bluuebunny/crossref_metadata_2025 huggingface dataset:
An Economic Analysis of the Organization of Serfdom in Eastern Europe
Authors: Millward Robert
Published: September 2009

The rise of serfdom in the sixteenth century undoubtedly has political explanations, but the form that it took has economic explanations. In particular, it took the form of forced labor on enlarged manorial farms. The economic explanation, buttressed with evidence from the period, is that an enserfed labor force must be watched more than free renters and the watching is best done in a manorial framework. The model is stated formally and its implications compared point-by- point with the voluminous evidence for Poland and neighboring regions.
A High Standard of Living in Nineteenth-Century Japan: Fact or Fantasy?
Authors: Hanley Susan B.
Published: September 2009

In an effort to begin to solve the continuing controversy over how high the standard of living was in Japan prior to industrialization, this paper goes beyond the inadequate quantitative data and examines also qualitative and local evidence. Information on housing and food, urban water quality and waste disposal, and life styles is examined along with representative family budgets and two sets of real wage estimates. The evidence, taken together with life expectancy estimates, suggests that the standard of living in mid-nineteenth-century Japan was not only higher than in the 1700s, but relatively high in comparison to most of the industrializing West.
Did Incomes for Most of the Population Fall from 1923 Through 1929?
Authors: Smiley Gene
Published: September 2009

This paper uses independent real wages, earnings, labor force data, and an examination of Kuznet's 1953 data to explore the recent contention that real per capita incomes for most of the American population declined from 1923 through 1929. It concludes that there is little evidence to support this contention.
Uneven Regional Development in Interwar Britain
Authors: Heim Carol E.
Published: September 2009

This study examines Great Britain's adaptation in the 1920s and 1930s to the decline in the market for its nineteenth-century exports: cotton textiles, ships, iron and steel products, and coal. Continued growth in a mature economy depends at certain points upon structural change, in this case a movement from declining to expanding industries. At such times, I contend, the developing sector tends to grow independently, rather than through transformation of existing productive structures. Growth does not occur primarily through a reallocation of capital and labor from declining to expanding industries and regions.
Economies of Scale in Tobacco Manufacture, 1897–1910
Authors: Burns Malcolm R.
Published: September 2009

The survivor technique is applied to a virtually complete set of plant and output data to determine the extent of scale economies in the plug, smoking, snuff, and fine-cut branches of the tobacco industry between 1897 and 1910. The data indicate that the relative cost advantage of large tobacco factories was substantial, with facilities of minimum efficient size often requiring market shares approaching 10 per cent of U. S. output. These results support one of the principal themes of The Visible Hand—that the realization of scale economies motivated the consolidation movement in American manufacturing at the turn of the century.
Monetary Aspects of the Treasury Notes of the War of 1812
Authors: Kagin Donald H.
Published: September 2009

Between 1812 and 1815, the United States authorized five Treasury note issues. In total, over $36 million in denominations of $3 to $1000 were emitted. The last issue included small circulating notes in denominations of less than $100. Because of the shortage of adequate circulating medium and revenue to conduct the War of 1812, these notes proved to be extremely useful as they were transferable by delivery and receivable for duties, taxes, and public use at par plus accrued interest. They also served as interest-bearing reserves for banks since they were convertible into any kind of money and bore interest simultaneously. The success of the Treasury notes was demonstrated by the fact that they were fully subscribed and accepted by the banks and merchants. In addition, the small Treasury note issues of 1815 indirectly served to increase the circulating medium of the country. They were used to buy goods and services by individuals, pay custom duties by merchants, and acted as cash reserves for banks, preventing bank notes from being discounted. They thus became the first circulating paper currency issued by the United States after ratification of the Constitution.
A Reassessment of Investment Failure in the Interwar American Economy
Authors: Bernstein Michael A.
Published: September 2009

A radical shift in the industrial composition of investment and final demand played an important role in delaying a complete recovery from the trough of 1932. Under the conditions of technological discovery prevailing in the 1930s, this shift in the composition of demand made full employment virtually impossible to achieve as recovery from the crash got under way. A complete recovery required a mass of interrelated new techniques and human and physical capital which, in the timid financial environment prevailing after 1929 (and given the uncertainties of the New Deal), could not be organized on the necessary scale by private investment markets. These findings pose a new agenda for research on the political economy of the New Deal and on the economic history of the post-World War II era.
Rostow's Kondratieff Cycle in Australia
Authors: Pope David
Published: September 2009

The turn of economic events in the early 1970s correlates with a revival of ideas about the existence of long swings in economic development. The subject of Kondratieff cycles has attracted the pens of social scientists of very different persuasions. This paper draws on Walt W. Rostow's interpretation—with its emphasis on the role of exporters of food and raw materials in the world economy—to explore Australian long waves over the last 110 years. I conclude that the case for their existence is not confirmed and moreover that Rostow's cycle-mechanics offer a doubtful explication of movements in the Australian series.
Agricultural Structure and Proto-Industrialization in Russia: Economic Development With Unfree Labor
Authors: Rudolph Richard L.
Published: September 2009

