risk as an offset and adjusted for the facility cluster effect, where each matched facility pair was considered a cluster.

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This study was supported by Pursuit Vascular Inc. S.M.B. is an employee of DaVita Clinical Research; D.B.V.W. and L.N. are employees of DaVita Inc.; L.E.L., D.P.K., and R.J.Z. are employees of Pursuit Vascular Inc. and may have patents, board membership, and/or stock ownership. Pursuit Vascular sponsored the study and thus paid DaVita Clinical Research, the clinical research organization of DaVita, for conducting the study. No additional financial relationships exist between DaVita and Pursuit Vascular.

Since randomization has been a core point of dispute between the major philosophical schools of statistics, it seems necessary and appropriate to address these issues here.

5.1 The Frequentist position

Possibly the most important, some would say outstanding argument in favour of randomization is the view that the major “function of randomization is to generate the sample space and hence provide the basis for estimates of error and tests of significance” [ 36 ]. It has been proposed and defended by prominent statisticians, once dominated the field of statistics, and still has a stronghold in certain quarters, in particular medical statistics, where controlled trials have been the gold standard.

In a statistical experiment one controls the random mechanism, thus the experimenter knows the sample space and the distribution in question. This constructed and therefore “valid” framework keeps nuisance variables at bay, and sound reasoning within the paradigm leads to correct results. Someone following this “Frequentist” train of thought could therefore state—and several referees of this contribution have indeed done so—that the above models underline the rather well-known fact that randomization can have difficulties in constructing similar groups (achieving exchangeablility/comparability, balancing covariates), in particular if is small. However, this goal is quite subordinate to the major goal of establishing a known distribution on which quantitative statistical conclusions can be based. More precisely,

In other words, because of randomization, all effects of a large (potentially infinite) number of nuisance factors can be captured by a single probability statement. How is this remarkable goal achieved?

Any analytical procedure, e.g., a statistical test, is an algorithm, transferring some numerical input into a certain output which, in the simplest case, is just a number. Given the same data, it yields exactly the same result. The procedure does not go any further: In general, there are no semantics or convincing story associated with a bare numerical result that could increase the latter’s impact. In other words, a strong interpretation needs to be based on the framework in which the calculations are embedded.

Now, since randomization treats all variables (known and unknown) alike, the analytical procedure is able to “catch” them all and their effects show up in the output. For example, a confidence interval, so the story goes, gives a quantitative estimate of all of the variables’ impact. One can thus numerically assess how strong this influence is, and one has, in a sense, achieved explicit quantitative control. In particular, if the total influence of all nuisance factors (including random fluctuations due to randomization) is numerically small, one may conclude with some confidence that a substantial difference between and should be due to the experimental intervention.

Following this line of argument, owing to randomization, a statistical experiment gives a valid result in the sense that it allows for far-reaching, in particular causal, conclusions. Thus, from a Frequentist point of view, one should distinguish between two very different kinds of input: (randomized) experimental data on the one hand and (non-randomized) non-experimental data on the other. Moreover, since randomization seems to be crucial—at least sufficient—for a causal conclusion, some are convinced that it is also necessary. For example, the frequently heard remark that “only randomization can break a causal link” ([ 38 ], p. 200) echoes the equally famous statement that there is “no causation without manipulation” [ 39 ].

This train of thought is supplemented by the observation that random assignment is easy to implement, and that hardly any (questionable) assumptions are needed in order to get a strong conclusion. For example, Pawitan [ 40 ] says:

Finally, one finds a rather broad range of verbal arguments why randomization should be employed, e.g. “valid” conclusions, either based on the randomization distribution [ 41 ] or some normal-theory approximation [ 42 ], removal of investigator bias [ 43 ], face validity, fairness, and simple analysis [ 44 ], justification of inductive steps, in particular generalizations from the observed results to all possible results [ 45 ].

randomization in design … is supposed to provide the grounds for uncertainty about the possible effects of nuisance factors with a probability statement about error ([ 37 ], p. 214, my emphasis).

You can find much more information about project-oriented work and internships af AUs Job and Project Bank .

As a linguistics student at the University of Aarhus, you have plenty of opportunity to participate in social events of both a study-related and a less academic nature.

Student-to-student

Student-to-student is your opportunity to ask about being a student at the Faculty of Arts and about Aarhus and Denmark in general to another international student who has already taken the leap and now lives in Denmark and studies for his/her Master's degree at the Faculty of Arts.

You can read more about the student-to-student service and find the list of AU international student ambassadors at Arts .

