bluuebunny/crossref_metadata_2025 huggingface dataset:
Can the dual-route cascaded computational model of reading offer a valid account of the masked onset priming effect?
Authors: Mousikou Petroula , Coltheart Max , Finkbeiner Matthew , Saunders Steven
Published: September 2009

The masked onset priming effect (MOPE) refers to the empirical finding that target naming is faster when the target (SIB) is preceded by a briefly presented masked prime that starts with the same letter/phoneme ( suf) than when it does not ( mof; Kinoshita, 2000, Experiment 1). The dual-route cascaded (DRC) computational model of reading (Coltheart, Rastle, Perry, Langdon, & Ziegler, 2001) has offered an explanation for how the MOPE might occur in humans. However, there has been some empirical discrepancy regarding whether for nonword items the effect is limited to the first-letter/phoneme overlap between primes and targets or whether orthographic/phonological priming effects occur beyond the first letter/phoneme. Experiment 1 tested these two possibilities. The human results, which were successfully simulated by the DRC model, showed priming beyond the first letter/phoneme. Nevertheless, two recent versions of the DRC model made different predictions regarding the nature of these priming effects. Experiment 2 examined whether it is facilitatory, inhibitory, or both, in order to adjudicate between the two versions of the model. The human results showed that primes exert both facilitatory and inhibitory effects.
The angiopietin-1–Tie2 pathway prevents rather than promotes pulmonary arterial hypertension in transgenic mice
Authors: Kugathasan Lakshmi , Ray Julie Basu , Deng Yupu , Rezaei Effat , Dumont Daniel J. , Stewart Duncan J.
Published: September 2009

The role of the angiopoietin-1 (Ang1)–Tie2 pathway in the pathogenesis of pulmonary arterial hypertension (PAH) is controversial. Although Ang1 is well known to prevent endothelial activation and injury in systemic vascular beds, this pathway has been suggested to mediate pulmonary vascular remodeling in PAH. Therefore, we used transgenic models to determine the effect of increased or decreased Tie2 activity on the development of PAH. We now report modest spontaneous elevation in right ventricular systolic pressure in Tie2-deficient mice (Tie2+/−) compared with wild-type (WT) littermate controls, which was exacerbated upon chronic exposure to the clinically relevant PAH triggers, serotonin (5-HT) or interleukin-6 (IL-6). Moreover, overexpression of Ang1 in transgenic mice had no deleterious effect on pulmonary hemodynamics and, if anything, blunted the response to 5-HT. Exposure to 5-HT or IL-6 also decreased lung Ang1 expression, further reducing Tie2 activity and inducing pulmonary apoptosis in the Tie2+/− group only. Similarly, cultured pulmonary artery endothelial cells subjected to Tie2 silencing demonstrated increased susceptibility to apoptosis after 5-HT treatment. Finally, treatment of Tie2-deficient mice with Z-VAD, a pan-caspase inhibitor, prevented the pulmonary hypertensive response to 5-HT. Thus, these findings firmly establish that endothelial survival signaling via the Ang1–Tie2 pathway is protective in PAH.
NOD2 regulates hematopoietic cell function during graft-versus-host disease
Authors: Penack Olaf , Smith Odette M. , Cunningham-Bussel Amy , Liu Xin , Rao Uttam , Yim Nury , Na Il-Kang , Holland Amanda M. , Ghosh Arnab , Lu Sydney X. , Jenq Robert R. , Liu Chen , Murphy George F. , Brandl Katharina , van den Brink Marcel R.M.
Published: September 2009

Nucleotide-binding oligomerization domain 2 (NOD2) polymorphisms are independent risk factors for Crohn's disease and graft-versus-host disease (GVHD). In Crohn's disease, the proinflammatory state resulting from NOD2 mutations have been associated with a loss of antibacterial function of enterocytes such as paneth cells. NOD2 has not been studied in experimental allogeneic bone marrow transplantation (allo-BMT). Using chimeric recipients with NOD2−/− hematopoietic cells, we demonstrate that NOD2 deficiency in host hematopoietic cells exacerbates GVHD. We found that proliferation and activation of donor T cells was enhanced in NOD-deficient allo-BMT recipients, suggesting that NOD2 plays a role in the regulation of host antigen-presenting cells (APCs). Next, we used bone marrow chimeras in an experimental colitis model and observed again that NOD2 deficiency in the hematopoietic cells results in increased intestinal inflammation. We conclude that NOD2 regulates the development of GVHD through its inhibitory effect on host APC function.
Association of Legionnaires Disease with Construction: Contamination of Potable Water?
Authors: Mermel Leonard A. , Josephson Stephen L. , Giorgio Christina H. , Dempsey Jane , Parenteau Stephen
Published: September 2009

Objective:

To describe two cases of nosocomial legionellosis and discuss the epidemiology of this infection.

Design:

Potable water was collected from multiple sites. Patient and environmental isolates were characterized by the Legionella slide agglutination test and monoclonal antibody subtyping. Concordance among isolates was confirmed by pulsed-field gel electrophoresis (PFGE).

Setting:

A 713-bed university-affiliated hospital.