A revised view of the nature of Russian industrialization is proposed. It is argued that economic conditions on the serf estates did not hinder industrialization; they in fact facilitated proto-industrialization by promoting the nonagricultural pursuits of the peasantry. In opposition to the traditional view that industrialization took place after the Emancipation of the serfs in 1861, and that there was an “agrarian crisis” in the nineteenth century, it is argued that industrialization was well underway on a wide scale on the basis of serf labor before 1861. The so-called agrarian crisis may really have been a period of increased proto-industrial activity by the peasants.
Population Turnover in the English West Indies in the Late Seventeenth Century: A Comparative Perspective
Authors: Galenson David W.
Published: September 2009

I present estimates here of the geographic persistence of estate owners and managers in Barbados during 1673–1723. The estimates are based on evidence generated by the functioning of an economic market; the evidence was produced by tracing the names of purchasers over time through the invoice accounts of slave sales held by the Royal African Company on the island.Estimated rates of out-migration from Barbados were low during the 1670s, comparable in magnitude to those found in colonial New England towns, but the rates rose considerably during the following decades. The initially low rates of out-migration might have been the result of the great profitability of sugar planting in early Barbados, while the subsequent increase might have been due to the development of methods of plantation management that allowed estate owners to earn profits as absentees.
Why Employer-based Pension Plans? The Case of Britain
Authors: Hannah Leslie
Published: September 2009

Private savings–often through employer-based pension plans–account for a larger proportion of retirement incomes in Britain than elsewhere. The strength of employer–based pension plans in Britain can be traced to a variety of factors; their early development and security are emphasized. The pattern of spread, with heavy concentration initially in bureaucratic firms, suggests that old-age saving entered the employment relationship around 1900 because large-scale bureaucracies needed conditional, lifetime payment systems. By the 1930s, the other main intermediaries for old-age saving, specializing in private provision on an individual basis, had moved into the market for collective, employer-based pension plans.
Unemployment and Minimum Wages in Australia, 1900–1930
Authors: Forster Colin
Published: September 2009

The paper focuses on the development in Australia of minimum wage-setting and its relationship to unemployment. A variety of industrial tribunals embarked on a course of wage-setting early in the twentieth century as part of their task of reducing industrial conflict. In varying degree, the tribunals kept in mind what was thought of as wage justice for workers with low bargaining power. By 1921 a standard minimum wage for unskilled men had emerged and formed the basis of the wage system. It was a wage which had a strong welfare basis. Other wages more closely reflected the market. During the 1920s unemployment was not high but was concentrated on less-capable unskilled men. The limited evidence available points to the wage structure as the main cause.
The Russian Industrial Society and Tsarist Economic Policy, 1867–1905
Authors: Owen Thomas C.
Published: September 2009

The Russian Industrial Society, the first national organization of commercial and industrial interests in the empire, attempted to win governmental support for a comprehensive program of economic development. It enjoyed some successes in the fields of tariff protection, factory legislation, and the conquest of Central Asia. The tsarist bureaucracy, however, proved unwilling or unable to implement rational reforms in such key areas as subsoil mineral rights, monopolies, and corporate law. Moreover, policy disagreements among the society's regional branches, especially those in Moscow, Warsaw, and Lodz, weakened the organization from the 1880s onward.
Market Structure and Profits: A Further Rejoinder
Authors: Inikori J. E.
Published: September 2009

Seymour Drescher's comments center on whether British traders exporting slaves from Africa directly to non-British territories in the Americas were able to load more slaves per ton after 1788 than the slave-ton ratios imposed by British laws. The bone of contention here arose originally from attempts to estimate the volume of the trade. I argued that the British traders did load considerably more slaves per ton after 1788. Neglecting this factor would lead to a significant underestimate of the volume. Drescher disagreed and offered comments in Econocide; I replied in Forced Migration. In discussing the profits I found the subject still relevant: I argued that loading considerably more slaves than British laws allowed enhanced profits of the larger firms with access to non-British territories. On this Drescher here takes issue.
One Market or Many? Labor Market Integration in the Late Nineteenth-Century United States
Authors: Rosenbloom Joshua L.
Published: September 2009

This article examines the geographic integration of U.S. labor markets from 1870 to 1898, using previously unexploited wage and price data for 23 occupations in 12 major cities. In contrast to the increasing nationalization found in other markets at that time, the labor market was characterized by large and persistent real wage differentials both within and between regions, leaving little doubt that late nineteenth-century labor markets remained far from completely integrated. The differentials, however, owed as much to substantial variations in labor demand growth as to the lack of labor market integration.
Is Deposit Insurance Necessary? A Historical Perspective
Authors: Calomiris Charles W.
Published: September 2009

The motivation and structure of various banking insurance experiments in U.S. history are analyzed, along with their political alternative, branch banks. In both the antebellum period and in the 1920s, insurance systems that relied on self-regulation, made credible by mutual liability, were successful, while compulsory state systems were not. Branch banking increased stability and resiliency to shocks.
British Myopia and the Collapse of Indian Textile Demand
Authors: Wolcott Susan
Published: September 2009

