bluuebunny/crossref_metadata_2025 huggingface dataset:
Natural History of Colonization With Vancomycin-Resistant Enterococci, Methicillin-Resistant Staphylococcus Aureus, And Resistant Gram-Negative Bacilli Among Long-Term–Care Facility Residents
Authors: Pacio Glenn A. , Visintainer Paul , Maguire George , Wormser Gary P. , Raffalli John , Montecalvo Marisa A.
Published: March 2006

Objective:

To determine the natural history of colonization with vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), and resistant gram-negative bacilli among long-term–care facility (LTCF) residents.

Design:

Observational cohort study.

Setting:

A 355-bed LTCF with a ventilator unit and a subacute unit.

Participants:

Residents with colonization or infection with VRE, MRSA or resistant gram-negative bacilli housed at the LTCF between December 1,1999, and February 29, 2000.

Methods:

Cultures of clinical and surveillance sites were performed at regular intervals. Charts were reviewed for clinical characteristics associated with clearance of colonization. Kaplan–Meier curves were constructed to analyze the number of days to clearance of colonization.

Results:

Forty-nine residents had 65 episodes of colonization (27 VRE, 30 MRSA and 8 resistant gram-negative bacilli). Eighteen (28%) of the episodes cleared. The clearance rate was 2.7 episodes per 1,000 person-days. Clearance occurred significantly more often with resistant gram-negative bacilli colonization compared with VRE or MRSA colonization (6 [75%] vs 12 [21%]; P = .007; relative risk, 4.17; 95% confidence interval, 1.26 to 11.8). There was a trend toward longer use of antimicrobial agents among residents with persistent colonization. Infections occurred most frequently with MRSA The urinary tract was the most common site of infection.

Conclusion:

Among LTCF residents, colonization with resistant gram-negative bacilli is four times more likely to clear than colonization with VRE or MRSA. Performance of surveillance cultures at regular intervals may reduce the need for contact precautions for LTCF residents with resistant gram-negative bacilli colonization.
AcinetobacterOutbreaks, 1977–2000
Authors: Villegas Maria Virginia , Hartstein Alan I.
Published: March 2006

This review ofAcinetobacteroutbreaks summarizes factors related to the presence and recognition of organism transmission and describes the implementation of control and prevention measures directed at limiting spread. Exogenous transmission ofAcinetobactershould be considered when infections are endemic and when case rates increase. Increasing or new antimicrobial resistances in a collection of isolates also suggest transmission, and transmission can be definitively confirmed when isolates are found to be indistinguishable from or related to one another by a discriminatory genotyping test. An investigation for a common source should be conducted. When a common source cannot be found and eliminated, or once an endemically transmitted organism is established, containment or prevention efforts may require aggressive interventions, complex interventions, or both. Colonization at multiple sites, the relative ease of induction of antibiotic resistance in the organism following patient exposure to multiple drugs, and long-term environmental survival provide enhanced opportunities for the transmission ofAcinetobacterbetween and among patients. New approaches and interventional trials are needed to define effective measures for the prevention and control ofAcinetobacterinfections.
Colonization and Infection With Multiple Nosocomial Pathogens Among Patients Colonized With Vancomycin-ResistantEnterococcus
Authors: Donskey Curtis J. , Ray Amy J. , Hoyen Claudia K. , Fuldauer Peter D. , Aron David C. , Salvator Ann , Bonomo Robert A.
Published: March 2006

Objective:

To test the hypothesis that patients colonized with vancomycin-resistantEnterococcus(VRE) have a higher frequency of colonization or infection with other nosocomial pathogens than do patients who are not colonized with VRE.

Design:

A rectal swab culture survey was conducted to determine the point-prevalence of stool colonization with ceftazidime-resistant gram-negative bacilli in hospitalized patients with or without VRE stool colonization. For a 6-month period, the frequency ofClostridium difficilediarrhea and isolation of antibiotic-resistant (ie, ceftazidime-, piperacillin/tazobactam-, levofloxacin-, or trimethoprim/sulfamethoxazole-resistant) gram-negative bacilli, methicillin-resistantStaphylococcus aureus(MRSA), and non-albicansCandidaspecies from clinical specimens other than stool was examined.

Setting:

A Department of Veterans Affairs medical center.

Patients:

All patients hospitalized in the acute care facility and one nursing home unit during a 1-week period in February 2001.

Results:

VRE-colonized patients had a higher point-prevalence of rectal colonization with ceftazidime-resistant gram-negative bacilli than did patients not colonized with VRE (17% vs 4%;P= .026). During a 6-month period, the VRE-colonized patients were more likely to haveClostridium difficile–associated diarrhea (26% vs 2%;P= .001), MRSA infection (17% vs 4%;P= .017), or colonization or infection with gram-negative bacilli resistant to 4 different antibiotics.