The main Aarhus University campus is unique, with buildings closely grouped together and surrounded by nature. The campus is conveniently situated close to the city centre, and student accommodation is readily available as long as you apply on time. There are a range of activities, ranging from running to regatta on the lake, as well as guest lectures, film screenings, and university events taking place throughout the year. To ensure student well-being, counselling services are available for students, to offer support and guidance during their time at Aarhus. Read more about the study environment at Aarhus University .

As the second-largest city in Denmark, Aarhus is a young and dynamic place with plenty of opportunities. The 40,000 students at the university make up 17.5% of the city’s population, which leaves its mark on city life. An attractive feature of Aarhus is that there are beaches and woods a short bike-ride away, as well as cultural events taking place throughout the year, including the Aarhus Festival in September. The theatres in the city and the ARoS international art museum offer many events that enable you to experience the Danish culture.

Why choose Aarhus? See studyguide.au.dk and get all practical information about beeing an international student.

Follow the student life at Aarhus University

-experienced, photographed and filmed by the students themselves.

With thousands of pictures #yourniversity gives insight into the everyday life as a student at AU; the parties, procrastination, exams and all the other ways you’ll spend your time at university.

This data is derived from AU's 2013/2014 employment survey. This data should not be considered a completely accurate representation of the labour market and job functions for all graduates of the individual degree programmes. It exclusively represent the responses submitted to the survey in the years in question.

The most common career paths for linguistics graduates are:

You have the option of applying for admission to the PhD programme at the faculty’s Graduate School. You can apply when you have completed your Bachelor’s degree and one year of your Master’s degree studies or when you have completed your Master’s degree.Read more about AUs PhD degree programmes .

What’s more, many situations in traditional companies evoke feelings not unlike an inmate’s uncertainty about her worth and her intensified need for respect. Consider someone working in a low-status occupation or for a company undergoing a change in leadership that raises questions about whether employees will continue to be valued. The need for both owed and earned respect—and the validation they confer—are key factors shaping workers’ attitudes and behaviors across a variety of employment situations.

In all but the most toxic workplaces, building a respectful organization does not demand an overhaul of HR policies or any other formal changes. Rather, what’s needed is ongoing consideration of the subtle but important ways in which owed and earned respect can be conveyed. Here are seven small ones leaders and managers can use to make an outsize impact on workers.

Every employee should feel that his or her dignity is recognized and respected. This is especially important for lower-level workers. In a study of being valued or devalued at work, conducted by Jane Dutton (of the University of Michigan), Gelaye Debebe (George Washington University), and Amy Wrzesniewski (Yale), many hospital cleaners described seemingly subtle cues that prompted them to feel that their worth was enhanced or diminished. Some cleaners were never acknowledged by other staff members, making them feel invisible or as though they were looking in on hospital operations from the outside. Others reported a boost in energy and worth from a doctor’s simply greeting them or holding a door. Even in prestigious companies, issues of owed respect are top of mind. An Apple sales associate described his first impression of the company’s CEO in a 2011 blog: “For Tim Cook there are no dumb questions. When he answered me he spoke to me as if I were the most important person at Apple. Indeed, he addressed me as if I were Steve Jobs himself. His look, his tone, the long pause…that’s the day I began to feel like more than just a replaceable part. I was one of the tens of thousands of integral parts of Apple.” Take a moment to consider whether your professional status is keeping you from perceiving a gap in respect, and note that simple acknowledgment or praise from a leader is often enough to make an employee feel valued.

Whether we are leaders or coworkers, we can all shape an environment where colleagues reinforce respectful cues and make social worth a day-to-day reality for one another. Research points to specific behaviors that convey owed respect, such as active listening and valuing diverse backgrounds and ideas. For leaders, delegating important tasks, remaining open to advice, giving employees freedom to pursue creative ideas, taking an interest in their nonwork lives, and publicly backing them in critical situations are some of the many behaviors that impart respect.

Pay attention to norms about how to convey respect; they may vary, even from one department to another. Perhaps people in your previous workplace signaled owed respect by exchanging morning pleasantries with colleagues, but those in your new workplace would find that a rude distraction during the critical start to the workday. Or maybe in your prior environment providing both praise and critical feedback during practice sessions for client presentations was considered an expression of earned respect, but your current colleagues would see that as offensive.

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Christy Woodrow

Christy Woodrow is a travel photographer and professional blogger based in San Diego. She has been traveling around the world with her partner in crime, Scott, since 2006. Join them in their quest to find off-the-beaten-path destinations by signing up for weekly emails and following her on Instagram .

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