Results:

There was widespread contamination of potable water with Legionella pneumophila during a period of major construction; cooling towers were without growth of Legionella. One patient's isolate was the same by PFGE as the environmental isolate collected from the water faucet in his room. Control measures included superheating water used in all patient care areas to 75°C for 72 hours and flushing superheated water through faucets and showers; cleaning shower heads with a sonicator washer; and raising the hot water storage tank temperature from 43°C to 52°C. After these interventions, repeat environmental cultures over the next 6 months were without growth of Legionella, and no further cases of nosocomial legionnaires' disease were documented. An association between legionnaires' disease and construction is postulated. Heightened surveillance and preventive measures may be warranted during periods of excavation on hospital grounds or when potable water supplies are otherwise shut down and later repressurized.
Immunization with High-Dose Intradermal Recombinant Hepatitis B Vaccinein Healthcare Workers Who Failed to Respond to Intramuscular Vaccination
Authors: Levitz Robert E. , Cooper Brian W. , Regan Helen C.
Published: September 2009

Objective:

To achieve immunity to hepatitis B in healthcare workers who failed to respond to intramuscular vaccination and boosters.

Design:

An open prospective study of intradermal vaccination with recombinant hepatitis B vaccine.

Setting:

A large community hospital in Connecticut.

Participants:

Healthcare workers including physicians, nurses, and laboratory workers.

Results:

Immunization with high-dose intradermal recombinant hepatitis B vaccine, given in up to four doses, achieved immunity in 88% of healthcare workers who had previously been nonimmune.

Conclusions:

We conclude that intradermal vaccination is efficacious in the majority of healthcare workers who failed to respond to intramuscular vaccine. Further studies, including randomized comparisons with intramuscular vaccine as well as studies of cell-mediated immunity, appear warranted.
Nosocomial Outbreak Caused by a Multiresistant Clone of Acinetobacter baumannii: Results of the Case- Control and Molecular Epidemiologic Investigations
Authors: Scerpella E.G. , Wanger A.R. , Armitige L. , Anderlini P. , Ericsson C.D.
Published: September 2009

Objective:

To describe a nosocomial outbreak caused by multiresistant Acinetobacter baumannii.

Design:

Descriptive and case-control study. Antibiotic susceptibilities and pulsed-field gel electrophoresis (PFGE) of genomic DNA digested with Sfil and also with Apal were used as markers of strain identity.

Setting:

A large medical school-affiliated hospital in the city of Houston, Texas.

Results:

During a 10-week period, A baumannii was isolated from 25 patients admitted to the intensive care unit (ICU). The attack rate was 14.3 per 100 ICU admissions. Case patients were intubated more frequently and for longer periods, and had longer ICU and hospital stays (P<0.05 for each of these characteristics). Multivariate logistic regression analysis identified the length of ICU stay and the use of third-generation cephalosporins as associated with the acquisition of A baumannii. Patients infected with A baumannii had a higher mortality rate than colonized patients and control patients [P<0.0l). Sixteen isolates recovered from these 25 patients were susceptible only to imipenem/ cilastatin, and PFGE confirmed that a single clone was the cause of this outbreak. Nine isolates of A baumannii from patients infected or colonized in two other hospitals in Houston during the same period, differed from the outbreak isolates by their susceptibility to ciprofloxacin. However, PFGE results were identical, indicating unsuspected genetic relatedness among isolates from three different hospitals.

Conclusions:

A baumannii is an important nosocomial opportunistic pathogen and can adversely affect the outcome of ICU patients who acquire this organism. This outbreak was caused by a single clone that was isolated concurrently from three hospitals.
Disposal-Related Sharps Injuries at a New York City Teaching Hospital
Authors: Weltman Andre C. , Short Louise J. , Mendelson Meryl H. , Lilienfeld David E. , Rodriguez Marge
Published: September 2009

Objective:

To characterize disposal-related sharps injuries.

Design:

A three-part study including (a) descriptive analysis of disposal-related injuries in a l-year period, (b) 4:l matched case-control study of nurses injured while using sharps disposal containers, and (c) survey to solicit opinions of users of containers.

Setting:

An 1,181-bed teaching hospital in New York City.

Participants:

For epidemiologic analyses, persons with self-reported injuries identified via New York State and Occupational Safety and Health Administration forms and control nurses without self-reported injuries. For survey, convenience sample of hospital nurses, laboratory workers, and maintenance workers.

Main Outcome Measures:

Circumstances of injuries determined by study questionnaires. Employee opinions obtained by questionnaires and discussions during small group sessions.

Results:

Three hundred sixty-one persons reported sharps injuries, of whom 72 (20%) had disposal-related injuries. Persons with disposal-related injuries included four hospital visitors and one patient. Of 67 disposal-related injuries among employees, 25 (37%) directly involved use of a sharps disposal container. Significant risk factors for injury included container height greater than 4 ft above the floor, distance less than 5 ft from site of sharp object use to nearest container, and lack of attendance at universal precautions inservice classes. Survey groups involved 69 employees who identified a variety of preferred features for sharps disposal containers.

Conclusions:

Disposal of sharp objects is an important cause of sharps injuries. Ergonomic factors, worker education, and appropriate container design should be considered in injury prevention strategies. Relevant guidelines and regulations are lacking and are needed.
Evaluation of a Rapid Readout Biological Indicator for 121°C Gravity and 132°C Vacuum-Assisted Steam Sterilization Cycles
Authors: Vesley Donald , Nellis Melissa A. , Allwood Paul B.
Published: September 2009

Objective:

A biological indicator (BI), based on fluorescent detection of a spore-associated enzyme, has been developed. We evaluated the new BI against five conventional self-contained BIs in a 121°C gravity-displacement sterilizer and, packaged in towel packs and disposable steam test packs, in a 132°C vacuum-assisted sterilizer.

