bluuebunny/crossref_metadata_2025 huggingface dataset:
Patterned variation in prehistoric chiefdoms
Authors: Drennan Robert D. , Peterson Christian E.
Published: February 2006

Comparative study of early complex societies (chiefdoms) conjures visions of a cultural evolutionary emphasis on similarities and societal typology. Variation within the group has not been as systematically examined but offers an even more productive avenue of approach to fundamental principles of organization and change. Three widely separated trajectories of early chiefdom development are compared here: the Valley of Oaxaca (Mexico), the Alto Magdalena (Colombia), and Northeast China. Archaeological data from all three regions are analyzed with the same tools to reveal variation in human activities, relationships, and interactions as these change in the emergence of chiefly communities. Patterning in this variation suggests the operation of underlying general principles, which are offered as hypotheses that merit further investigation and evaluation in comparative study of a much larger number of cases.
Frequency selectivity of synaptic exocytosis in frog saccular hair cells
Authors: Rutherford Mark A. , Roberts William M.
Published: February 2006

The ability to respond selectively to particular frequency components of sensory inputs is fundamental to signal processing in the ear. The frog (
Rana pipiens
) sacculus, which is used for social communication and escape behaviors, is an exquisitely sensitive detector of sounds and ground-borne vibrations in the 5- to 200-Hz range, with most afferent axons having best frequencies between 40 and 60 Hz. We monitored the synaptic output of saccular sensory receptors (hair cells) by measuring the increase in membrane capacitance (Δ
C
m
) that occurs when synaptic vesicles fuse with the plasmalemma. Strong stepwise depolarization evoked an exocytic burst that lasted 10 ms and corresponded to the predicted capacitance of all docked vesicles at synapses, followed by a 20-ms delay before additional vesicle fusion. Experiments using weak stimuli, within the normal physiological range for these cells, revealed a sensitivity to the temporal pattern of membrane potential changes. Interrupting a weak depolarization with a properly timed hyperpolarization increased Δ
C
m
. Small sinusoidal voltage oscillations (±5 mV centered at −60 mV) evoked a Δ
C
m
that corresponded to 95 vesicles per s at each synapse at 50 Hz but only 26 vesicles per s at 5 Hz and 27 vesicles per s at 200 Hz (perforated patch recordings). This frequency selectivity was absent for larger sinusoidal oscillations (±10 mV centered at −55 mV) and was largest for hair cells with the smallest sinusoidal-stimuli-evoked Ca
2+
currents. We conclude that frog saccular hair cells possess an intrinsic synaptic frequency selectivity that is saturated by strong stimuli.
Effects of cyclothiazide on GluR1/AMPA receptors
Authors: Fucile Sergio , Miledi Ricardo , Eusebi Fabrizio
Published: February 2006

Cyclothiazide (CTZ), a positive allosteric modulator of ionotropic α-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA)-type glutamate receptors, is used frequently to block the desensitization of both native and heterologously expressed AMPA receptors. Specifically, CTZ is known to produce a fast inhibition of AMPA receptor desensitization and a much slower potentiation of the AMPA current. By using patch-clamp techniques, the effects of CTZ were studied in HEK 293 cells stably transfected with the rat flip GluR1 subunit. Upon CTZ treatment, we found an increased apparent affinity for the agonist, a slow whole-cell current potentiation, a fast inhibition of desensitization, and a lengthening of single-channel openings. Furthermore, we show that CTZ alters the channel gating events modifying the relative contribution of different single-channel classes of conductance (γ), increasing and decreasing, respectively, the contributions of γM(medium) and γL(low) without altering that of the γH(high) conductance channels. We also present a kinetic model that predicts well all of the experimental findings of CTZ action. Finally, we suggest a protocol for standard cell treatment with CTZ to attain maximal efficacy of CTZ on GluR1 receptors.
Z-DNA-forming sequences generate large-scale deletions in mammalian cells
Authors: Wang Guliang , Christensen Laura A. , Vasquez Karen M.
Published: February 2006

Spontaneous chromosomal breakages frequently occur at genomic hot spots in the absence of DNA damage and can result in translocation-related human disease. Chromosomal breakpoints are often mapped near purine–pyrimidine Z-DNA-forming sequences in human tumors. However, it is not known whether Z-DNA plays a role in the generation of these chromosomal breakages. Here, we show that Z-DNA-forming sequences induce high levels of genetic instability in both bacterial and mammalian cells. In mammalian cells, the Z-DNA-forming sequences induce double-strand breaks nearby, resulting in large-scale deletions in 95% of the mutants. These Z-DNA-induced double-strand breaks in mammalian cells are not confined to a specific sequence but rather are dispersed over a 400-bp region, consistent with chromosomal breakpoints in human diseases. This observation is in contrast to the mutations generated in
Escherichia coli
that are predominantly small deletions within the repeats. We found that the frequency of small deletions is increased by replication in mammalian cell extracts. Surprisingly, the large-scale deletions generated in mammalian cells are, at least in part, replication-independent and are likely initiated by repair processing cleavages surrounding the Z-DNA-forming sequence. These results reveal that mammalian cells process Z-DNA-forming sequences in a strikingly different fashion from that used by bacteria. Our data suggest that Z-DNA-forming sequences may be causative factors for gene translocations found in leukemias and lymphomas and that certain cellular conditions such as active transcription may increase the risk of Z-DNA-related genetic instability.
Establishment of multiple sublineages of H5N1 influenza virus in Asia: Implications for pandemic control
Authors: Chen H. , Smith G. J. D. , Li K. S. , Wang J. , Fan X. H. , Rayner J. M. , Vijaykrishna D. , Zhang J. X. , Zhang L. J. , Guo C. T. , Cheung C. L. , Xu K. M. , Duan L. , Huang K. , Qin K. , Leung Y. H. C. , Wu W. L. , Lu H. R. , Chen Y. , Xia N. S. , Naipospos T. S. P. , Yuen K. Y. , Hassan S. S. , Bahri S. , Nguyen T. D. , Webster R. G. , Peiris J. S. M. , Guan Y.
Published: February 2006