Britain's textile industry contracted sharply in the interwar period due to the growth of domestic industries in many of its export markets. Lazonick and Mass argue that, because this growth was inevitable, British entrepreneurs should not have focused on the less developed countries. This article questions whether the interwar growth of the Indian textile industry was inevitable. A quantitative study of Indian import demand and production techniques suggests that the rapid growth of the industry was due to exogenous events—postwar British inflation and change in the Indian political regime—rather than to the natural evolution of Indian productivity.
Bank Mergers in Late Nineteenth-Century New England: The Contingent Nature of Structural Change
Authors: Lamoreaux Naomi R.
Published: September 2009

Although New England's unit banking system was declining in profitability during the late nineteenth century, the existing competitive environment prevented large institutions from outperforming their smaller rivals. As a result, there was little change in the structure of the banking system during this period. At the turn of the century, however, a wave of mergers radically transformed the banking sectors of Boston and Providence. Although the greater profitability of the mergers indicates they were a better fit to the economic environment than their smaller predecessors, their creation was only made possible by a special combination of historical circumstances.
Bureaucratic Opposition to the Assignment of Property Rights: Overgrazing on the Western Range
Authors: Libecap Gary D.
Published: September 2009

This paper analyzes the roles of the Departments of Agriculture and the Interior in restricting the assignment of property rights to rangeland in the American West. While common property conditions encouraged overgrazing and dissipation of the rental value of the land, it was in the interest of both departments to oppose the private claims of the ranchers. Moreover, jurisdictional competition for administration of federal land holdings likely delayed the installation of bureaucratic controls on entry and range use until 1934.
The Organization of Exchange in Early Christian Ireland
Authors: Gerriets Marilyn
Published: September 2009

The major contrast between preindustrial and modern economies is that the latter enjoy regular and rapid growth, whereas income per capita tends to stagnate in the former. Analysis of the organization of exchange in early Christian Ireland shows that the exchange and therefore the production of material wealth was so thoroughly integrated into securing and exercising power, as well as into establishing and maintaining family and social ties, that any improvements in technology which might have led to economic growth would inevitably have generated prohibitive social costs.
Human Capital Accumulation in Premodern Rural Japan
Authors: Nakamura J. I.
Published: September 2009

Premodern human capital accumulation helps to explain the exceptional growth performance of the Japanese economy in the last hundred years. Prior to this century informal institutions were more important for human capital formation than were the more formal ones familiar today. This paper examines a few seminal changes—national market formation, population control, and the involvement of farmers in rural administration—that were primarily responsible for the emergence of economically responsive, more productive individuals in rural Japan.
The Choice Between High-Pressure and Low-Pressure Steam Power in America in the Early Nineteenth Century
Authors: Halsey Harlan I.
Published: September 2009

In the early nineteenth century, five versions of stationary steam engines were in widespread use. In America, the high-pressure engine was dominant in the West, but on the eastern seaboard the low-pressure engine was viable. In Britain, the low-pressure engine was overwhelmingly dominant. Here we analyze the evidence on cost and performance of high- and low-pressure engines, and show that fuel-price and interest-rate differentials were sufficient to explain the distribution of steam engine types in America.
Through the Blockade: The Profitability and Extent of Cotton Smuggling, 1861–1865
Authors: Lebergott Stanley
Published: September 2009

Although cotton smuggling through the North's blockade of the South during the American Civil War has often been viewed as a highly profitable activity, only a small percentage of blockade-running ships made more than one run. New figures for capture rates reconcile these observations by showing that the risks of blockade running were substantial. Estimates are also provided for the amount of cotton smuggled through the blockade and of its disposition between the North and Europe.
Uneven Development in the Nineteenth Century: A Comparison of the Habsburg Empire and the United States
Authors: Good David F.
Published: September 2009

Unlike most studies of uneven development before World War I, this paper uses the region (not the nation) as the unit of study. Weak market links with the national market partially explain persisting relative backwardness in the Habsburg Empire's eastern hinterland and in the American South. Even if product and factor markets had been perfectly integrated, institutional rigidities would have greatly retarded development. In the Empire, growth emerged in the west where serfdom was weakening and spread slowly as feudal institutions decayed. In America, capitalistic institutions promoted development in the North more thoroughly than did slavery and postbellum institutions in the South.
R & D, Defense, and Spatial Divisions of Labor in Twentieth-Century Britain
Authors: Heim Carol E.
Published: September 2009

New spatial patterns, with areas specializing by function rather than industry, reflect twentieth-century developments in industrial organization, the role of the state, and Britain's system of cities. In the short run, World War II and postwar regional policy increased factory-building and employment in formerly depressed areas. Longer-run effects of both helped concentrate research and development within the South near London and dispersed routinized production to other areas. Organizational links within firms and to government departments, intellectual and commercial contacts in London, and locational preferences of professional and technical workers influenced R & D location.
“Going in Between”: The Impact of European Technology on the Work Patterns of the West Main Cree of Northern Ontario
Authors: George Peter J. , Preston Richard J.
Published: September 2009