Design:

In the 121°C gravity-displacement sterilizer, rapid readout BIs and conventional BIs were tested together in an otherwise empty chamber. Exposure times were 5, 10, and 15 minutes. In the 132°C vacuum-assisted steam sterilizer, BIs were contained in towel packs or disposable steam test packs. Surgical packs were added to represent a full load. Exposure times were 0, 1, and 2 minutes.

Result:

In gravity-displacement 5-minute cycles, the rapid readout BIs yielded 100% positive results within 30 minutes. The conventional BIs ranged from 72% to 100% positive in 48 hours. At 10 minutes, the rapid readout BIs were 83% positive after 3 hours, whereas the conventional BIs ranged from 0% to 37% positive after 48 hours. All indicators were negative after 15-minute exposures. In vacuum-assisted cycles, all indicators were negative after 3 minutes. After 1-minute exposures, the rapid readout BIs were 40% to 60% positive, whereas the conventional BIs were 15% to 20% positive.

Conclusion:

The rapid readout BIs are a more sensitive indicator of marginal steam sterilization cycles than conventional selfcontained BIs. They yield results within 3 hours, as compared to 24 to 48 hours for the conventional BIs.
Antimicrobial Use in Patients With Positive Intravascular Catheter Cultures A Six-Month Prospective Survey in a Teaching Hospital
Authors: Rello Jordi , Vallés Jordi , Fontanals Dionisia , Jubert Paola , Segura Ferran
Published: September 2009

Review of medical records revealed that, of 190 intravascular catheters sent for culture during the study period, 50 were positive. Of these 50, 11 (22%) were sent for culture as a routine procedure without special clinical indications. Of the remaining 39 cultures, only 11 (28%) had clinical impact in the patient's management. Ten of the 50 therapeutic interventions were inappropriate. Restricting cultures to patients who may have catheter-related infection is likely to lead to significant cost savings.
Plasmid Analysis of 26 Staphylococcal Species by a Rapid Microscale Technique
Authors: Herchline Thomas , Maher William
Published: September 2009

Objective:

Evaluate a plasmid typing technique for a diverse group of staphylococci.

Design:

In vitro testing on known isolates.

Setting:

University hospital.

Intervention:

The plasmid content of 195 isolates representing 26 staphylococcal species was analyzed by agarose gel electrophoresis following lysostaphin-alkaline-SDS lysis, with and without acetone treatment.

Results:

Isolates yielded plasmid profiles with 0 to 7 extra-chromosomal bands (median, 1; 1.5); 171 (88%) had a profile with at least 1 band. Species with more than one isolate available for testing showed considerable diversity of plasmid profiles, except for Staphylococcus haemolyticus.

Conclusions:

The ease of the procedure and the diversity of plasmid profiles within each species examined suggests that plasmid profiling is an accessible and useful epidemiologic tool applicable to most staphylococcal species by epidemiologic units or clinical laboratories.
Prevention and Control of Varicella-Zoster Infections in Healthcare Facilities
Authors: Weber David J. , Rutala William A. , Hamilton Holli
Published: September 2009

Varicella-zoster virus (VZV) is the causative agent of two diseases: varicella (chickenpox) and zoster (shingles). Although varicella generally is a mild disease in children, serious morbidity and mortality are common if infection occurs in neonates, pregnant women, adults, or immunocompromised patients. For this reason, the Centers for Disease Control and Prevention recommends that all the hospitals institute control measures. Healthcare workers should be screened for VZV immunity and, if susceptible, should receive the recently licensed Oka/Merck vaccine (unless contraindicated). This article reviews nosocomial outbreaks associated with VZV and provides detailed algorithms for preexposure immunization and postexposure management of healthcare workers exposed to VZV.
Percutaneous Feeding Tube Changes in Long-Term–Care Facility Patients
Authors: Graham Sylvia , Sim Gloria , Laughren Ruby , Chicoine Joyce , Stephenson Edith , Leche Gwen , McIntyre Margaret , Murray David , Aoki Fred Y. , Nicolle Lindsay E.
Published: September 2009

Objective:

To compare patient outcomes when percutaneous feeding tubes were changed routinely each month or only when necessary (prn).

Design:

Prospective, randomized, nonblinded crossover study of 6 months of routine monthly changes compared with 6 months of prn changes.

Setting:

416-bed long-term–care facility.

Patients:

26 permanent residents with nutrition managed through percutaneous gastrostomy or jejunosto-my feeding tubes. The median age was 61.5 years; 8 (31%) also had tracheostomies, and 3 (12%) had indwelling urinary catheters.

Results:

The frequency of feeding tube changes was 40 per 1,000 patient-days during the 6 months of routine tube changes and 14 per 1,000 when tubes were changed prn (P<.001). There were no differences between the two study periods in frequency of stoma site infections, fever, episodes of emesis, and total antibiotic courses. The median duration in situ of feeding tubes with prn changes was 104 days. For both periods, feeding tubes were significantly more likely to fall out and require replacement within 24 hours of previous tube replacement.

Conclusion:

There were no observed differences in clinical outcomes in long-term–care facility patients when feeding tubes were changed only as necessary as compared to routine monthly changes.
Gram-Negative Bacteremia in Open-Heart–Surgery Patients Traced to Probable Tap-Water Contamination of Pressure-Monitoring Equipment
Authors: Rudnick Judith R. , Beck-Sague Consuelo M. , Anderson Roger L. , Schable Barbara , Miller J. Michael , Jarvis William R.
Published: September 2009

Objective: To determine the cause(s) of an outbreak of gram-negative bacteremia (GNB) in open-heart–surgery (OHS) patients at hospital A.