Preparedness for a possible influenza pandemic caused by highly pathogenic avian influenza A subtype H5N1 has become a global priority. The spread of the virus to Europe and continued human infection in Southeast Asia have heightened pandemic concern. It remains unknown from where the pandemic strain may emerge; current attention is directed at Vietnam, Thailand, and, more recently, Indonesia and China. Here, we report that genetically and antigenically distinct sublineages of H5N1 virus have become established in poultry in different geographical regions of Southeast Asia, indicating the long-term endemicity of the virus, and the isolation of H5N1 virus from apparently healthy migratory birds in southern China. Our data show that H5N1 influenza virus, has continued to spread from its established source in southern China to other regions through transport of poultry and bird migration. The identification of regionally distinct sublineages contributes to the understanding of the mechanism for the perpetuation and spread of H5N1, providing information that is directly relevant to control of the source of infection in poultry. It points to the necessity of surveillance that is geographically broader than previously supposed and that includes H5N1 viruses of greater genetic and antigenic diversity.
Partial tuning of motor cortex neurons to final posture in a free-moving paradigm
Authors: Aflalo Tyson N. , Graziano Michael S. A.
Published: February 2006

Motor cortex neurons in the monkey brain were tested with a diverse and naturalistic arm movement set. Over this global set of movements, the neurons showed a limited but significant degree of tuning to the multijoint posture attained by the arm at the end of each movement. Further supporting the hypothesis that the neurons are partially tuned to end posture, the postures preferred by the neurons significantly matched the postures evoked by electrical stimulation of the same cortical sites. However, much of the variance in neuronal activity remained unexplained even by the end-posture model, and thus other variables must have contributed to the response profile of the neurons. One possibility is that motor cortex neurons become tuned to the wide variety of movement parameters that are relevant to the animal’s normal behavioral repertoire, and, therefore, any one parameter accounts for only a limited amount of neuronal variance.
The DDB1-CUL4A
DDB2
ubiquitin ligase is deficient in xeroderma pigmentosum group E and targets histone H2A at UV-damaged DNA sites
Authors: G. Kapetanaki Maria , Guerrero-Santoro Jennifer , Bisi Dawn C. , Hsieh Ching L. , Rapić-Otrin Vesna , Levine Arthur S.
Published: February 2006

Xeroderma pigmentosum (XP) is a heritable human disorder characterized by defects in nucleotide excision repair (NER) and the development of skin cancer. Cells from XP group E (XP-E) patients have a defect in the UV-damaged DNA-binding protein complex (UV-DDB), involved in the damage recognition step of NER. UV-DDB comprises two subunits, products of the
DDB1
and
DDB2
genes, respectively. Mutations in the
DDB2
gene account for the underlying defect in XP-E. The UV-DDB complex is a component of the newly identified cullin 4A-based ubiquitin E3 ligase, DDB1-CUL4A
DDB2
. The E3 ubiquitin ligases recognize specific substrates and mediate their ubiquitination to regulate protein activity or target proteins for degradation by the proteasomal pathway. In this study, we have addressed the role of the UV-DDB-based E3 in NER and sought a physiological substrate. We demonstrate that monoubiquitinated histone H2A in native chromatin coimmunoprecipitates with the endogenous DDB1-CUL4A
DDB2
complex in response to UV irradiation. Further, mutations in
DDB2
alter the formation and binding activity of the DDB1-CUL4A
DDB2
ligase, accompanied by impaired monoubiquitination of H2A after UV treatment of XP-E cells, compared with repair-proficient cells. This finding indicates that DDB2, as the substrate receptor of the DDB1-CUL4A-based ligase, specifically targets histone H2A for monoubiquitination in a photolesion-binding-dependent manner. Given that the loss of monoubiquitinated histone H2A at the sites of UV-damaged DNA is associated with decreased global genome repair in XP-E cells, this study suggests that histone modification, mediated by the XPE factor, facilitates the initiation of NER.
An unexpected antibody response to an engineered influenza virus modifies CD8+T cell responses
Authors: Thomas Paul G. , Brown Scott A. , Yue Wen , So Jenny , Webby Richard J. , Doherty Peter C.
Published: February 2006

