Clinical impact of needle-free connector design: A systematic review of literature.

The objective of this systematic review is to analyze types of needle-free connectors and open systems and their effects on central line-associated bloodstream infection rates and other adverse outcomes through a research protocol consistent with the Preferred Reporting Items for Systematic Reviews' recommendations. MEDLINE and Cochrane databases of systematic reviews were searched for relevant comparative studies published from January 2000 to September 2017. Eighteen studies compared central line-associated bloodstream infection (according to the Centers for Disease Control and Prevention/National Healthcare Safety Network definition), internal microbial contamination, occlusions, phlebitis, and other outcomes associated with needle-free connectors with a positive displacement device, negative displacement device, neutral displacement device, or three-way stopcock. Ten studies reported central line-associated bloodstream infection rates, which were lower with positive displacement devices versus negative displacement devices/neutral displacement devices (one study) and with negative displacement devices versus three-way stopcocks (three studies), but varied with different positive displacement device and negative displacement device/neutral displacement device designs (four studies). Seven studies reported internal microbial contamination rates, which were higher with three-way stopcocks versus negative displacement devices (two studies) and positive displacement devices (two studies), lower when positive displacement devices were used versus neutral displacement devices (one study), and varied with different types of negative displacement device (one study). Central line-associated bloodstream infection rates and most other outcomes analyzed were statistically significantly higher with three-way stopcocks (open devices) versus positive displacement device, negative displacement devices, and neutral displacement devices, but varied among closed device designs.

SES Differences in Children's Argumentative Production.

Recent studies have examined the argumentative strategies used by young children in everyday situations as well as in experimental settings. However, differences in argumentative production as a function of Socio-Economic Status (SES) have been minimally explored. This study aims to analyze eventual differences regarding social group in the use of argumentative strategies and connectors marking causal and adversative relationships within these strategies. The corpus is 615 disputes occurred during play situations in the homes of 39 4-year old children living in Buenos Aires, Argentina: 453 of mid SES children and 162 of low SES. Argumentative strategies were codified using a system of inductively derived categories: a) the reiteration of the child's point of view; b) the narration of previous experiences; c) the anticipation of courses of action; d) generalization; e) the description of the characteristics of an object, event or internal state; f) referencing authority; g) the mitigation of the point of view; h) providing an alternative proposal. Results show that in both social groups the use of an argumentative strategy to sustain the point of view predominates over merely stating the point of view. Additionally, we found significant differences in a) Reiteration strategy, with the low SES group showing a greater use of this strategy and b) Generalization and Description strategies, with the mid SES children employing these ones more frequently. Regarding the connectors, significant differences were only detected in the use of consecutive and adversative markers. The mid SES group showed a greater use of these particular connectors.