Design: Case-control and cohort studies and an environmental survey.

Results: Nine patients developed GNB with Enterobacter cloacae (6), Pseudomonas aeruginosa (5), Klebsiella pneumoniae (3), Serratia marcescens (2), or Klebsiella oxytoca (1) following OHS; five of nine patients had polymicrobial bacteremia. When the GNB patients were compared with randomly selected OHS patients, having had the first procedure of the day (8 of 9 versus 12 of 27, P=.02), longer cardiopulmonary bypass (median, 122 versus 83 minutes, P=.01) or cross-clamp times (median, 75 versus 42 minutes, P=.008), intraoperative dopamine infusion (9 of 9 versus 15 of 27, P=.01), or exposure to scrub nurse 6 (6 of 9 versus 4 of 27, P=.001) were identified as risk factors. When stratified by length of the procedure, only being the first procedure of the day and exposure to scrub nurse 6 remained significant. First procedures used pressure-monitoring equipment that was assembled before surgery and left open and uncovered overnight in the operating room, whereas other procedures used pressure-monitoring equipment assembled immediately before the procedure. At night, operating rooms were cleaned by maintenance personnel who used a disinfectant-water solution sprayed through a hose connected to an automatic diluting system. Observation of the use of this hose documented that this solution could have contacted and entered uncovered pressure-monitoring equipment left in the operating room. Water samples from the hose revealed no disinfectant, but grew P aeruginosa. The outbreak was terminated by setting up pressure-monitoring equipment immediately before the procedure and discontinuing use of the hose-disinfectant system.

Conclusions: This outbreak most likely resulted from contamination of uncovered preassembled pressure-monitoring equipment by water from a malfunctioning spray disinfectant device. Pressure-monitoring equipment should be assembled immediately before use and protected from possible environmental contamination.
Basic Microbiologic Support for Hospital Epidemiology
Authors: Herwaldt Loreen A. , McGowan John E. , Metchock Beverly G.
Published: September 2009

The laboratory plays a major role in the epidemiology program's efforts to minimize nosocomial infections in healthcare institutions. This article will describe some of the interactions between the laboratory and the epidemiology program, and will identify resources and procedures that the laboratory needs to achieve epidemiologic goals.
The Effect of a Portable Hepa-Filtered Body Exhaust System on Airborne Microbial Contamination in a Conventional Operating Room
Authors: Bohn William W. , McKinsey David S. , Dykstra Mark , Koppe Susan
Published: September 2009

Objective: To study the effect of a portable HEPA-filtered air exhaust system (Stackhouse Freedom Surgical Helmet System) on airborne microbial contamination in a modern conventional operating room.

Design and Setting: Microbial air sampling was done with a two-stage Anderson sampler at the wound site during 46 total joint replacements. All operations were performed by the same surgeon in the same operating room at a large community hospital.

Results: In 18 cases done without air exhaust hoods, the number of bacterial and fungal colony-forming units (CFU) ranged from 0.6 to 11.7 (mean, 3.6). Air sampling during 28 operations with the operating team in air exhaust hoods revealed a mean of 3.6 CFU (range, 0 to 11.4). Bacterial CFU averaged 3.4 without hoods and 3.2 with exhaust hoods. Coagulase-negative staphylococci were the most common isolates (48% of isolates with hood, 55% without hood). No infections occurred.

Conclusion: We conclude that these air exhaust hoods did not lower airborne microbial contamination detectable with this air sampling method, as compared to standard head cover and mask, in a modern conventional operating room.
Influenza Vaccination of Medical Residents at the University of Virginia: 1986 to 1994
Authors: Fedson David S.
Published: September 2009

During the 9-year period from 1986 to 1994, medical residents at the University of Virginia Health Sciences Center were offered free influenza vaccine in the General Medicine Clinic (GMC). Vaccination rates rose from 24% in 1986 to 99% in 1991. With changes in the GMC staff, the rates during the next 2 years dropped to 82% and 63%, respectively. Renewed attention to the vaccination program in 1994 led to a vaccination rate among eligible residents of 97%. Although the Employee Health Service also conducted its own vaccination programs for hospital personnel, the GMC accounted for most of the influenza vaccinations given to the medical residents throughout the 9-year period. The success of the GMC program demonstrates the importance of offering influenza vaccine to healthcare workers at their worksites and of focused responsibility to ensure that this is done.
Dissolving the Problem of Infectious Medical Waste
Authors: Crow Sue
Published: September 2009

Decisions in purchasing healthcare products are based on fiscal responsibility, employee safety, regulatory agency guidelines, and environmental conservation. One of today's major dilemmas in health care is that of disposing of medical waste. The Isolyser Company of Norcross, Georgia, is one of the first to develop a biocycle system to reduce the problem of contaminated waste. A description of the system is provided, along with its advantages and disadvantages.
Emerging Infectious Diseases in the Institutional Setting: Another Hot Zone
Authors: Ostroff Stephen M.
Published: September 2009