The ovalbumin323–339peptide that binds H2I-Abwas engineered into the globular heads of hemagglutinin (H) molecules from serologically non-cross-reactive H1N1 and H3N2 influenza A viruses, the aim being to analyze recall CD4+T cell responses in a virus-induced respiratory disease. Prime/challenge experiments with these H1ova and H3ova viruses in H2bmice gave the predicted, ovalbumin-specific CD4+T cell response but showed an unexpectedly enhanced, early expansion of viral epitope-specific CD8+T cells in spleen and a greatly diminished inflammatory process in the virus-infected respiratory tract. At the same time, the primary antibody response to the H3N2 challenge virus was significantly reduced, an effect that has been associated with preexisting neutralizing antibody in other experimental systems. Analysis of serum from the H1ova-primed mice showed low-level binding to H3ova but not to the wild-type H3N2 virus. Experiments with CD4+T cell-depleted and Ig−/−mice indicated that this cross-reactive Ig is indeed responsible for the modified pathogenesis after respiratory challenge. Furthermore, the effect does not seem to be virus-dose related, although it does require infection. These findings suggest intriguing possibilities for vaccination and, at the same time, emphasize that engineered modifications in viruses may have unintended immunological consequences.
Voltage-gated ion channels in the axon initial segment of human cortical pyramidal cells and their relationship with chandelier cells
Authors: Inda Maria Carmen , DeFelipe Javier , Muñoz Alberto
Published: February 2006

The axon initial segment (AIS) of pyramidal cells is a critical region for the generation of action potentials and for the control of pyramidal cell activity. Here we show that Na
+
and K
+
voltage-gated channels, together with other molecules involved in the localization of ion channels, are distributed asymmetrically in the AIS of pyramidal cells situated in the human temporal neocortex. There is a high density of Na
+
channels distributed along the length of the AIS together with the associated proteins spectrin βIV and ankyrin G. In contrast, Kv1.2 channels are associated with the adhesion molecule Caspr2, and they are mostly localized to the distal region of the AIS. In general, the distal region of the AIS is targeted by the GABAergic axon terminals of chandelier cells, whereas the proximal region is innervated, mostly by other types of GABAergic interneurons. We suggest that this molecular segregation and the consequent regional specialization of the GABAergic input to the AIS of pyramidal cells may have important functional implications for the control of pyramidal cell activity.
Cell culture-grown hepatitis C virus is infectious
in vivo
and can be recultured
in vitro
Authors: Lindenbach Brett D. , Meuleman Philip , Ploss Alexander , Vanwolleghem Thomas , Syder Andrew J. , McKeating Jane A. , Lanford Robert E. , Feinstone Stephen M. , Major Marian E. , Leroux-Roels Geert , Rice Charles M.
Published: February 2006

Hepatitis C virus (HCV) is a major cause of chronic liver disease, frequently progressing to cirrhosis and increased risk of hepatocellular carcinoma. Current therapies are inadequate and progress in the field has been hampered by the lack of efficient HCV culture systems. By using a recently described HCV genotype 2a infectious clone that replicates and produces infectious virus in cell culture (HCVcc), we report here that HCVcc strain FL-J6/JFH can establish long-term infections in chimpanzees and in mice containing human liver grafts. Importantly, virus recovered from these animals was highly infectious in cell culture, demonstrating efficient
ex vivo
culture of HCV. The improved infectivity of animal-derived HCV correlated with virions of a lower average buoyant density than HCVcc, suggesting that physical association with low-density factors influences viral infectivity. These results greatly extend the utility of the HCVcc genetic system to allow the complete
in vitro
and
in vivo
dissection of the HCV life cycle.
Depletion “skraps” and dynamic buffering inside the cellular calcium store
Authors: Launikonis Bradley S. , Zhou Jingsong , Royer Leandro , Shannon Thomas R. , Brum Gustavo , Ríos Eduardo
Published: February 2006

Ca
2+
signals, produced by Ca
2+
release from cellular stores, switch metabolic responses inside cells. In muscle, Ca
2+
sparks locally exhibit the rapid start and termination of the cell-wide signal. By imaging Ca
2+
inside the store using shifted excitation and emission ratioing of fluorescence, a surprising observation was made: Depletion during sparks or voltage-induced cell-wide release occurs too late, continuing to progress even after the Ca
2+
release channels have closed. This finding indicates that Ca
2+
is released from a “proximate” compartment functionally in between store lumen and cytosol. The presence of a proximate compartment also explains a paradoxical surge in intrastore Ca
2+
, which was recorded upon stimulation of prolonged, cell-wide Ca
2+
release. An intrastore surge upon induction of Ca
2+
release was first reported in subcellular store fractions, where its source was traced to the store buffer, calsequestrin. The present results update the evolving concept, largely due to N. Ikemoto and C. Kang, of calsequestrin as a dynamic store. Given the strategic location and reduction of dimensionality of Ca
2+
-adsorbing linear polymers of calsequestrin, they could deliver Ca
2+
to the open release channels more efficiently than the luminal store solution, thus constituting the proximate compartment. When store depletion becomes widespread, the polymers would collapse to increase store [Ca
2+
] and sustain the concentration gradient that drives release flux.
Dormancy and germination in three Acacia (Fabaceae) species from central Argentina
Authors: Funes Guillermo , Venier Paula
Published: February 2006

We studied dormancy and germination requirements of seeds of Acacia aroma, A. caven and A. furcatispina from a semi-arid region of central Argentina. Imbibition experiments were performed to determine the rate of water uptake in seeds. To determine optimal temperature for germination, seeds were incubated at three temperature regimes (15/5, 25/15 and 35/20°C) with a 12/12 h daily photoperiod or in total darkness. Additionally, differences in dormancy and germination in seed colour morphs of A. aroma were studied. Seeds of A. aroma and A. caven had impermeable coats, while those of A. furcatispina did not. Seeds of the three species showed the same pattern of germination. Germination percentages were significantly lower at 15/5°C than at 25/15 or 35/20°C. The germination temperature pattern found for these species is probably related to the summer seasonal nature of rainfall in the study area. In A. aroma, seeds of the two colour morphs showed a similar pattern of dormancy and germination.
Seed storage behaviour and seed germination in African and Malagasy baobabs (Adansonia species)
Authors: Razanameharizaka Juvet , Grouzis Michel , Ravelomanana Didier , Danthu Pascal
Published: February 2006