The West Main Cree of northern Ontario adapted readily but selectively to the European technologies and institutions made available by the fur trade. Yet some basic cultural and psychological differences regarding the accumulation of wealth, attitudes to work, and dependence on relief and government transfers complicated Indian-European relations. In a rational attempt to compromise among today's complex choices, the Cree have abandoned their traditional bush pursuits for village life and wage employment, with hunting and trapping reduced to part-time or recreational activities.
Manufacturing and the Convergence Hypothesis: What the Long-Run Data Show
Authors: Broadberry Stephen N.
Published: September 2009

The commonly accepted chronology for comparative productivity levels, based on GDP data, does not apply to the manufacturing sector, which shows evidence of a much greater degree of stationarity of comparative labor productivity performance among the major industrialized countries of Britain, Germany, and the United States. These results for manufacturing suggest that convergence of GDP per worker must have occurred through trends in other sectors and through compositional effects of structural change. The persistent, large labor productivity gap between the United States and Europe cannot be explained simply by differences in capital per worker, but is related to technological choice.
TWO NEW SPECIES OF BEGONIA (BEGONIACEAE) FROM SOUTH SULAWESI, INDONESIA
Authors: Thomas D. C. , Ardi W. H. , Hartutiningsih M. Siregar , Hughes M.
Published: September 2009

Two new species of Begonia (Begoniaceae), Begonia didyma D.C.Thomas & Ardi and Begonia guttapila D.C.Thomas & Ardi, are described from the Latimojong Mountains, South Sulawesi (Sulawesi Selatan), Indonesia. Both species belong to Begonia sect. Petermannia.
Complementary relationship of evaporation and the mean annual water‐energy balance
Authors: Szilagyi Jozsef , Jozsa Janos
Published: September 2009

By combining the complementary relationship of evaporation with the coupled long‐term water‐energy balance of Porporato et al. (2004) in a Budyko‐type framework, one can, from atmospheric measurements alone, derive important ecosystem characteristics, such as the mean effective relative soil moisture and the maximum soil water storage, as well as predict changes in the rooting depth of vegetation as a response to climate variations.
Green tea polyphenol (−)‐epigallocatechin gallate suppressed the differentiation of murine osteoblastic MC3T3‐E1 cells
Authors: Kamon Masayoshi , Zhao Ran , Sakamoto Kazuichi
Published: September 2009

Recently, various physiological effects of the tea polyphenol catechin for alleviating diseases such as cancer, arteriosclerosis, hyperlipidaemia and osteoporosis have been reported. However, the physiological effect of catechin on bone metabolism remains unclear. We examined the physiological effect of EGCG [(−)‐epigallocatechin‐3‐gallate], which is the main component of green tea catechin, on osteoblast development using the precursor cell line of osteoblasts, MC3T3‐E1, and co‐culture of the osteoblasts from mouse newborn calvaria and mouse bone marrow cells. Although EGCG did not affect the viability and proliferation of MC3T3‐E1 cells, EGCG inhibited the osteoblast differentiation. Furthermore, EGCG did not affect the mineralization of differentiated MC3T3‐E1 cells, and reduced osteoclast formation in co‐culture. These results suggest that EGCG can effectively suppress bone resorption, and can be used as an effective medicine in the treatment of the symptoms of osteoporosis.
Différent vs autre et l’opposition réciproque vs comparatif
Authors: Tovena Lucia M. , Van Peteghem Marleen
Published: September 2009

Summary

This paper tests on French Beck’s (2000) analysis of plural and quantified NP dependent readings of different in English. According to her, different works as a relational adjective when it depends on a plural NP, and as a comparison operator when it depends on a universally quantified NP. Beck treats as evidence in favour of her thesis the fact that German uses two distinct ‘different’ (verschieden and ander) to produce the range of possible readings of different in English. We show, however, that the opposition between différent and autre in French does not locate the border of lexical differentiation there where we find it in German and where Beck sets the functional split. Furthermore, a close scrutiny of the English data exposes inconsistencies in her analysis of different as a comparison operator.

In sum, our contrastive study of the three languages does not provide evidence for a clear-cut opposition between different uses of ‘different’. On the contrary, the situation depicted is better described as a gradient divided up in different ways by the various languages when realised as lexical items.
A minor issue?
Authors: Engel Dulcie M.
Published: September 2009

‘Minor sentences’ is one of the many terms used in the literature to refer to a phenomenon usually relegated to an obscure paragraph of the grammar book, or treated principally as a spoken discourse feature. These forms are also referred to as sentence fragments, incomplete sentences, verbless sentences, and nominal sentences, to name but a few of the terms found. Despite the marginal status attributed to the forms, more detailed study is warranted. Minor sentences occur frequently in the written language, and perform important communicative functions in a range of contexts. The term is used to refer to apparently complete phrases which do not conform to canonical sentence structure. Typically, they lack a subject noun phrase, or a finite verb, i.e. one of the two ‘essential’ elements of the sentence. In this paper, we begin with an overview of English and French grammar book and discourse analysis approaches. We then discuss previous studies of minor sentence contexts, French recipes and newspaper headlines, before turning to a corpus consisting of public signs and notices, headlines, advertising slogans, and crossword clues, in an effort to determine whether certain minor sentence types can be associated with particular (written) discourse functions.
Prevalence of PPD Positivity Among New Employees at a Hospital in New York City
Authors: Sepkowitz Kent A. , Fella Peter , Rivera Pedro , Villa Nerinda , DeHovitz Jack
Published: September 2009

Objective:

To determine the prevalence of tuberculin reactivity among all new employees at a hospital in New York City.