During the closing years of the 20th century, there has been an unprecedented number of newly recognized infectious agents and a resurgence of infectious diseases only recently thought to be conquered. These problems have been compounded by the increasing number of pathogens that have evolved resistance to antimicrobial agents. Hospitals and other institutional settings occupy a pivotal niche in the emergence of infectious agents due to factors such as the large concentrations of ill and immunocompromised persons, evolving technologies in healthcare settings, routine breeches of host defense mechanisms, and frequent use of antimicrobial agents. Any comprehensive strategy to address emerging infectious diseases must incorporate provisions for healthcare settings, including efforts to enhance surveillance, response capacity, training, education, applied research, and routine implementation of prevention measures.
Automatic Alerts for Methicillin-Resistant Staphylococcus aureus Surveillance and Control: Role of a Hospital Information System
Authors: Pittet Didier , Safran Edith , Harbarth Stephan , Borst François , Copin Pascale , Rohner Peter , Scherrer Jean-Raoul , Auckenthaler Raymond
Published: September 2009

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is an escalating problem in hospitals worldwide. The hospital reservoir for MRSA includes recognized and unrecognized colonized or infected patients, as well as previously colonized or infected patients readmitted to the hospital. Early and appropriate infection control measures (ICM) are key elements to reduce MRSA transmission and to control the hospital reservoir.

Objective: To describe the role of an expert system applied to the control of MRSA at a large medical center (1,600 beds) with high endemic rates.

Methods: The University Hospital of Geneva has an extended hospital information system (HIS), DIOGENE, structured with an open distributed architecture. It includes administrative, medical, nursing, and laboratory applications with their relational databases. Among available patient databases, clinical microbiology laboratory and admission-discharge-transfer (ADT) databases are used to generate computer alerts. A laboratory alert (lab alert) is printed daily in the Infection Control Program (ICP) offices, listing all patients with cultures positive for MRSA detected within the preceding 24 hours. Patients might be either newly detected patients colonized or infected with MRSA, or previously recognized MRSA patients having surveillance cultures. The ICP nurses subsequently go to the ward or call the ward personnel to implement ICM. A second alert, the “readmission alert,” detects readmission to the hospital of any patient previously colonized or infected with MRSA by periodic queries (q 1 min) to the ADT database. The readmission alert is printed in the ICP offices, but also forwarded with added guidelines to the emergency room.

Results: During the first 12 months of application (July 1994 to June 1995), the lab alert detected an average of 4.6 isolates per day, corresponding to 314 hospital admissions (248 patients); the use of this alert saved time for the ICP nurses by improving work organization. There were 438 readmission alerts (1.2 alerts per day) over the study period; of 347 patients screened immediately upon readmission, 114 (33%) were positive for MRSA carriage. Delayed recognition of readmitted MRSA carriers decreased significantly after the implementation of this alert; the proportion of MRSA patients recognized at the time of admission to the hospital increased from 13% in 1993 to 40% in 1995 (P<.001).

Conclusions: Hospital information system-based alerts can play an important role in the surveillance and early prevention of MRSA transmission, and it can help to recognize patterns of colonization and transmission.
Host-Bacteria Interactions in Foreign Body Infections
Authors: François Patrice , Vaudaux Pierre , Foster Timothy J. , Lew Daniel P.
Published: September 2009

Persistent staphylococcal infections are a major medical problem, especially when they occur on implanted materials or intravascular catheters. This review describes some of the recently discovered molecular mechanisms of Staphylococcus aureus attachment to host proteins coating biomedical implants. These interactions involve specific surface proteins, called bacterial adhesins, that recognize specific domains of host proteins deposited on indwelling devices, such as fibronectin, fibrinogen, or fibrin. Elucidation of molecular mechanisms of S aureus adhesion to the different host proteins may lead to the development of specific inhibitors blocking attachment of S aureus, which may decrease the risk of bacterial colonization of indwelling devices.
Operative Precautions in HIV and Other Bloodborne Virus Diseases
Authors: Raahave Dennis
Published: September 2009

Mathematical means have suggested that the surgical team is at particular risk of acquiring HIV (or other bloodborne viruses) from a source patient. To reduce this risk, it is mandatory to avoid accidental injuries during operative procedures. The surgeon must handle tissues with instruments and must minimize finger use. Sharp instruments should be passed through a neutral zone to ensure that the surgeon and nurse do not touch the same instrument at the same time. Instruments should not be handled blindly, but instead should be accompanied by eye and verbal contact. We find these changes in surgical technique are necessary for present and future generations of surgeons.
Prevention of Fungal Infections in Hematology Patients
Authors: Philpott-Howard John
Published: September 2009

Endogenous infections such as candidiasis can be minimized by oral fluconazole prophylaxis, although oral or intravenous amphotericin, or itraconazole, are suitable for certain patients. Exogenous fungal infections most commonly are transmitted by the airborne route, but the benefits of high-efficiency particulate air-filtered room air probably are diminishing as broad-spectrum prophylaxis against Aspergillus species and other fungi improves. However, high-risk environmental sources such as construction work always must be avoided near neutropenic patients. Reactivation of quiescent pulmonary Aspergillus infection can be prevented by surgical resection during remission, or by systemic amphotericin prophylaxis during subsequent neutropenic episodes.
Epidemiology, Diagnosis, and Therapy of Fungal Infections in Surgery
Authors: Giamarellou Helen , Antoniadou Anastasia
Published: September 2009