The Adansonia (baobab) genus comprises seven species in Africa, six of which are endemic to Madagascar. Depending on the species, baobabs develop in widely varying ecosystems, including arid zones and savannahs, as well as dry and wet forests. Seeds from all species exhibited orthodox behaviour, tolerating dehydration to a moisture content of around 5%. There was no physical dormancy in the two species belonging to the Brevitubae section, A. grandidieri and A. suarezensis. Their seeds germinated without any prior scarification. The five other species, belonging to Adansonia and Longitubae section, have seeds with water-impermeable coats. In the case of A. digitata and A. za, the proportion of water-impermeable seeds was around two-thirds, whereas with A. rubrostipa, A. madagascariensis and A. perrieri, the proportion was >90%. Treatments allowing for the removal of physical dormancy needed to be markedly more severe with A. madagascariensis than with the other species. None the less, it seems impossible to link these characteristics and the interspecific differences to a strategy for adaptation by these species to their environment.
Faecal elastase‐1 concentration in cystic fibrosis patients with CFTR I1234V mutation
Authors: Rahman H. Abdel , Wahab A. Abdul , Rahman M. O. Abdel , Mostafa Ossama Abdel Rahman
Published: February 2006

Aim: To assess the exocrine pancreatic function among cystic fibrosis patients with cystic fibrosis trans‐membrane conductance regulator (CFTR) I1234V mutation. Methods: Cross‐sectional study of 40 cystic fibrosis patients with homozygous CFTR I1234V mutation belonging to a large Arab kindred family and 25 healthy subjects as a control group over a period of 12 mo. Assessment of their exocrine pancreatic function was performed by measuring faecal elastase‐1 (FE1) concentration with a commercial ELISA kit using polyclonal antibodies (BioServ Diagnostics) in CF patients compared to healthy subjects. The results were compared with those obtained from a second laboratory using another commercial ELISA (ScheBo; Biotech, Germany) that uses two monoclonal antibodies against different specific epitopes of human pancreatic elastase. Results: All CF patients with CFTR I1234V mutation had normal levels of faecal elastase 1. No significant difference was found between the two methods for the CF groups or between the CF patients with and without pancreatic enzyme replacement.

Conclusion: Cystic fibrosis with homozygous CFTR I1234V mutation is associated with pancreatic sufficiency. Assessment of exocrine function using polyclonal antibodies does not significantly differ from that using two monoclonal antibodies against different specific epitopes of human pancreatic elastase.
Molecular Epidemiology of an Outbreak ofSerratia marcescensin a Neonatal Intensive Care Unit
Authors: Villari Paolo , Crispino Margherita , Salvadori Alessandra , Scarcella Alda
Published: February 2006

Objective:

To investigate and control a biphasic outbreak ofSerratia marcescensin a neonatal intensive care unit (NICU).

Design:

Epidemiological and laboratory investigation of the outbreak.

Setting:

The NICU of the 1,470-bed teaching hospital of the University “Federico II,” Naples, Italy.

Patients:

The outbreak involved 56 cases of colonization by Smarcescensover a 15-month period, with two epidemic peaks of 6 and 3 months, respectively. Fourteen (25%) of the 56 colonized infants developed clinical infections, 50% of which were major (sepsis, meningitis, or pneumonia).

Methods:

Epidemiological and microbiological investigations, analysis of macrorestriction pattern of genomic DNA through pulsed-field gel electrophoresis (PFGE) of clinical and environmental isolates, and institution of infection control measures.

Results:

Analysis of macrorestriction patterns of genomic DNA by PFGE demonstrated that the vast majority of Smarcescensisolates, including three environmental strains isolated from two handwashing disinfectants and the hands of a nurse, were of the same clonal type. The successful control of the outbreak was achieved through cohorting of noncolonized infants, isolation of Smarcescens-infectedand -colonized infants, and an intense educational program that emphasized the need for adherence to glove use and handwashing policies. The NICU remained open to new admissions.

Conclusions:

Outbreaks caused by Smarcescensare very difficult to eradicate. An infection control program that includes molecular typing of microorganisms and the proper dissemination among staff members of the typing results is likely to be very effective in reducing NICU-acquired infections and in controlling outbreaks caused by Smarcescens,as well as other multiresistant bacteria.
Pseudo-Outbreak ofMycobacterium scrofulaceumLinked to Cross-Contamination With a Laboratory Reference Strain
Authors: Oda Gina V. , DeVries Michelle M.
Published: February 2006

Mycobacterium scrofulaceumwas isolated from three clinical specimens over a period of 2 months. In the preceding 10 years, the institution had not reported any cases of this unusual mycobacterium. Investigation and confirmatory molecular testing indicated a laboratory control strain to be the source of contamination.
Physician Preferences for Continuing Medical Education With a Focus on the Topic of Antimicrobial Resistance: Society for Healthcare Epidemiology of America
Authors: Brown Torrance T. , Proctor Suzanne E. , Sinkowitz-Cochran Ronda L. , Smith Theresa L. , Jarvis William R. ,   Society for Healthcare Epidemiology of America, Inc
Published: February 2006

Objective:

To determine the type of media preferred for continuing medical education (CME) and to assess the factors that affect physician preferences for CME in general and on the special topic of antimicrobial resistance.