Designs:

Prospective measurement of purified protein derivative (PPD) status in consecutive new employees at a hospital in New York City from 1991 to 1993. All employees are tested as part of a pre-employment physical, assuring complete compliance. Aplisol (Parke-Davis, Morris Plains, NJ) was used in 1991 and 1992, and Tubersol (Connaught, Swiftwater, PA) in 1993. Tests were applied and interpreted by trained employee health personnel.

Results:

Of 313 consecutive new employees, comprising all job categories, 40% were PPD positive at time of initial hire, including 20% of US-born and 70% of foreign-born employees. Of 114 persons who had received BCG vaccination, 67% were PPD positive. By multivariate regression analysis, age, BCG vaccination history, and foreign country of birth were independent predictors of a reactive PPD test.

Conclusions:

The high prevalence of tuberculin reactivity may reflect high rates of Mycobacterium tuberculosis infection and disease in the community, complicating interpretation of the efficacy of Centers for Disease Control and Prevention (CDC) guidelines to prevent the spread of tuberculosis in healthcare facilities.
Infection Control in Long-Term-Care Facilities
Authors: Nicolle Lindsay E. , Garibaldi Richard A.
Published: September 2009

Although patients in long-term-care facilities are at increased risk of infection, little is known about how to practice infection control in this setting. This article reviews risk factors for infection, the components of an infection control program, and particular infections that are important in long-term care facilities. In addition, special characteristics of long-term-care facilities that challenge the individuals charged with conducting effective infection control programs will be discussed.
Probable Role of Ultraviolet Irradiation in Preventing Transmission of Tuberculosis: A Case Study
Authors: Stead William W. , Yeung Carole , Hartnett Carolyn
Published: September 2009

The problem of transmission of tuberculosis (TB) in healthcare facilities is a serious one, all the more so when compounded by organisms that are drug resistant. The purpose of this report is to describe our experience with prolonged hospital care of a patient with advanced multidrug-resistant cavitary pulmonary TB in a hospital with complete pre-exposure tuberculin skin-test data.

The patient, a 59-year-old white man with ankylosing spondylitis, was admitted to our hospital on January 2, 1992, with a diagnosis of cavitary pulmonary TB. In June 1990, he had been treated in another state with isoniazid (INH) and rifampin for 11 months with apparent recovery, despite irregular compliance. However, in the fall of 1991, he again developed a productive cough, for which the same drugs were given. When he failed to improve, he moved to Arkansas to be near a sister.
Tuberculosis Infection Among Staff at a Canadian Community Hospital
Authors: Liss Gary M. , Khan Ruth , Koven Esther , Simor Andrew E.
Published: September 2009

Objective:

To determine risks for tuberculin skin-test conversion among employees of a community hospital in Ontario, Canada.

Design:

Cohort morbidity study.

Setting:

Of 14 metropolitan Toronto area hospitals surveyed for data on tuberculin skin-test conversions, only one provided tuberculosis (TB) test data on all employees. Between 1991 and June 1994, 24 patients were treated at this hospital for pulmonary TB.

Population Studied:

The population at risk included those on staff from January 1991 through December 1993 who previously were skin-test negative; they were followed until the end of June 1994. Exposure was estimated (a) based on ranking departments according to an estimate of the number of hours of direct patient contact during a typical day, and (b) based on location of sputum-positive patients.

Outcome Measure:

Risks of skin-test conversion among hospital employees with documented prior negative skin tests.

Main Results:

A total of 809 skin-test negative employees were followed for 2,084 person-years; 18 employees with skin-test conversions were identitled. The overall conversion rate was 0.9% per year (0.86 per 100 person-years). After excluding two conversions attributed to contact with coworkers, the relative risk of conversion was 4.5 (5.5 after adjusting for age and gender) among those in the highest exposure category (≥4 hours per day), compared to those in departments ranked as having the lowest exposure (<2 hours per day). Among those working in wards in which sputum-positive patients were treated, 2.4% converted; the risk of conversion was over six times greater than among those working on wards with no TB patients or in departments with no patient contact, of whom 0.4% converted. Among the emergency room staff, the department in which the greatest number of sputum-positive patients were treated, at least 5% of staff converted. In those instances in which conversions were associated with exposure to a specific TB patient, the involved patients had been in the hospital for at least 4 days prior to being isolated.