Over the past decade, the incidence of hospital-acquired bloodstream infections caused by Candida strains has risen, while the implicated species have changed. Candida tropicalis, Candida parapsilosis, and Candida glabrata all have increased in incidence. Data from the Centers for Disease Control and Prevention reveal that, between 1980 and 1990, Candida emerged as the sixth most common nosocomial pathogen (7.2.%) and was the fourth most common pathogen in nosocomial bloodstream infections, surpassed only by coagulase-negative staphylococci, Staphylococcus aureus, and enterococci. The incidence of candidemia is dramatically higher in high-risk critical-care units: 25% of cases occur in surgical intensive-care units (ICUs) versus 25% in bone marrow transplantation units, 20% in medical ICUs, 20% in general medical wards, and 10% in oncology-hematology units. Burns and gastrointestinal surgery predispose to nosocomial candidemia. Independent risk factors include prior therapy with multiple antibiotics, isolation of Candida from sites other than blood, and prior hemodialysis. Crude mortality exceeds 55% and is associated with older age and concomitant renal failure, hepatic failure, acute respiratory diseases, or postoperative shock. In addition to extreme vigilance for early recognition of Candida sepsis in critically ill surgical patients, the high risk for candidemia probably necessitates fungal surveillance cultures and initiation of preemptive antifungal therapy in high-risk surgical patients.
Healthcare Workers' Attitudes and Compliance With Universal Precautions Gender, Occupation, and Specialty Differences
Authors: Jeffe Donna B. , Mutha Sunita , L'Ecuyer Paul B. , Kim Lynn E. , Singal Renee B. , Evanoff Bradley A. , Fraser Victoria J.
Published: September 2009

We describe variations in healthcare workers' attitudes toward double gloving and reporting needlesticks, and in their readiness to comply with double gloving and hepatitis B vaccine. Differences related to occupation, specialty, and gender have implications for the need to tailor interventions for specific groups of healthcare workers to improve compliance with Universal Precautions.
Risk Features for Surgical-Site Infections in Coronary Artery Bypass Surgery
Authors: Vuorisalo Sailaritta , Haukipuro Kari , Pokela Risto , Syrjälä Hannu
Published: September 2009

OBJECTIVE: To identify preoperative and perioperative features that may lead to a risk of surgical-site infection (SSI) after coronary artery bypass surgery.

DESIGN: 884 patients who underwent coronary artery bypass grafting in 1992 and 1993 were studied. The associations between 23 preoperative and perioperative features and the presence of SSI at the donor site or in the chest area were evaluated by univariate analysis followed by multivariate logistic regression analysis.

SETTING: A university hospital.

RESULTS: 172 patients (19.5%) either had an SSI recorded before discharge or had received antibiotics prescribed for a suspected SSI during the 1-month surveillance period after discharge. Multivariate logistic regression analysis showed an extreme body mass index (BMI; P=.015), female gender (P=.023), and chronic obstructive pulmonary disease (COPD; P=.030) to be independent risk features for SSI. The donor site was infected in 136 patients (15.4%), an event for which female gender (P=.003) was the only independent risk feature. Forty-seven patients (5.3%) had an SSI of the chest area, with diabetes (P=.003) and extreme BMI (P=.010) as independent risk features.

CONCLUSION: Extreme BMI, female gender, and COPD are highly significant independent predictors of the development of SSI. Female gender is a risk feature specifically for SSI at the donor site, whereas diabetes and extreme BMI predict it in the chest area.
Comparing Nosocomial Infection Rates Among Surgical Intensive-Care Units: The Importance of Separating Cardiothoracic and General Surgery Intensive-Care Units
Authors: Keita-Perse Olivia , Edwards Jonathan R. , Culver David H. , Gaynes Robert P.
Published: September 2009

Among surgical intensive-care units (ICUs), we assessed differences in risk-adjusted nosocomial infection rates between cardiothoracic (CT) and general surgery ICUs, using National Nosocomial Infection Surveillance data from 1987 to 1995. Device-associated rates and average length of stay were significantly lower in CT ICUs. Comparisons of risk-adjusted nosocomial infection rates among CT ICUs should be made separately from rates from general surgery ICUs.
Preventing Antibiotic Resistance Using Rapid DNA-Based Diagnostic Tests
Authors: Bergeron Michel G. , Ouellette Marc
Published: September 2009

Improved diagnostic procedures should be an effective way to control infectious diseases and the spread of antibiotic resistance. To do so, diagnostics will need to be obtained within 1 hour of sampling and will require nucleic acid-based amplification tests directly on the clinical specimen.
Modeling Measles, Mumps, and Rubella: Implications for the Design of Vaccination Programs
Authors: Gay Nigel J.
Published: September 2009

Mathematical models of disease transmission are being used increasingly in the design of population-based vaccination programs. Their use is illustrated in a review of some modeling studies that have implications for the use of measles, mumps, and rubella vaccine. Investigations of vaccination strategy options yield predictions for effectiveness and cost-effectiveness analyses. A quantitative understanding of the factors affecting disease transmission enables the setting of targets for vaccination programs and underpins disease elimination initiatives.
Critical-Care–Unit Bedside Design and Furnishing: Impact on Nosocomial Infections
Authors: Harvey Maurene A.
Published: September 2009

Hospitals in the process of building or renovating intensive-care units (ICUs) often establish multidisciplinary design teams. However, these teams rarely include infection control professionals. Because nosocomial infection is common in the ICU, design features can affect the risk of infection transmission, and outbreaks can occur during construction, this exclusion seems shortsighted. Infection control professionals are familiar with the relevant research, as well as the regulations and guidelines related to ICU design and infection control practices. Not only is their input essential to the design and construction of safe and effective units but their presence on the design team can allow the prospective collection of comparative data to turn the building project into a research project.
Simultaneous linearization of holomorphic germs in presence of resonances
Authors: Raissy Jasmin
Published: September 2009