Design:

A voluntary survey of the membership of the Society for Healthcare Epidemiology of America, Inc. (SHEA).

Methods:

SHEA in collaboration with other medical societies and with technical assistance from the Centers for Disease Control and Prevention, designed and mailed the survey to its membership. The survey included questions about media used, preferred, and of interest to try for CME delivery in general and on the topic of antimicrobial resistance in specific. The survey also included demographic and general questions, such as work environment, percentage of time in direct patient care, and experience treating patients with antimicrobial-resistant pathogens.

Results:

225 SHEA members completed the survey. The majority of physicians were in clinical practice (59%) and worked in a hospital (57%). The median year of graduation from medical school was 1979 (range, 1951-1999). CME subject matter (46%) was ranked as the most important factor affecting media preference. Journal articles (52%) were the most frequently used educational medium; local grand rounds (53%) and regional meetings (53%) were the most preferred media. CD-ROM (56%) and the Internet (46%) were selected as media of greatest interest to try. On the topic of antimicrobial resistance, the most frequently used and the preferred medium was journal articles (67% and 87%, respectively). Most (94%) had received an educational update on current antimicrobial resistance issues within the past year. Stratification of the data by graduation date revealed no significant differences in the medical education media used most (F=0.59, degrees of freedom [df]=4, P=.6715) or preferred by SHEA members in general or on the topic of antimicrobial resistance (F=1.99, df=4, P=.0982).

Conclusions:

This study provides an understanding of how physicians learn, prefer to learn, and implement best practices for optimal patient outcomes in decreasing the spread of antimicrobial resistance.
Changing Pattern of Antibiotic Resistance in Methicillin-ResistantStaphylococcus aureusFrom German Hospitals
Authors: Witte Wolfgang , Braulke Christine , Cuny Christa , Heuck Dagmar , Kresken Michael
Published: February 2006

Objective:

To investigate the background of changes of resistance phenotypes in methicillin-resistantStaphylococcus aureus(MRSA) from nosocomial infections in German hospitals by molecular typing and identification of particular resistance genes.

Methods:

Isolates from the network for monitoring the spread of MRSA in Germany were subjected to quantitative susceptibility testing, to molecular typing, and to polymerase chain reaction identification of resistance genes.

Participants:

The network consists of 175 German clinical microbiological laboratories collaborating with the German Reference Center for Staphylococci, which performs typing of staphylococcal isolates from nosocomial infections and data analysis.

Results:

During the past 5 years, MRSA susceptible to other antibiotics such as oxytetracycline, erythromycin, and gentamicin became more frequent. The proportion of epidemic MRSA clones that had been disseminated in the past and that exhibited broad resistance phenotypes decreased, whereas the proportion of recently emerging MRSA carrying only a few other resistance determinants has increased (1994, 11.5%; 1998, 39%).

Conclusions:

The changing pattern of resistance phenotypes of MRSA from nosocomial infections in Germany is mainly due to the spread of recently emerging epidemic strains that are less frequently resistant to antibacterials other than oxacillin. The observed changes cannot simply be attributed to overall antibiotic consumption.
Association Between Hospital-Acquired Infections and Patients' Transfers
Authors: Eveillard Matthieu , Quenon Jean-Luc , Rufat Pierre , Mangeol Alain , Fauvelle Francis
Published: February 2006

Objective:

To assess the risk of nosocomial infection in transferred patients and to determine whether transfer is only a risk marker or is independently associated with nosocomial infection.

Design:

Retrospective analysis.

Setting:

A 400-bed general hospital in the Paris area.

Patients:

All the patients hospitalized on the days of the surveys were included.

Methods:

Epidemiological analysis of data collected in four annual nosocomial infection prevalence surveys conducted between 1993 and 1996.

Results:

Of the 1,326 patients included in the four surveys, 70 (5.3%) had been transferred from another hospital and 199 (15.0%) from another ward of our hospital. Transferred patients more frequently had known risk factors of nosocomial infection: age >65 years (P<10-5), a length of hospital stay >7 days on the day of the survey (P<10-6), at least one invasive procedure (34.2% vs 27.2%;P<.05), a recent surgical intervention (P<.05), and an immunosuppression (P<.01). The prevalence rate of infected patients was 6.7% (95% confidence interval, 5.3-8.1). The risk of being infected on a given day was more than 4 times higher in transferred patients (P<10-6); however, the risk was similar between patients transferred from another hospital (20.0%) and patients transferred within the hospital (17.1%). The multivariate analysis performed by logistic regression showed that intrahospi-tal transfer, a length of hospital stay >7 days, and having had at least one invasive procedure were independent risk factors of infection.