Conclusions:

These results indicate that even in a hospital with few admissions due to tuberculosis, skin-test conversions associated with occupational exposure may occur.
Reduction of Surgical-Site Infections in Cardiothoracic Surgery by Elimination of Nasal Carriage of Staphylococcus aureus
Authors: Kluytmans Jan A.J.W. , Mouton Johan W. , VandenBergh Marjolein F.Q. , Manders Marie-José A.A.J. , Maat Alexander P.W.M. , Wagenvoort Johan H.T. , Michel Marc F. , Verbrugh Henri A.
Published: September 2009

Objective:

To test the hypothesis that perioperative elimination of nasal carriage of Staphylococcus aureus using mupirocin nasal ointment reduces the surgical-site infection (SSI) rate in cardiothoracic surgery.

Design:

Unblinded intervention trial with historical controls.

Setting:

A university hospital, tertiary referral center for cardiothoracic surgery.

Patients:

Consecutive patients undergoing cardiothoracic surgery between August 1, 1989, and February 1, 1991 (historical control group), and between March 1, 1991, and August 1, 1992 (intervention group).

Results:

The historical control group consisted of 928 patients and the intervention group of 868, of whom 752 actually were treated. The 116 patients who were unintentionally not treated were considered as a concurrent control group. In the intention-to-treat analysis, a significant reduction in SSI rate was observed after the intervention (historical-control group 7.3% and intervention group 2.8%; P<.0001). The SSI rate in the concurrent control group was significantly higher than in the treated group (7.8% and 2.0%, respectively; P=.0023). Resistance of S aureus to mupirocin was not observed.

Conclusion:

The results of this study indicate that perioperative elimination of nasal carriage using mupirocin nasal ointment significantly reduces the SSI rate in cardiothoracic surgery patients and warrants a prospective, randomized, placebo-controlled efficacy trial. This preventive measure may be beneficial in other categories of surgical patients as well.
Tuberculosis Control in Health Care
Authors: Pugliese Gina , Tapper Michael L.
Published: September 2009

This article describes the basic framework for developing a tuberculosis (TB) control program. We suggest how to assess the risk of TB in a healthcare delivery setting, how to prioritize control measures based on their effectiveness, and how to meet current regulatory requirements. In addition, we discuss some problematic issues, examples of how other hospitals have confronted these issues, and where to obtain additional information on nosocomial TB.
Ethical Aspects of Infection Control
Authors: Herwaldt Loreen A.
Published: September 2009

This article describes ethical dilemmas faced routinely by infection control personnel and outlines the basic principles of ethics as applied to the practice of infection control and hospital epidemiology.
A Cluster of Legionnaires' Disease in a Community Hospital—A Clue to a Larger Epidemic
Authors: Guerrero Isabel C. , Filippone Christine
Published: September 2009

Four patients with atypical pneumonias admitted within a 1-week period to a community hospital were suspected and confirmed to have Legionnaires' disease. The patients had a common travel histor y. This cluster of cases uncovered a larger epidemic associated with cruise travel.
Respiratory Distress and Sudden Death Associated with Receipt of a Peripheral Parenteral Nutrition Admixture
Authors: Shay David K. , Farm Lynda M. , Jarvis William R.
Published: September 2009

Objective:

To detect respiratory adverse reac¬tions potentially related to receipt of peripheral parenteral nutrition (PPN) in hospitalized patients and to determine risk factors for their occurrence.

Design:

Retrospective cohort study.

Setting:

Federal tertiary-care hospital.

Patients:

Medical and pharmacy records of all patients who received PPN from October 1992 to February 1994 were abstracted for demographics, diagnoses, medications received, indications for and formulation of PPN, and severity of illness as measured by Acute Physiology and Chronic Health Evaluation II scores.

Results:

A case-patient was defined as any patient who, while receiving PPN, had unexplained chest pain, dyspnea, cardiopulmonary arrest, or new interstitial infiltrates on chest radiograph. Patients who received PPN in which FreAmine was the amino acid source were more likely than those who received PPN made with Travasol to meet the case definition (5/11 vs 0/39; relative risk, >18; 95% confidence interval, 3.3->136; P<.001).

Conclusions:

A change in the amino acid source of a PPN admixture was associated with respiratory adverse events that ranged from interstitial infiltrates to sudden death. These events apparently resulted from the infusion of a calcium phosphate precipitate in an opaque admixture. Each new PPN admixture should be tested for stability before clinical use and infused into patients through an appropriate filter.
Infection Prevention and Control in the Long-Term-Care Facility
Authors: Smith Philip W. , Rusnak Patricia G.
Published: September 2009

More than 1.5 million residents reside in US nursing homes. In recent years, the acuity of illness of nursing home residents has increased. Long-term-care facility residents have a risk of developing nosocomial infection that is similar to acute-care hospital patients. A great deal of information has been published concerning infections in the long-term-care facility, and infection control programs are nearly universal.