Conclusion:

VRE-colonized patients in our institution have a higher frequency of colonization or infection with other nosocomial pathogens than do patients who are not colonized with VRE. This suggests that isolation measures implemented to control VRE could help limit the dissemination of other, coexisting pathogens.
Implication of a Healthcare Worker With Chronic Skin Disease in the Transmission of an Epidemic Strain of Methicillin-Resistant Staphylococcus aureus in a Pediatric Intensive Care Unit
Authors: Berthelot Philippe , Grattard Florence , Fascia Pascal , Fichtner Christine , Moulin Martine , Lavocat Marie Pierre , Teyssier Georges , Lucht Frédéric , Pozzetto Bruno
Published: March 2006

This outbreak of colonization of neonates in a 10-bed pediatric intensive care unit illustrates the probable role of a healthcare worker (HCW) in the transmission of methicillin-resistant Staphylococcus aureus, despite good hygienic practices. It raises the issue of preventive exclusion of HCWs affected by chronic skin disease from high-risk units.
Impact of Antibiotic-Resistant Pathogens Colonizing the Respiratory Secretions of Patients in an Extended-Care Area of the Emergency Department
Authors: Dantas Sônia R. P. E. , Moretti-Branchini M. Luiza
Published: March 2006

Objective:

To determine the incidence of acquired infection, and the incidence, risk factors, and molecular typing of multidrug-resistant bacterial organisms (MROs) colonizing respiratory secretions or the oropharynx of patients in an extended-care area of the emergency department (ED) in a tertiary-care university hospital.

Methods:

A case-control study was conducted regarding risk factors for colonization with MROs in ED patients from July 1996 to August 1998. The most prevalent MRO strains were determined using plasmid and genomic analysis with PFGE.

Results:

MROs colonized 59 (25.4%) of 232 ED patients and 173 controls. The mean ED length of stay for the 59 cases was 13.9 days versus 9.8 days for the 173 controls. The mean length of stay prior to the first isolation of MROs was 9.9 days. MRO species includedAcinetobacter baumannii, Staphylococcus aureus,andPseudomonas aeruginosa.The rate of hospital-acquired infection was 32.7 per 1,000 ED patient-days. The case fatality rate was significantly higher for cases. Univariate analysis identified mechanical ventilation, nebulization, nasogastric intubation, urinary catheterization, antibiotic therapy, and number of antibiotics as risk factors for MRO colonization. Multivariate regression analysis found that mechanical ventilation and nasogastric intubation independently predicted MRO colonization. Endemic clones were identified by PFGE in ED patients and were also found in patients in other parts of the hospital.

Conclusions:

Prolonged stay in the ED posed a risk for colonization with MROs and for contracting nosocomial infections, both of which were associated with increased mortality. Patients colonized with antibiotic-resistantA. baumanniimay serve as a reservoir for spread in this hospital.
A Prospective Observational Study of the Effect of Penicillin Skin Testing on Antibiotic Use in the Intensive Care Unit
Authors: Arroliga Mercedes E. , Radojicic Christine , Gordon Steven M. , Popovich Marc J. , Bashour C. Allen , Melton Alton L. , Arroliga Alejandro C.
Published: March 2006

Background:

Patients with penicillin allergy admitted to the intensive care unit (ICU) frequently receive non-beta-lactam antimicrobials for the treatment of infection. The use of these antimicrobials, more commonly vancomycin and fluoroquinolones, is associated with the emergence of multidrug-resistant infections. The penicillin skin test (PST) can help detect patients at risk of developing an immediate allergic reaction to penicillin and those patients with a negative PST may be able to use a penicillin antibiotic safely.

Methods:

We determined the incidence of true penicillin allergy, the percentage of patients changed to a beta-lactam antimicrobial when the test was negative, the safety of the test, and the safety of administration of beta-lactam antimicrobials in patients with a negative test. Skin testing was performed using standard methodology.

Results:

One hundred patients admitted to 4 ICUs were prospectively studied; 58 of them were male. The mean age was 63 years. Ninety-six patients had the PST: one was positive (1.04%), 10 (10.4%) were nondiagnostic, and 85 (88.5%) were negative. Of the 38 patients who received antimicrobials for therapeutic reasons, 31(81.5%) had the antibiotic changed to a beta-lactam antimicrobial after a negative reading versus 7 patients of the 57 (12%) who had received a prophylactic antimicrobial (P < .001). No adverse effects were reported after the PST or after antimicrobial administration.

Conclusions:

The PST is a safe, reliable, and effective strategy to reduce the use of non-beta-lactam antimicrobials in patients who are labeled as penicillin allergic and admitted to the ICU.
Environmental Contamination Due to Methicillin-Resistant Staphylococcus aureus: Possible Infection Control Implications
Authors: Boyce John M. , Potter-Bynoe Gail , Chenevert Claire , King Thomas
Published: March 2006

Objective:

To study the possible role of contaminated environmental surfaces as a reservoir of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals.

Design:

A prospective culture survey of inanimate objects in the rooms of patients with MRSA.

Setting:

A 200-bed university-affiliated teaching hospital.

Patients:

Thirty-eight consecutive patients colonized or infected with MRSA. Patients represented endemic MRSA cases.