Conclusion:

According to this study, patient transfer is both a risk marker (associated with several known risk factors) and independently associated with nosocomial infection. The origin of a transferred patient is readily known at admission. It would be useful to adopt specific measures for such patients, particularly if they have other risk factors of nosocomial infection, both to protect them and to prevent transmission of the infection to other hospitalized patients.
Hepatitis C in a Ward for Cystic Fibrosis and Diabetic Patients Possible Transmission by Spring-Loaded Finger-Stick Devices for Self-Monitoring of Capillary Blood Glucose
Authors: Desenclos Jean-Claude , Bourdiol-Razès Martine , Rolin Bernard , Garandeau Patrick , Ducos Jacques , Bréchot Christian , Thiers Valérie
Published: February 2006

Objective:

To identify the routes of transmission in a nosocomial outbreak of hepatitis C virus (HCV) infection.

Design:

Epidemiological investigation, including screening for HCV of hospitalized patients, and a retrospective cohort study, review of hygiene and medical practices, and molecular comparison of HCV isolates.

Setting:

A specialized care unit for cystic fibrosis (CF) and diabetic patients at an acute-care facility in the south of France.

Results:

Of the 57 CF patients (age in 1995: 2-28 years), 38 (66.7%) were tested and 22 (57.9%) were anti-HCV positive. Eight (50%) of 16 patients with anti-HCV antibody tested by polymerase chain reaction were viremic. No patients had received blood products or had any history of intravenous drug use. All 18 (100%) patients with CF who had ever undergone self-monitoring of capillary blood glucose in the unit were anti-HCV positive, compared to 4 (20%) of 20 who had not (relative risk, 5.0; 95% confidence interval, 2.1-12.0). Seventy (39.5%) of the patients with diabetes were screened for anti-HCV; 12 (18.8%) tested positive, with 3 (25%) positive for HCV-RNA. Patients with diabetes had routine capillary blood glucose monitoring while hospitalized and shared with CF patients the same spring-triggered devices for capillary blood glucose monitoring. The disposable platform of the devices was not changed between patient use. All HCV isolates belonged to the type 1, subtype b, and phylogenetic analysis showed a close homology by sequencing of NS5b and E2/HVR regions.

Conclusion:

As reported earlier for the hepatitis B virus, shared spring-triggered devices for capillary blood glucose monitoring by finger puncture may transmit HCV. Strict application of Standard Precautions procedures is warranted in any healthcare setting.
Nosocomial Infections in a Children's Hospital in Argentina: Impact of a Unique Infection Control Intervention Program
Authors: Gentile Angela de , Rivas Noemi , Sinkowitz-Cochran Ronda L. , Momesso Teresa , Iriart Emilio Martinez , Lopez Eduardo , Beck-Sague Consuelo M. , Jarvis William R.
Published: February 2006

Objective:

To assess the efficacy of parental education and use of parents as nursing assistants on reducing nosocomial infections.

Design:

Prospective study.

Methods:

Active surveillance for nosocomial infections was performed on two wards. On ward A, parents were educated about infection control practices and assisted nursing staff with routine tasks, so that nursing personnel could focus their efforts on procedures with higher risk of infection. Parental assistance was not sought on ward B, the comparison ward.

Results:

From October 1990 through September 1991, 1,081 patients were admitted to wards A (470) or B (611). The overall nosocomial infection rate was 7.1 per 100 admissions; the nosocomial infection rate was significantly higher on ward B than ward A (63/611 vs 14/470; P<.001). Multivariate analysis identified risk factors for nosocomial infection on the two wards as age <2 years (P=.01), malnutrition (P=.005), duration of hospitalization (P<.001), ward B hospitalization (P=.003), and ward cleanliness score (P=.009); the distribution of patients with these factors was similar on the two wards.

Conclusions:

Our data suggest that parental infection control education and recruitment to relieve nursing staff of routine low-risk procedures are economical and easily implemented measures to reduce nosocomial infections in hospitals with limited personnel resources in the developing world.
The Economic Impact of Methicillin-Resistant Staphylococcus aureus in Canadian Hospitals
Authors: Kim Tony , Oh Paul I. , Simor Andrew E.
Published: February 2006

Objectives:

To determine the costs associated with the management of hospitalized patients with methicillin-resistantStaphylococcus aureus(MRSA), and to estimate the economic burden associated with MRSA in Canadian hospitals.

Design:

Patient-specific costs were used to determine the attributable cost of MRSA associated with excess hospitalization and concurrent treatment. Excess hospitalization for infected patients was identified using the Appropriateness Evaluation Protocol, a criterion-based chart review process to determine the need for each day of hospitalization. Concurrent treatment costs were identified through chart review for days in isolation, antimicrobial therapy, and MRSA screening tests. The economic burden to Canadian hospitals was estimated based on 3,167,521 hospital discharges for 1996 and 1997 and an incidence of 4.12 MRSA cases per 1,000 admissions.

Setting:

A tertiary-care, university-affiliated teaching hospital in Toronto, Ontario, Canada.

Patients:

Inpatients with at least one culture yielding MRSA between April 1996 and March 1998.

Results:

A total of 20 patients with MRSA infections and 79 colonized patients (with 94 admissions) were identified. This represented a rate of 2.9 MRSA cases per 1,000 admissions. The mean number of additional hospital days attributable to MRSA infection was 14, with 11 admissions having at least 1 attributable day. The total attributable cost to treat MRSA infections was $287,200, or $14,360 per patient. The cost for isolation and management of colonized patients was $128,095, or $1,363 per admission. Costs for MRSA screening in the hospital were $109,813. Assuming an infection rate of 10% to 20%, we determined the costs associated with MRSA in Canadian hospitals to be $42 million to $59 million annually.