This position paper reviews the literature on infections and infection control programs in the long-term-care facility, covering such topics as tuberculosis, bloodborne pathogens, epidemics, isolation systems, immunization, and antibiotic-resistant bacteria. Recommendations are developed for long-term-care infection control programs based on interpretation of currently available evidence. The recommendations cover the structure and function of the infection control program, including surveillance, isolation, outbreak control, resident care, and employee health. Infection control resources also are presented.
A Mixed Foodborne Outbreak With Salmonella heidelberg and Campylobacter jejuni in a Nursing Home
Authors: Layton Marcelle C. , Calliste Susan G. , Gomez Thomas M. , Patton Charlotte , Brooks Steven
Published: September 2009

Objective:

To investigate a mixed Salmonella heidelberg and Campylobacter jejuni foodborne outbreak in a nursing home.

Design:

Retrospective cohort study with a nested case-control design. Cases were defined by positive stool-culture results. Controls needed to be both asymptomatic and culture-negative.

Setting and Patients:

Residents of a 580-bed nursing home in Brooklyn, New York.

Results:

Of the 580 residents, 119 (21%) developed illness. Of the 93 symptomatic patients who submitted specimens, cultures were positive for S heidelberg in 24 (26%), C jejuni in 14 (15%), and both microorganisms in 25 (27%).

Only the pureed diet was associated highly with infection by either Salmonella (odds ratio [OR], 17.6; 95% confidence interval [CI95], 4.8-68.7; P<.001), Campylobacter (OR, 13.3; CI95, 3.2-59.2; P<.001), or both organisms (OR, 8.9; CI95, 2.7-30.3; P<.001). Among the 52 pureed foods served during the 5 days before the outbreak, five meat or poultry items were associated most strongly with culture positivity.

Of these five meat items, only a chopped-liver salad was implicated by the two employees reporting illness. A reported food-handling error occurred when ground, cooked chicken livers were placed in a bowl containing raw chicken-liver juices.

Intervention:

Recommendations for proper cleaning and sanitizing of kitchen equipment to prevent cross-contamination between raw and cooked foods.

Conclusions:

Mixed foodborne outbreaks occur rarely. During this outbreak, contamination of a single food item with multiple bacterial pathogens was the likely source of transmission. Improper food-handling techniques that promote growth of one microorganism also allow growth of other pathogens that may be present. Because different sources and routes of transmission may be implicated for different pathogens, specific preventive measures may vary depending on the organisms involved.
Pseudo-Outbreak of Multiresistant Pseudomonas aeruginosa in a Hematology Unit
Authors: Verweij Paul E. , Bijl Diana , Melchers Willem J.G. , De Pauw Ben E. , Meis Jacques F.G.M. , Hoogkamp-Korstanje Jacomina A.A. , Voss Andreas
Published: September 2009

Objective:

To describe the investigation of a pseudo-outbreak of multiresistant Pseudomonas aeruginosa fecal colonization in a hematology unit.

Design:

Retrospective chart review; prospective environmental sampling and observation of stool culture technique; genotyping by random arbitrary primer polymorphic DNA polymerase chain reaction (RAPD-PCR).

Setting:

An academic tertiary-care hospital.

Patients:

Between August and October 1994, P aeruginosa resistant to imipenem, ceftazidime, ciprofloxacin, and all aminoglycosides was isolated from surveillance stool cultures from 10 neutropenic patients cared for in the hematology unit. P aeruginosa, with an identical susceptibility pattern, was isolated from three patients admitted to the same unit in the year before the “outbreak.” Two months before the outbreak, 12 healthcare workers had been added to the staff.

Results:

Observation of stool sampling techniques as performed by healthcare workers revealed that samples for surveillance cultures were taken from feces in the toilet. When the proper sampling technique was used, P aeruginosa was not isolated from stool samples from 8 of 10 patients with previously positive cultures. P aeruginosa also was isolated from two wash basins, toilet flushing water, and a toilet brush. Genotyping by RAPD-PCR showed that the isolate from the toilet flushing water was identical to the P aeruginosa strains of eight patients from the outbreak.

Conclusions:

This pseudo-outbreak emphasizes the importance of proper sampling techniques and that periodic observation may be necessary to verify proper sampling techniques.
Infection Risk and Cost-Effectiveness of Commercial Bags or Glass Bottles for Total Parenteral Nutrition
Authors: Durand-Zaleski Isabelle , Delaunay Laurent , Langeron Olivier , Belda Eric , Astier Alain , Brun-Buisson Christian
Published: September 2009

Objective:

To determine whether the greater daily expense of administering total parenteral nutrition (TPN) via plastic bags changed once daily, compared to glass bottles changed thrice daily, could be offset by savings from a reduction in nosocomial infections.

Design:

The costs and potential benefits of commercially available TPN bags and TPN in glass containers were compared. Costs were computed from the viewpoint of the hospital, first in a general model and then for two specific examples, Crohn's disease and intensive-care unit (ICU) patients. The extra cost of using bags was $20 per day. The total cost of nosocomial bacteremia was estimated at $6,000. The monetary benefits of using TPN bags were $6,000XT, where XT was the percentage of nosocomial infections averted. We also considered that reduction in intravenous (IV)-line manipulation could reduce bacteremia-related mortality and computed a cost-per-life-saved ratio.