Results:

Ninety-six (27%) of 350 surfaces sampled in the rooms of affected patients were contaminated with MRSA. When patients had MRSA in a wound or urine, 36% of surfaces were contaminated. In contrast, when MRSA was isolated from other body sites, only 6% of surfaces were contaminated (odds ratio, 8.8; 95% confidence interval, 3.725.5; Pく.0001). Environmental contamination occurred in the rooms of 73% of infected patients and 69% of colonized patients. Frequently contaminated objects included the floor, bed linens, the patient's gown, overbed tables, and blood pressure cuffs. Sixty-five percent of nurses who had performed morning patient-care activities on patients with MRSA in a wound or urine contaminated their nursing uniforms or gowns with MRSA. Forty-two percent of personnel who had no direct contact with such patients, but had touched contaminated surfaces, contaminated their gloves with MRSA.

Conclusions:

We concluded that inanimate surfaces near affected patients commonly become contaminated with MRSA and that the frequency of contamination is affected by the body site at which patients are colonized or infected. That personnel may contaminate their gloves (or possibly their hands) by touching such surfaces suggests that contaminated environmental surfaces may serve as a reservoir of MRSA in hospitals.
Acquisition of Methicillin-Resistant Staphylococcus aureus in a Large Intensive Care Unit
Authors: Marshall Caroline , Harrington Glenys , Wolfe Rory , Fairley Christopher K. , Wesselingh Steve , Spelman Denis
Published: March 2006

Objectives:

To determine the prevalence of MRSA colonization on admission to the ICU and the incidence of MRSA colonization in the ICU.

Design:

Prospective cohort study.

Setting:

University hospital.

Participants:

Patients admitted to the ICU in 2000-2001.

Methods:

Patients were screened for MRSA with nose, throat, groin, and axilla swabs on admission and discharge. MRSA acquisition was defined as a negative admission screen and a positive discharge screen. Risk factors analyzed included previous wards/current unit, gender, age, and length of stay prior to and in the ICU. Univariate and multivariate analyses were performed using logistic regression.

Results:

Of screened patients, 6.8% were MRSA colonized on admission to the ICU. Some patients (11.4%) became newly colonized during their stay in the ICU. Factors that remained significant in the multivariate analysis of MRSA colonization on admission were previous admission to various wards and length of stay prior to ICU admission of more than 3 days. In the multivariate analysis of MRSA acquisition in the ICU, being a trauma patient and length of stay in the ICU greater than 2 days remained significant. Thirty-six percent of patients had both admission and discharge swabs taken. This percentage increased in the presence of a supervisory nurse.

Conclusion:

Significant acquisition of MRSA occurs in the ICU of our hospital, with trauma patients at increased risk. Patients who had been on the cardiothoracic ward prior to the ICU had a lower risk of MRSA colonization on admission. Presence of a supervisory nurse improved compliance with screening.
An Outbreak of Methicillin-ResistantStaphylococcus aureusin a Neonatal Intensive Care Unit
Authors: Saiman Lisa , Cronquist Alicia , Wu Fann , Zhou Juyan , Rubenstein David , Eisner William , Kreiswirth Barry N. , Della-Latta Phyllis
Published: March 2006

Objective:

To describe the epidemiologic and molecular investigations that successfully contained an outbreak of methicillin-resistantStaphylococcus aureus(MRSA) in a neonatal intensive care unit (NICU).

Design:

Isolates of MRSA were typed by pulsed-field gel electrophoresis (PFGE) and S.aureusprotein A(spa).

Setting:

A level III-IV, 45-bed NICU located in a children's hospital within a medical center.

Patients:

Incident cases had MRSA isolated from clinical cultures (eg, blood) or surveillance cultures (ie, anterior nares).

Interventions:

Infected and colonized infants were placed on contact precautions, cohorted, and treated with mupirocin. Surveillance cultures were performed for healthcare workers (HCWs). Colonized HCWs were treated with topical mupirocin and hexachlorophene showers.

Results:

From January to March 2001, the outbreak strain of MRSA PFGE clone B, was harbored by 13 infants. Three (1.3%) of 235 HCWs were colonized with MRSA. Two HCWs, who rotated between the adult and the pediatric facility, harbored clone C. One HCW, who exclusively worked in the children's hospital, was colonized with clone B. From January 1999 to November 2000, 22 patients hospitalized in the adult facility were infected or colonized with clone B.Spatyping and PFGE yielded concordant results. PFGE clone B was identified asspatype 16, associated with outbreaks in Brazil and Hungary.

Conclusions:

A possible route of MRSA transmission was elucidated by molecular typing. MRSA appears to have been transferred from our adult facility to our pediatric facility by a rotating HCW.Spatyping allowed comparison of our institution's MRSA strains with previously characterized outbreak clones.
Mupirocin-Resistant, Methicillin-ResistantStaphylococcus aureus: Does Mupirocin Remain Effective?
Authors: Walker Elaine S. , Vasquez Jose E. , Dula Roy , Bullock Hollie , Sarubbi Felix A.
Published: March 2006

Objective:

To determine the efficacy of mupirocin ointment in reducing nasal colonization with mupirocin-susceptible, methicillin-resistantStaphylococcus aureus(MS MRSA) as well as mupirocin-resistant MRSA (MR MRSA).

Design:

Prospective evaluation in which patients colonized with MRSA were treated twice daily with 2% topical mupirocin ointment for 5 days.