Let 

f

1

,
…
,

f

m

f_{1}, \dots , f_{m}

be 

m
≥
2

m\ge 2

germs of biholomorphisms of 

C

n

\mathbb {C}^{n}

, fixing the origin, with 

(

d

f

1

)

O

(\mathrm {d}f_{1})_{O}

diagonalizable and such that 

f

1

f_{1}

commutes with 

f

h

f_{h}

for any 

h
=
2
,
…
,
m

h=2,\dots , m

. We prove that, under certain arithmetic conditions on the eigenvalues of 

(

d

f

1

)

O

(\mathrm {d}f_{1})_{O}

and some restrictions on their resonances, 

f

1

,
…
,

f

m

f_{1}, \dots , f_{m}

are simultaneously holomorphically linearizable if and only if there exists a particular complex manifold invariant under 

f

1

,
…
,

f

m

f_{1}, \dots , f_{m}

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Metabolism and Pharmacokinetics of San‐Huang‐Xie‐Xin‐Tang, a Polyphenol‐Rich Chinese Medicine Formula, in Rats and Ex-Vivo Antioxidant Activity
Authors: Shia Chi-Sheng , Hou Yu-Chi , Juang Shin-Hun , Tsai Shang-Yuan , Hsieh Pei-Hsun , Ho Lu-Ching , Chao Pei-Dawn Lee
Published: September 2009

San‐Huang‐Xie‐Xin‐Tang (SHXXT), a widely used Chinese herbal formula, consists of rhizomes of Rheum officinale, roots of Scutellaria baicalensis and rhizomes of Coptis chinesis. This study investigated the metabolism and pharmacokinetics of polyphenols in SHXXT, including baicalin, baicalein, wogonin, emodin, aloe‐emodin, rhein and chrysophanol. The quantitation methods of SHXXT decoction and rat serum using high performance liquid chromatography were developed and validated in this study. After oral administration of SHXXT decoction to rats, the parent forms of various constituents and their conjugated metabolites in serum were determined before and after hydrolysis with β‐glucuronidase and sulfatase. The results showed that only free form of rhein can be quantitated, whereas the parent forms of coptisine, palmatine, berberine, baicalein, wogonin, emodin, aloe‐emodin and chrysophanol were not detected in serum. The glucuronides of baicalein, wogonin, emodin, aloe‐emodin, rhein and chrysophanol were the predominant forms in bloodstream. In order to evaluate the in vivo antioxidant activity of SHXXT, the serum metabolite of SHXXT was prepared, characterized and followed by evaluation of the effect on AAPH‐induced hemolysis. The results indicated that metabolites of SHXXT exhibited significant free radical scavenging activity. We suggest that biologists redirect their focus to the bioactivity of the conjugated metabolites of these polyphenols.
Transmission of Grapevine Leafroll Viruses byPlanococcus ficus(Hemiptera: Pseudococcidae) andCeroplastes rusci(Hemiptera: Coccidae)
Authors: Mahfoudhi N. , Digiaro M. , Dhouibi M. H.
Published: September 2009

Grapevine leafroll associated virus-3 (GLRaV-3) and Grapevine leafroll associated virus-5 (GLRaV-5), two members of the genus Ampelovirus associated with grapevine leafroll disease, were transmitted by the mealybug Planococcus ficus and the soft scale insect Ceroplastes rusci from infected to healthy vines under experimental conditions. The efficiencies of transmission of GLRaV-3 and GLRaV-5 by P. ficus were 23.3 and 8.3%, respectively, and by C. rusci were 3.3 and 1.7%, respectively. Juvenile instars of P. ficus were more efficient in transmission of the viruses than adult females. This is the first report of the ability of C. rusci to transmit these viruses to grapevines.
Seasonal Progress of Phomopsis longicolla Infection on Soybean Plant Parts and Its Relationship to Seed Quality
Authors: Mengistu Alemu , Castlebury Lisa , Smith Rusty , Ray Jeff , Bellaloui Nacer
Published: September 2009

Phomopsis longicolla is a major seed pathogen of soybean (Glycine max) in hot, humid environments. The objective of this study was to monitor the infection and development of P. longicolla on vegetative and reproductive tissues of six cultivars and to determine the relationship between this infection and subsequent seed infection and seed germination. Cultivars were grown for 3 years (2002 to 2004) without irrigation or with irrigation applied at pre- plus postflowering or at postflowering growth stages. P. longicolla was isolated most frequently from leaf, stem, pod, root, and seed. Diaporthe phaseolorum and three unidentified Phomopsis sp. were also isolated. Diaporthe aspalathi, which previously has not been reported on soybean, was also recovered from leaf samples. These isolates, however, were recovered very infrequently. Recovery of P. longicolla from roots was much lower than from leaves, stems, and pods in all years and irrigation environments. The recovery of P. longicolla from seed was affected by irrigation environments. Seed from irrigated plots had more P. longicolla than that from nonirrigated plots. Isolation of P. longicolla from seed was negatively correlated with percentage of seed germination in irrigated environments but not in the nonirrigated environment. Pod infection was correlated with seed infection in all three irrigation environments. Even though infection of leaves and stems increased with increasing moisture availability, such infection did not consistently correlate with seed infection. Seed germination and seed infection were negatively correlated with percent hard seed. This study provided the first demonstration of the seasonal progression of P. longicolla on soybean cultivars grown under three irrigation environments.
Mustard and Other Cover Crop Effects Vary on Lettuce Drop Caused bySclerotinia minorand on Weeds
Authors: Bensen Tiffany A. , Smith Richard F. , Subbarao Krishna V. , Koike Steven T. , Fennimore Steven A. , Shem-Tov Shachar
Published: September 2009