Conclusions:

These results indicate that there is a substantial economic burden associated with MRSA in Canadian hospitals. These costs will continue to rise if the incidence of MRSA increases further.
Laboratory-Based Surveillance for Vancomycin-Resistant Enterococci: Utility of Screening Stool Specimens Submitted for Clostridium difficile Toxin Assay
Authors: Leber Amy L. , Hindler Janet F. , Kato Ellen O. , Bruckner David A. , Pegues David A.
Published: February 2006

Objective:

To study vancomycin-resistant enterococci (VRE) gastrointestinal colonization prevalence in high-risk hospitalized patients and to assess the cost and utility of this laboratory-based surveillance.

Setting:

Large university teaching hospital.

Design:

Quarterly prevalence culture survey of 50 stool specimens submitted forClostridium difficiletoxin A assay from October 1996 through June 1999 (n=526). Screening culture survey of allC difficile-positive stool specimens from July 1998 through June 1999 (n=140).

Patients:

Specimens for analysis were collected from patients who were admitted to the hospital and who hadC difficiletoxin A testing ordered. Patient samples were excluded from analysis if they were obtained from patients not hospitalized at UCLA Medical Center, if theC difficiletoxin assay result was indeterminate, or if the patient was known to have previous VRE colonization or infection.

Results:

During quarterly surveillance, VRE was detected in 19.8%,C difficiletoxin A in 9.5%, and both VRE andC difficiletoxin A in 3.2% of stool specimens submitted forC difficiletoxin assay. Patients whose stool specimens were positive forC difficiletoxin A were significantly more likely than those whose specimens were negative to have VRE detected (odds ratio, 2.3; 95% confidence interval, 1.2-4.5). Based on these findings, in July 1998, we began routine screening of allC difficile-positive stool specimens for VRE. From July 1998 through June 1999, 58 (41.4%) of 140 patients withC difficile-positive specimens had VRE newly detected in the stool. The combined cost of the two laboratory-based surveillance strategies was approximately $62 per VRE-positive patient identified and $5,800 per year.

Conclusion:

Quarterly surveillance of stool submitted forC difficileassay combined with screening allC difficile-positive stools is a cost-effective and efficient strategy for detecting VRE stool colonization among high-risk hospitalized patients. Such a laboratory-based surveillance should be included as part of a comprehensive program to limit nosocomial VRE transmission.
Emergency Department Management of Occupational Exposures: Cost Analysis of Rapid HIV Test
Authors: Kallenborn J. Celeste , Price Timothy G. , Carrico Ruth , Davidson Audrey B.
Published: February 2006

Objective:

To compare costs for evaluation and treatment of a healthcare worker (HCW) experiencing an occupational exposure, using a rapid human immunodeficiency virus (HIV) test versus a standard enzyme-linked immunosorbent assay (ELISA) HIV test.

Design:

Retrospective chart review of all HCWs presenting to the emergency department (ED) for care of an occupational exposure over a 13-month period.

Setting:

A 404-bed university-based level 1 trauma center with an annual ED census of approximately 35,000.

Participants:

All HCWs experiencing an occupational exposure treated in the ED using a rapid HPV protocol were included in the analysis.

Methods:

A calculation of selected costs of the initial evaluation and treatment of patients whose evaluation included a rapid HIV test on the source patient were performed. A similar calculation was then made for these patients, had the standard ELISA test been used. Evaluated costs included laboratory tests, postexposure prophylactic medications, and estimated lost work time. Other costs were constant and were not included in the evaluation.

Results:

Total evaluated cost using the rapid HIV test as part of the evaluation and treatment protocol was $465.80 for 17 patients. Had the ELISA test been used instead of the rapid test, the total evaluated cost for the 17 patients would have been $5,965.81.

Conclusions:

When used as part of the evaluation and treatment of the HCW with an occupational exposure, the rapid HIV test results in substantial cost savings over the ELISA test.
Rapid Molecular Typing of Methicillin-ResistantStaphylococcus aureusby PCR-RFLP
Authors: Wichelhaus Thomas A. , Hunfeld Klaus-Peter , Böddinghaus Boris , Kraiczy Peter , Schàfer Volker , Brade Volker
Published: February 2006

Objective:

To establish a new, rapid, and reliable genotypic fingerprinting technique for methicillin-resistantStaphylococcus aureus(MRSA) typing in routine epidemiological surveillance.

Design:

The method is based on polymerase chain reaction (PCR) restriction fragment-length polymorphism (RFLP) followingHaeII digestion of simultaneously amplified parts of the protein A gene, the coagulase gene, and the hypervariable region adjacent tomecA. A total of 46 MRSA initial isolates were analyzed, including 14 isolates from five countries; the six German epidemic strains; 16 isolates from the Frankfurt metropolitan area, which were known to be heterogeneous by pulsed-field gel electrophoresis (PFGE); and 10 isolates obtained during three epidemics, all of which displayed an identical genotype.

Results:

Restriction analysis by PCR-RFLP permitted discrimination of 10 of 14 international isolates, all six German epidemic strains, and 15 of 16 national isolates. It also confirmed the homogeneous character of the 10 outbreak isolates.