Setting:

James H. Quillen Veterans' Affairs Medical Center.

Patients:

Forty hospitalized patients with two anterior nares cultures positive for MRSA within a 7-day period.

Methods:

Treated patients had post-treatment cultures at day 3 and weeks 1,2, and 4. Isolates underwent mupirocin-susceptibility testing and DNA typing. MRSA clearance and type turnover were assessed for isolates that were mupirocin-susceptible, low-level (LL) MR MRSA and high-level (HL) MR MRSA.

Results:

Post-treatment nares cultures on day 3 were negative for 78.5%, 80%, and 27.7% of patients with MS MRSA, LL-MR MRSA, and HL-MR MRSA, respectively. Sustained culture negativity at 1 to 4 weeks was more common in the MS MRSA group (91%) than in the LL-MR MRSA group (25%) or the HL-MR MRSA group (25%). Positive post-treatment cultures usually showed the same DNA pattern relative to baseline. Plasmid curing of 18 HL-MR MRSA resulted in 15 MS MRSA and 3 LL-MR MRSA.

Conclusions:

Mupirocin was effective in eradicating MS MRSA, but strains of MR MRSA often persisted after treatment. This appeared to reflect treatment failure rather than exogenous recolonization. MR MRSA is now more prevalent and it is appropriate to sample MRSA populations for mupirocin susceptibility prior to incorporating mupirocin into infection control programs.
A 17-Month Evaluation of a Chlorine Dioxide Water Treatment System to Control Legionella Species in a Hospital Water Supply
Authors: Srinivasan Arjun , Bova Gregory , Ross Tracy , Mackie Karen , Paquette Nicholas , Merz William , Perl Trish M.
Published: March 2006

Objective:

To assess the safety and efficacy of a chlorine dioxide water treatment system in controlling Legionella in a hospital water supply.

Design:

For 17 months following installation of the system, we performed regular water cultures throughout the building, assessed chlorine dioxide and chlorite levels, and monitored metal corrosion.

Results:

Sites that grew Legionella species decreased from 41% at baseline to 4% (P = .001). L. anisa was the only species recovered and it was found in samples of both hot and cold water. Levels of chlorine dioxide and chlorite were below Environmental Protection Agency (EPA) limits for these chemicals in potable water. Further, enhanced carbon filtration effectively removed the chemicals, even at chlorine dioxide levels of more than twice what was used to treat the water. After 9 months, corrosion of copper test strips exposed to the chlorine dioxide was not higher than that of control strips. During the evaluation period, there were no cases of nosocomial Legionella in the building with the system, whereas there was one case in another building.

Conclusions:

Our results indicate that operation of a chlorine dioxide system effectively removed Legionella species from a hospital water supply. Furthermore, we found that the system was safe, as levels of chlorine dioxide and chlorite were below EPA limits. The system did not appear to cause increased corrosion of copper pipes. Our results indicate that chlorine dioxide may hold promise as a solution to the problem of Legionella contamination of hospital water supplies.
Shutting Down Operating Theater Ventilation When the Theater Is Not in Use: Infection Control and Environmental Aspects
Authors: Dettenkofer Markus , Scherrer M. , Hoch V. , Glaser H. , Schwarzer G. , Zentner J. , Daschner F. D.
Published: March 2006

Objective:

In hospital operating rooms (ORs), specially conditioned air is supplied to protect patients from airborne agents that may cause infections. This study investigated whether it is hygienically safe to shut down the air supply at night if measures are taken to ensure a timely restart before surgery is performed.

Design:

Experimental study.

Setting:

Neurosurgical OR of a German university hospital.

Methods:

The ventilation system was switched off and restarted after 10 hours. Particles suspended in the air near the operating table were counted, OR temperature was measured, and settle plates were exposed and incubated.

Results:

In 13 investigations, a median of 1.3 × 104 particles 0.5 μm/m3 or greater (range, 5.8 × 103 to 1.1 × 105) were documented immediately after restart in the morning. After 10 minutes and subsequently, no test showed a particle count exceeding the threshold limit of 1.0 × 104 particles 0.5 μm/m3 or greater recommended by the German Society of Hygiene and Microbiology. Only a few colony-forming units (CFU) were detected per settle plate (median, 0 CFU/60 cm2; range, 0 to 8) and OR temperatures quickly reached normal levels.

Conclusions:

Shutting down OR ventilation during off-duty periods does not appear to result in an unacceptably high particle count or microbial contamination of the OR air shortly after the system is restarted. Because substantial energy and cost savings are likely, this should be considered in hygienically safe heating, ventilation, and air conditioning systems. However, normal ventilation should be established at least 30 minutes before surgical activity.
Antianaerobic Antibiotic Therapy Promotes Overgrowth of Antibiotic-Resistant, Gram-Negative Bacilli and Vancomycin-Resistant Enterococci in the Stool of Colonized Patients
Authors: Bhalla Anita , Pultz Nicole J. , Ray Amy J. , Hoyen Claudia K. , Eckstein Elizabeth C. , Donskey Curtis J.
Published: March 2006

Background and Objective:

Antianaerobic antibiotic therapy promotes persistent high-density growth of vancomycin-resistant enterococci (VRE) in the stool of colonized patients. We tested the hypothesis that antibiotic regimens with potent antianaerobic activity promote overgrowth of coexisting antibiotic-resistant, gram-negative bacilli in the stool of VRE-colonized patients.