Mustard cover crops have been suggested as a potential biofumigant for managing soilborne agricultural pests and weeds. We conducted several experiments in commercial lettuce fields in the Salinas Valley, CA, to evaluate the effects of mustard cover crops on lettuce drop caused by Sclerotinia minor and on weed density and seed viability. In a long-term study, we measured the effects of white and Indian mustard cover crops on the density of S. minor sclerotia in soil, lettuce drop incidence, weed densities, weed seed viability, and crop yield in head lettuce. We also tested broccoli and rye cover crop treatments and a fallow control. Across several short-term studies, we evaluated the density of S. minor sclerotia in soil, lettuce drop incidence, weed densities, and weed seed viability following cover cropping with a mustard species blend. Numbers of sclerotia in soil were low in most experimental locations and were not affected by cover cropping. Mustard cover crops did not reduce disease incidence in the long-term experiment but the incidence of lettuce drop was lower in mustard-cover-cropped plots across the short-term experiments. With the exception of common purslane and hairy nightshade, weed densities and weed seed viability were not significantly reduced by cover cropping with mustard. Head lettuce yield was significantly higher in mustard-cover-cropped plots compared with a fallow control. Glucosinolate content in the two mustard species was similar to those measured in other studies but, when converted to an equivalent of a commercial fumigant, the concentrations were much lower than the labeled rate for lettuce production. Although mustard cover cropping resulted in yield benefits in this study, there was little to no disease or weed suppression.
Infection of ‘d'Anjou’ Pear Fruit by Potebniamyces pyri in the Orchard in Relation to Phacidiopycnis Rot during Storage
Authors: Liu Q. , Xiao C. L.
Published: September 2009

Phacidiopycnis rot, caused by Potebniamyces pyri, is a recently recognized postharvest fruit rot disease of ‘d'Anjou’ pear (Pyrus communis) in the United States. To determine the timing of fruit infection in the orchard in relation to incidence of Phacidiopycnis rot during storage, fruit were inoculated in the orchard at different times during the growing season, harvested, and monitored for decay development during storage at 0°C. Fruit inoculated in the field and laboratory were also used to determine the infection courts and the importance of necrotic tissues to infection of sepals that may lead to calyx-end Phacidiopycnis rot. Phacidiopycnis rot was observed during cold storage on the fruit inoculated any time after bloom till near harvest but not on the fruit inoculated during bloom. Phacidiopycnis rot symptoms only developed at the stem and calyx end of the fruit during storage. Relatively more calyx-end rot was observed than stem-end rot on the fruit inoculated before August. Incidence of stem-end rot increased significantly on the fruit inoculated near harvest. Incidence of total Phacidiopycnis rot increased as the timing of fruit infection in the orchard approached harvest. Potebniamyces pyri was recovered more frequently from sepals than from styles and stamens of the fruit. Most infections on sepals were associated with the necrotic tissues. Naturally occurring necrotic tissues occurred on more than 85% and all sepals in the early fruit-growing and late growing seasons, respectively. Such necrotic tissues on sepals could serve as potential infection sites for P. pyri. The results may suggest that chemical control of Phacidiopycnis rot should focus on protecting the pedicel (stem) and floral parts of fruit and that fungicides applied near harvest are likely most important in controlling latent infections of pear fruit by P. pyri leading to Phacidiopycnis rot during storage.
First Occurrence of Cucurbit Powdery Mildew Caused by Race 3-5 of Podosphaera fusca in Spain
Authors: Torés J. A. , Sánchez-Pulido J. M. , López-Ruiz F. , de Vicente A. , Pérez-García A.
Published: September 2009

A new race of cucurbit powdery mildew was observed for the first time on melon (Cucumis melo) in three research greenhouses in the Axarquia area of southern Spain during the spring of 2008. Fungal growth appeared as white powdery colonies initially restricted to the upper leaf surfaces. Morphological characteristics of colonies, conidiophores, conidia, germ tubes, and appressoria indicated that the powdery mildew fungus was Podosphaera fusca (also known as P. xanthii) (3), a fungal pathogen extensively reported in the area (1). However, the fungus developed on plants of melon cv. PMR 6, which is resistant to races 1 and 2 of P. fusca, suggesting that the fungus could belong to race 3, a race of P. fusca not yet reported in Spain. Race determination was carried out by inoculating the third true leaf of a set of differential melon genotypes that were maintained in a greenhouse. Symptoms and colonization observed on cvs. Rochet, PMR 45, PMR 6, and Edisto 47 indicated that the isolates belonged to race 3-5 of P. fusca. Fungal strains of races 1, 2, and 5 of P. fusca (all present in Spain) were used as controls. Pathotype designation was determined by inoculating different cucurbit genera and species (2). In addition to melon, the isolates were pathogenic on zucchini (Cucurbita pepo) cv. Diamant F1, but failed to infect cucumber (C. sativus) cv. Marketer and watermelon (Citrullus lanatus) cv. Sugar Baby; therefore, the isolates were pathotype BC (2). Races 1, 2, 4, and 5 of P. fusca have been previously reported in the area (1). The occurrence of race 3-5 represents another challenge in the management of cucurbit powdery mildew in Spain.

References: (1) D. del Pino et al. Phytoparasitica 30:459, 2002. (2) E. Křístková et al. Sci. Hortic. 99:257, 2004. (3) A. Pérez-García et al. Mol. Plant Pathol. 10:153, 2009.