Results:

Modeling showed that TPN in bags could yield a net benefit when the absolute reduction in the daily risk of nosocomial bacteremia reached the threshold value of 0.3%. Such a reduction could not be attained in patients with Crohn's disease, and corresponded to a 50% to 60% reduction of infection rates in ICU patients. Varying the risk of mortality attributable to IV-line-related infection from 1% to 13% resulted in a cost effectiveness of using TPN bags ranging from $90,000 to $7,000 per life saved in ICU, assuming a two-thirds reduction in IV-line infections, and from $180,000 to $14,000 if the infection rate was reduced by one third.

Conclusion:

The baseline cost-minimization analysis concluded that the extra cost of TPN bags was not justified by the extra savings. The cost-effectiveness analysis, however, found that the cost per life saved fell within the accepted range of public health interventions, provided a large fraction of infections are averted using TPN bags.
Varied Approaches to Tuberculosis Control in a Multihospital System
Authors: Woeltje Keith F. , L'Ecuyer Paul B. , Seiler Sondra , Fraser Victoria J.
Published: September 2009

Objectives:

To document the actual tuberculosis (TB) control policies and procedures in a nonoutbreak setting in a variety of hospitals. To determine if any particular practices are linked to higher rates of employee tuberculin skin-test conversion.

Design:

Survey of hospital occupational health and infection control practitioners for the year 1994 regarding hospital TB policies. Review of hospital records to verify the number of patients with TB at each hospital and to verify the number of employees with positive tuberculin skin tests. Smoke-stick testing of negative-pressure ventilation rooms.

Setting:

A 13-hospital health system in the Midwest.

Results:

Hospitals ranged in size from 40 to 1,208 beds (median 220) and employed 150 to 6,500 workers (median 875). There were seven rural and six urban centers, including four teaching hospitals. All 13 hospitals had TB control plans, and all performed annual tuberculin skin testing on employees. Annual skin-test positivity rates ranged from 0% to 1.0% (median 0.3%). Negative-pressure ventilation rooms were available in 11 hospitals. The percentage of negative-pressure rooms with effective negative pressure ranged from 44% to 100% (median 95%). Three of the 13 hospitals used high-efficiency particulate air (HEPA) masks as primary personal respiratory protection, and 8 used dust-mist or dust-mist-fume masks. We found no relation between the type of face mask used, number of functional negative-pressure rooms, or hospital TB risk category, and employee skin-test conversion rates.

Conclusions:

Considerable variation existed in the TB control policies and procedures between hospitals, but employee TB skin-test conversion rates were low in all settings.
Surgical Hand Disinfection With Alcohols at Various Concentrations: Parallel Experiments Using the New Proposed European Standards Method
Authors: Rotter Manfred L. , Simpson Rosemary A. , Koller Walter
Published: September 2009

Objectives:

To establish the concentration of isopropanol that exerts the same immediate and sustained effects as n-propanol 60% v/v in surgical scrubbing, and to assess the performance of the test method proposed as the European standard in parallel experiments.

Design:

Isopropanol at concentrations of 70%, 80%, and 90% v/v was tested in comparison with n-propanol 60%, the proposed reference preparation, in the draft method proposed by the European standard. A Latin square design was used with four balanced blocks of five volunteers each in four experimental runs that were spaced by intervals of 1 week each. Volunteers were allotted randomly to one of the four blocks. Independently, the volunteers' right and left hands also were randomized into two groups for the assessment of either immediate or sustained effects.

Setting:

Two laboratories supervised by two investigators, one from Vienna, Austria, and one from London, The United Kingdom.

Method:

The release of skin flora from the fingertips of clean hands was assessed before and after treatment by immediate sampling from one hand and by sampling of the other, gloved hand after 3 hours. The mean log10 reductions (RF) of bacterial release achieved by rubbing the alcoholic preparations for 3 minutes onto the hands were established.

Results:

For both experiments, the immediate effects of isopropanol 70% (RF, 2.0 and 2.1, respectively) were significantly smaller than those of the reference n-propanol 60% (RF, 2.4 and 2.6, respectively). This also was found with the sustained effects (RF, 0.7 and 1.1 vs 1.0 and 1.6, respectively). At 90%, isopropanol equalled the immediate effect of n-propanol 60%, whereas at 80% it proved slightly (although not significantly) less active. There were no significant differences in the results of both investigators. The sustained effects of isopropanol 80% and 90% were both larger than the reference in Vienna but were found smaller by the London investigator; none of the differences were significant. Mean RFs were significantly different between Vienna and London with n-propanol 60% and isopropanol 70%, but not with isopropanol at 80% or 90%.

Conclusions:

At 90%, isopropanol is as effective as n-propanol 60%, which was proposed by the European Committee for Standardization as a reference in testing :products for surgical hand disinfection. It could, therefore, serve as an alternative if the proposed agent is undesirable for any reason. In parallel experiments by two investigators, the proposed test method proved well workable; the results were very similar and the conclusions identical