Design:

Eight-month prospective study examining the effect of antibiotic therapy on the stool density of gram-negative bacilli resistant to ceftazidime, ciprofloxacin, or piperacillin/tazobactam.

Setting:

A Department of Veterans Affairs medical center including an acute care hospital and nursing home.

Patients:

All VRE-colonized patients with at least 3 stool samples available for analysis.

Results:

One-hundred forty stool samples were obtained from 37 study patients. Forty-nine (61%) of 80 stool samples obtained during therapy with an antianaerobic regimen were positive for an antibiotic-resistant, gram-negative bacillus, whereas only 14 (23%) of 60 samples obtained 4 or more weeks after completion of such therapy were positive (P< .001). Twenty-four (65%) of the 37 patients had one or more stool cultures positive for a gram-negative bacillus resistant to ciprofloxacin, ceftazidime, or piperacillin/tazobactam. The density of these organisms was higher during therapy with antianaerobic regimens than in the absence of such therapy for at least 2 weeks (mean ± standard deviation, 5.6 ± 1.4 and 3.9 ± 0.71 log10organisms/g;P< .001).

Conclusion:

Limiting the use of antianaerobic antibiotics in VRE-colonized patients may reduce the density of colonization with coexisting antibiotic-resistant, gram-negative bacilli.
Nasal and Hand Carriage ofStaphylococcus aureusin Staff at a Department for Thoracic and Cardiovascular Surgery: Endogenous or Exogenous Source?
Authors: Tammelin Ann , Klötz Fia , Hambræus Anna , Ståhle Elisabeth , Ransjö Ulrika
Published: March 2006

Objective:

To investigate the rates ofStaphylococcus aureuscarriage on the hands and in the noses of healthcare workers (HCWs) and the relatedness ofS. aureusisolates found in the two sites.

Design:

Point-prevalence study.

Setting:

Department for Thoracic and Cardiovascular Surgery at the University Hospital of Uppsala, Uppsala, Sweden.

Subjects and Methods:

Samples were obtained from 133 individuals, 18 men and 115 women, using imprints of each hand on blood agar and a swab from the nose.S. aureusisolates were identified by standard methods and typed by pulsed-field gel electrophoresis.

Results:

S. aureuswas found on the hands of 16.7% of the men and 9.6% of the women, and in the noses of 33.3% of the men and 17.4% of the women. The risk ratio forS. aureuscarriage on the hands with nasal carriage was 7.4 (95% confidence interval, 2.7 to 20.2;P< .001). Among the 14 HCWs carryingS. aureuson their hands, strain likeness to the nasal isolate was documented for 7 (50%).

Conclusions:

Half of the HCWs acquiredS. aureuson the hands from patients or the environment and half did so by apparent self-inoculation from the nose. Regardless of the source of contamination, good compliance with hand hygiene is needed from all HCWs to protect patients from nosocomial infections. The moderate rate ofS. aureuscarriage on hands in this setting could be the result of the routine use of alcoholic hand antisepsis.
Favorable Impact of a Multidisciplinary Antibiotic Management Program Conducted During 7 Years
Authors: Carling Philip , Fung Teresa , Killion Ann , Terrin Norma , Barza Michael
Published: March 2006

Objective:

To evaluate the impact of an interventional multidisciplinary antibiotic management program on expenditures for antibiotics and on the incidence of nosocomial infections caused by Clostridium difficile and antibiotic-resistant pathogens during 7 years.

Design:

Prospective study with comparison with preintervention trends.

Setting:

University-affiliated teaching hospital.

Patients:

All adult inpatients.

Intervention:

A multidisciplinary antibiotic management program to minimize the inappropriate use of third-generation cephalosporins was implemented in 1991. Its impact was evaluated prospectively. The incidence of nosocomial C. difficile and resistant Enterobacteriaceae infections as well as the rate of vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) were compared with those of National Nosocomial Infections Surveillance System hospitals of similar size.

Results:

Following implementation of the program, there was a 22% decrease in the use of parenteral broad-spectrum antibiotics (P < .0001) despite a 15% increase in acuity of patient care during the following 7 years. Concomitantly, there was a significant (P= .002) decrease in nosocomial infections caused by C. difficile and a significant (P = .02) decrease in nosocomial infections caused by resistant Enterobacteriaceae. The program also appeared to have a favorable impact on VRE rates without a sustained impact on MRSA rates.

Conclusion:

These results suggest that an ongoing multidisciplinary antibiotic management program may have a sustained beneficial impact on both expenditures for antibiotics and the incidence of nosocomial infection by C. difficile and resistant bacterial pathogens.
Graph-based analysis and visualization of experimental results with ONDEX
Authors: Köhler Jacob , Baumbach Jan , Taubert Jan , Specht Michael , Skusa Andre , Rüegg Alexander , Rawlings Chris , Verrier Paul , Philippi Stephan
Published: March 2006

Motivation: Assembling the relevant information needed to interpret the output from high-throughput, genome scale, experiments such as gene expression microarrays is challenging. Analysis reveals genes that show statistically significant changes in expression levels, but more information is needed to determine their biological relevance. The challenge is to bring these genes together with biological information distributed across hundreds of databases or buried in the scientific literature (millions of articles). Software tools are needed to automate this task which at present is labor-intensive and requires considerable informatics and biological expertise.