Conclusions:

This new and rapid PCR-RFLP typing method is an attractive tool in routine epidemiological surveillance. Its impressive characteristics are ease of performance and interpretation, while at the same time guaranteeing good discriminatory power, reproducibility, and typeability.
Two-Year Trends of Peripherally Inserted Central Catheter-Line Complications at a Tertiary-Care Hospital Role of Nursing Expertise
Authors: Funk Duane , Gray Janet , Plourde Pierre J.
Published: February 2006

We found reductions in peripherally inserted central catheter (PICC) complication rates over 2 years of observation (20.4 vs 13.8/1,000 line-days; relative risk, 0.5-0.9). This difference represents a cost saving due to reduced line reinsertions and reduced use of thrombolytic agents. The presence of a dedicated PICC insertion nursing team and education of ward nurses in PICC maintenance is a plausible explanation for the observed differences.
Surveillance of Hospital-Acquired Infection in England, Germany, and The Netherlands Will International Comparison of Rates Be Possible?
Authors: Coello Rosa , Gastmeier Petra , de Boer Annette S.
Published: February 2006

Three national surveillance systems for nosocomial infection have been developed independently and implemented successfully in England, Germany, and The Netherlands. All three are based on the American National Nosocomial Infections Surveillance System and have adopted a surveillance strategy that is targeted at specific infections or groups of patients for limited time periods. Case-finding methods, the minimum data set, and analysis of data are similar and could be standardized easily. Resolution of the differences in the definitions of infection, the study population, and follow-up should make possible the international comparison of infection rates. Such comparisons may identify differences in healthcare practices between countries and suggest areas for improvement.
Nosocomial Transmission of Imipenem-Resistant Pseudomonas Aeruginosa Following Bronchoscopy Associated With Improper Connection to the STERIS SYSTEM 1 Processor
Authors: Sorin Mircea , Segal-Maurer Sorana , Mariano Noriel , Urban Carl , Combest Anna , Rahal James J.
Published: February 2006

Objective:

To assess nosocomial transmission of imipenem-resistant Pseudomonas aeruginosa (IRPA) following bronchoscopy during August through October 1998.

Design:

Traditional and molecular epidemiological investigation of a case series.

Setting:

University-affiliated community hospital.

Patients:

18 patients with IRPA bronchial-wash isolates.

Interventions:

We reviewed clinical data, performed environmental cultures and molecular analysis of all IRPA isolates, and observed disinfection of bronchoscopes.

Results:

Of 18 patients who had IRPA isolated from bronchoscopic or postbronchoscopic specimens, 13 underwent bronchoscopy for possible malignancy or undiagnosed pulmonary infiltrates. Following bronchoscopy, 3 patients continued to have IRPA isolated from sputum and demonstrated clinical evidence of infection requiring specific antimicrobial therapy. The remaining 15 patients had no further IRPA isolated and remained clinically well 3 months following bronchoscopy. Pulsed-field gel electrophoresis revealed that all strains except one were >95% related. STERIS SYSTEM 1 had been implemented in July 1998 as an automatic endoscope reprocessor (AER) for all endoscopes and bronchoscopes. Inspection of bronchoscope sterilization cycles revealed incorrect connectors joining the bronchoscope suction channel to the STERIS SYSTEM 1 processor, obstructing peracetic acid flow through the bronchoscope lumen. No malfunction warning was received, and spore strips remained negative.

Conclusions:

The similarity of diverse connectors and limited training by the manufacturer regarding AER for bronchoscopes were the two factors responsible for the outbreak. Appropriate connections were implemented, and there was no further bronchoscope contamination. We suggest active surveillance of all bronchoscopy specimen cultures, standardization of connectors of various scopes and automated processors, and systematic education of staff by manufacturers with periodic on-site observation.
Carriage of Staphylococcus aureus and of Gram-Negative Bacilli Resistant to Third-Generation Cephalosporins in Cirrhotic Patients A Prospective Assessment of Hospital-Acquired Infections
Authors: Dupeyron Catherine , Campillo Bernard , Mangeney Nicole , Bordes Muriel , Richardet Jean-Philippe , Leluan Georges
Published: February 2006

Objective:

To study the relation between Staphylococcus aureus nasal and stool colonization, stool carriage of gram-negative bacilli resistant to third-generation cephalosporins (CephR), and subsequent infections during hospitalization.

Design:

Prospective study.

Patients:

551 cirrhotic patients with 589 consecutive hospital stays. All patients were screened within 48 hours of admission; 589 nasal swabs, 417 stool specimens, and 589 urine samples were analyzed.

Results:

Carriage rates were 18.8% for methicillin-sensitive S aureus (MSSA), 16.3% for methicillin-resistant S aureus (MRSA), and 13.7% for CephR. We observed 87 episodes of spontaneous bacterial peritonitis, 63 cases of bacteremia, and 167 urinary tract infections occurred. Only 1 case of bacteremia and 4 urinary tract infections due to CephR occurred in patients carrying the same organism in their stools. The risk of MRSA ascitic fluid infections, bacteremia, and urinary tract infections was 3.1% versus 1% (not significant), 8.3% versus 0.8% (P<.001), and 11.4% versus 0.6% (P<.001) in carriers and noncarriers, respectively. Pulsed-field gel electrophoresis (PFGE) of isolates from 16 patients infected by MSSA (3 cases) and MRSA (13 cases) demonstrated that the colonizing strains matched the invasive strains in the 3 MSSA cases and in 8 of 13 MRSA cases.

Conclusion:

Carriage of CephR strains is not associated with subsequent infection by these organisms in hospitalized cirrhotic patients. In contrast, MRSA carriage was an important risk factor for MRSA bacteremia and urinary tract infection.