Results: This article describes ONDEX and how it can be applied to the task of interpreting gene expression results. ONDEX is a database system that combines the features of semantic database integration and text mining with methods for graph-based analysis. An overview of the ONDEX system is presented, concentrating on recently developed features for graph-based analysis and visualization. A case study is used to show how ONDEX can help to identify causal relationships between stress response genes and metabolic pathways from gene expression data. ONDEX also discovered functional annotations for most of the genes that emerged as significant in the microarray experiment, but were previously of unknown function.

Availability: ONDEX is freely available under the GPL License and can be downloaded from SourceForge

Contact:  Jacob.Koehler@bbsrc.ac.uk

Supplementary information: Supplementary data are available at Bioinformatics online.
Explaining Variance; Or, Stuck in a Moment We Can't Get Out Of
Authors: Braumoeller Bear F.
Published: March 2006

Political scientists overwhelmingly seek evidence of causation by measuring changes in the mean of the distribution of the dependent variable. This article points out that some causal relationships produce changes in thevariance, not the mean, of that distribution. It makes the case for variance-altering causation by demonstrating its empirical relevance to political scientists. The article also lays out an array of causal mechanisms—under the general headings of aggregation, contagion, and constraint—in order to demonstrate the logical coherence of variance-altering causation and the many ways in which it can arise. The discussion highlights the often-stringent empirical and logical requirements that must be met if the researcher hopes to make concrete predictions about changes in variance.
Children's rights: have carers abandoned values?
Authors: Smith Carole
Published: March 2006

Traditionally, social workers have been concerned about the importance of values as significantly influencing professional practice. It is argued here that the emphasis on values has latterly been superseded by a focus on rights. This shift in perspective has come to characterise the activities of social workers and ‘professional’ carers such as foster and residential carers, and is related to a growing concentration on the externally measurable elements of practice (performativity) rather than the internal, and relatively intangible, quality of relationships (caring). It is necessary to understand the relationship between rights, needs and values in order to ensure that children are accorded their rights without having to forfeit the experiential quality of relationships with their carers.
Child‐rearing practices of two generations of Punjabi parents
Authors: Dosnajh J. S. , Ghuman P. A. S.
Published: March 2006

The major objective of this article is to report the findings of two studies which compare and contrast the early child‐rearing practices of two generations of Punjabi parents (1970s and 1990s) living in England. Additionally, the findings are compared with a small group of white mothers to broaden our understanding of the changing patterns of parenting. The data was collected through in‐depth semi‐structured interviews from the first generation during the period 1970–73 and from the second generation in 1995. The research perspective adopted is a qualitative one in that variables and procedures for data collection are not rigorously controlled, and the narratives of the mothers are used extensively to illuminate the key areas of early child rearing. The findings show that the second‐generation mothers are shedding most of the traditional customs and practices and are moving towards modern British ways.
Responding to family problems, alcohol and substance misuse
Authors: McKellar Susan , Coggans Niall
Published: March 2006

Children of alcohol and substance misusers are at risk of developing a range of behavioural problems of their own. The aim of this project was to assess the extent to which workers in the field of alcohol and substance misuse problems in the Glasgow area are aware of, and feel able to address, these risk factors. The evidence reported here indicates that workers in the field are aware of potential problems. However, there is also uncertainty about appropriate responses and a desire for training to enhance skills in this area. Locally based ‘befrienders’ projects provide a model for low‐key interventions with the potential to provide valuable support and positive socialisation within a structured and safe environment.
Abuse of Adolescents: Implications of North American Research for the UK
Authors: Rees Gwyther , Stein Mike
Published: March 2006

In the last edition of this journal we reviewed the extensive North Amercican (mainly US) literature on the abuse of adolescents. Here we look at the implications of the research for the current UK context.
The relationship between criminality and home background
Authors: Cullingford Cedric , Morrison Jenny
Published: March 2006

There are two extensive literatures which deal with this subject. One is that on criminality, defining the distinctions between morality and cultural definitions. The other is on how parents ought to influence their offspring. And there is also a smaller literative on the causal or statistical relationship between the two. This research tradition attempts to isolate particular hypotheses—like lone parents or genetics. What is missing is both a study of why certain influences are significant, and a connection between the actual cases of criminality and criminals' own experiences of their parents. For this purpose lengthy semistructured interviews with young offenders were carried out, exploring their memories and perceptions of home life and their attitudes to their parents and their subsequent experiences. This paper discusses the factors that the interviewees raised consistently, openly and articulately; violence in the home, neglect, laissez‐faire: and turning to peer groups for alternative support. At the heart of the evidence lies a lack of dialogue and the perception of a lack of active interest in them by parents. The consequences are discussed, including the inability to develop normal social relationships, leading to frustration and the repetition of violence in the home in different circumstances.
Inter‐agency perspectives on core group practice
Authors: Calder Martin C. , Barratt Mark
Published: March 2006

Core groups have been introduced into the child protection system with little central guidance. They have a pivotal role in formulating and implementing child protection plans, engaging parents and fostering inter‐agency partnerships, whilst remaining accountable to the commissioning body, the child protection conference. This paper, based on small scale research, elicited and compared the responses of school teachers, health visitors and social workers to issues around their respective roles, the management of core groups and their understanding about the core group tasks and highlighted congruence and conflict in their understanding of the system, of their own roles and responsibilities, and that of the other groups. It raises major questions about the extent to which child protection can become a truly corporate responsibility, as well as how the production of procedures and training does not automatically lead to a streamlined and clear operational system.
Partnership with parents in planning the care of their children
Authors: Sinclair Ruth , Grimshaw Roger
Published: March 2006

Working in partnership with parents is a guiding principle of the Children Act. This principle is made more concrete through specific requirements of the Act, such as those relating to care plans and reviews for children looked after by the local authority. This article examines the extent to which working in partnership with parents has been translated into practice, using some of the findings from a major research evaluation of child care planning under the Children Act.
Progress or procrastination? The education of young people who are looked after
Authors: Fletcher‐Campbell F.
Published: March 2006

The education of young people who are looked after by local authorities continues to be an issue which is inadequately addressed across England and Wales as a whole. However, recent research has shown that a number of local authorities are developing initiatives to enhance the educational experiences of this cohort of vulnerable young people. This article identifies the difficulties and, from research data, outlines some of the strategies which have proved effective. The data indicate that the problems can be resolved, given commitment, and suggest that practitioners in local authorities must continue to strive to ensure that all young people who they are looking after have an equal opportunity to experience a positive educational career.
Working children: the health and safety issue
Authors: McKechnie Jim , Hobbs Sandy , Lindsay Sandra , Lynch Margaret
Published: March 2006

Recent evidence has emerged that in Britain, like the US, many children below the official minimum school leaving age, are working. In many cases, the work is illegal. Research in the US suggests that many working children risk accidents and other hazards to health. Evidence from Britain on the health and safety aspects of child labour is of a more fragmentary nature, but enough exists to suggest a need for greater vigilance.
Quality in early childhood services: parent, provider and policy perspectives
Authors: Mooney Ann , Munton Anthony G.
Published: March 2006

Recent government proposals give local authorities responsibility for establishing early years partnerships. The partnerships provide people interested in early childhood services with an opportunity to discuss local provision. In any discussion of early childhood services, quality is likely to be high on the agenda. This paper describes a series of discussions on the meaning of quality in early childhood services. Parents, day care providers and other stakeholders took part. Differences of opinion between and within stakeholder groups are discussed in the context of current policies and ideologies concerning non‐parental child care.
Social profile, maternal depression and welfare concerns in clients of health visitors and social workers: a comparative study
Authors: Sheppard Michael
Published: March 2006

Research into the practice of health visitors and child care social workers with depressed mothers is limited. This is surprising in view of the known relationship between motherhood and depression, and the association also between child care problems and maternal depression. The study described below is the first which seeks to compare health visitor and child care social work clients/service users in relation to the issue of maternal depression. In particular, it seeks to compare the extent to which maternal depression is a feature of the work of social workers and health visitors, the relationship between maternal depression and the social composition of different client groups, the relationship between maternal depression and welfare concerns—particularly child abuse—and the extent to which such concerns lead to referral from health visitors to social workers. The research shows: (1) interesting similarities between the depressed health visitor clients and social work clients as a whole; (2) the importance of low income and absence of support in the ‘progression’ from health visitor to social work clients status; and (3) an alarming emerging gap in services provided for severely disadvantaged families with child and family care problems.
Developing interests in child care outcome measurement: a central government perspective
Authors: Davies Carolyn
Published: March 2006

Over the last decade, the research interest of central government in services to children and families has covered various parts of the child care system, though the focus on evaluation of outcomes has remained constant. Major research programmes encompass the outcomes of: child protection interventions, residential care and the implementation of the Children Act 1989.
Assessing child welfare outcomes: the American perspective
Authors: Maluccio Anthony N.
Published: March 2006

This paper examines US research on child welfare outcomes, focusing on family preservation, out‐of‐home care, and family reunification services. The review highlights the range of mixed findings in each of these areas, along with methodological issues and constraints. In light of the complexity of child welfare services, future outcome research should complement the rigorous use of quantitative methods with the careful application of qualitative methods.
Measuring outcomes in family support services (a case study using respite care)
Authors: Aldgate Jane
Published: March 2006

Measuring outcomes in family support services is a relatively new area of social research. This study aimed to explore the use of respite care (brief planned periods away from home with the same carers over several months) as a family support service to help prevent long term family breakdown. It studied the service from the perspectives of all those involved in it—social workers, carers, parents and children–and was funded by the UK Department of Health as part of a series of studies commissioned to explore the implementation of the English Children Act law and theory.
Using a child development model to assess the outcomes of social work interventions with families
Authors: Ward Harriet
Published: March 2006

The Children Act 1989 strengthens the view that the purpose of providing children's welfare services is to support families in promoting their satisfactory development. Implementation of the Looking After Children materials provides data that enables us to assess how far such aims are achieved both for individual children and for groups. Concrete information in each of the key areas of need, threshold, objective, service and progress across seven dimensions of development can be built up to provide complex assessments of outcome. Extending such assessments beyond the group of children looked after away from home raises questions about public responsibilities to families.
Comparing developmental outcomes for children in care with those for other children in Canada
Authors: Flynn Robert J. , Biro Chantal
Published: March 2006

This study assessed the test–retest reliability and convergent validity of single items from the Assessment and Action Record (AAR), from Looking After Children (Ward, 1995). It also compared developmental outcomes of 43 children cared for by a Canadian child welfare agency and those of an approximate comparison group of 1,600 children from the National Longitudinal Survey of Children and Youth (Statistics Canada, 1995). High and low reliability and validity were found for different AAR items. The children in care had worse outcomes than the comparison children on indicators of educational success and negative behaviour, but not on measures of identity, social and family relationships, or prosocial behaviour.
The use of Looking After Children in child protection
Authors: Bullock Roger
Published: March 2006

The vast majority of children who enter the child protection process are supported at home. While the Looking After Children approach can be used as a basis for assessing child care outcomes everywhere, we need to clarify what aspects of the materials are useful in assessing outcomes for children not looked after or whose separations are short.
Auditing the implementation of Looking After Children
Authors: Moyers Sue
Published: March 2006

An audit showed that all authorities in the first implementation cohort had introduced the LAC materials. Standards of completion varied and were greater for children admitted post‐implementation than for those already looked after.
Looking After Children: implications for social work education
Authors: Bell Margaret , Kent Julie , Noakes Sara
Published: March 2006

Pilot schemes demonstrated a wide range of areas in which the Looking After Children materials might be used in social work training, both as part of the academic and the practice curriculum.
Understanding the meanings of children: a reflexive process
Authors: Davis John M.
Published: March 2006

This paper identifies a number of children's voices within qualitative academic writing. It suggests that researchers can discover a variety of children's voices by employing reflexive techniques to ensure that their interpretations are not influenced by their personal prejudice, or the ethics, tools, roles and theories of their professional paradigm. It concludes that those who work with children may be able to reinforce the theme of the UN Convention on Rights of the Child by employing this reflexive approach to enable them to attribute equal status to the views of all the children whom they encounter.
A new look at the health and homeless experience of a cohort of five‐year olds
Authors: Burton Gillian , Blair Mitch , Crown Nicola
Published: March 2006

Homelessness is increasing and health workers and others need to be ever vigilant about the risk that this has on children's health. What is that risk and what are children's experiences of homelessness? A retrospective case note study was carried out to compare the health of a group of five‐year olds who had experienced homelessness and compare them with matched ‘non‐homeless’ controls. A home interview questionnaire was used to give a profile of the children's housing experience and the health issues faced during their time in temporary accommodation. Fifty‐three cases when compared with 41 controls showed a statistically greater prevalence of child protection issues and an increased number of health needs identified at the school nurse health appraisal. The housing profile identified that the case children moved homes many times (37 per cent more than five times), were homeless much longer than the officially registered period (67 per cent more than 12 months) and 61 per cent were made homeless through domestic violence. The study reinforces the need for us to acknowledge important environmental stress and to continue to advocate for this group of disadvantaged children.
From protection to concern: child protection careers without apologies
Authors: Thorpe David , Bilson Andy
Published: March 2006

This article provides evidence from a study of the careers of children in an English local authority from the point of the child protection investigation with a follow up of one year. The study demonstrates the way that for the vast majority welfare needs are ignored in the process of investigation and identifies the need to refocus investigations. The authors suggests criteria that can be used to provide a clearer focus on whether to investigate a referral.
Young people leaving care: moving towards ‘joined up’ solutions?
Authors: Broad Bob
Published: March 2006

This paper presents some of the findings of a national study of 46 leaving care projects working with 3308 young people leaving care, and an analysis of national post Children Act 1989 initiatives. It presents key implications for local and national policy and practice from that study and, in so doing, records the considerable achievements of, but also the problems faced by, these projects. It is argued that despite a welcome, new commitment by government to the social inclusion of this group, sustained solutions remain complex, have been long in coming and remain a challenge. Copyright © 1999 John Wiley & Sons, Ltd.
Open access family centres and their users: positive results, some doubts and new departures
Authors: Pithouse Andrew , Holland Sally
Published: March 2006

This article reports findings from a research study of two open access, multi‐use, community‐based family centres. Structured, qualitative interviews were conducted with 40 adult users and 40 local adult non‐users of the two centres. Additionally, a profile of user characteristics was derived from a survey of users attending over a one‐week period at both centres. The vast majority of users were women in their twenties, just over half of whom attended with their children. The benefits and limitations of the current functioning of open access centres are discussed, with a potential shift in emphasis along a social development model proposed. Copyright © 1999 John Wiley & Sons, Ltd.